Higher mortality and age-related disease patterns in pediatric COVID-19

A multinational study explaining acute and fatal coronavirus disease 2019 (COVID-19) in children in different countries in 2020 found that severe pediatric COVID-19, especially among children under the age of two. It shows that it has a significantly higher mortality rate than previously reported.

Background

During the first year of the COVID-19 pandemic, children were in an age group with significantly lower hospitalization rates or intensive care unit (ICU) admissions than adults. However, one-third of hospitalized children are required to enter the ICU. Overall, COVID-19 mortality is low in children.

The current survey is available as a preprint. medRxiv* Server, inspect children in pediatric ICU (PICU) care. Researchers collated data on presentations, management, and results for children in low- and middle-income countries (LMICs) and high-income countries suffering from COVID-19.

Previous studies have found that more than 90% of COVID-19 deaths in children were LMICs, especially under the age of one. This is probably due to differences in immune function, lack of coronavirus infection, and low incidence. Pediatric multisystem inflammatory syndrome (MIS-C), which is associated with lower mortality.

How was the study done?

Researchers have designed a prospective observational study comparing the clinical features and management of critical COVID-19 / MIS-C among children of different ages in LMIC and HMIC in the Americas and Europe. ..

All 557 participants were under the age of 19 and were admitted to the laboratory primarily for COVID-19 with current or previous infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). .. All had severe or severe COVID-19 or MIS-C.

What did the study show?

Researchers found 433 children with severe COVID-19, 76 children with severe illness, and 48 children with PICU. The median age was 8 years, about 60% were male, and 2 in 3 were from Latin America. More than half had other medical conditions, mainly heart disease and malnutrition, or asthma and obesity in younger and older children, respectively.

Younger children showed more respiratory symptoms and higher rates earlier Viral pneumonia.. Therefore, invasive ventilation (IMV) was used more frequently in young children. However, few had intestinal symptoms, fever, or mucosal skin features.

Older children were at increased risk of abnormal laboratory findings, including increased incidence of markers of inflammation and acute kidney injury. Pressor agents were often used in older children who also showed greater systemic inflammation. This group had a high rate of treatment with prophylactic anticoagulant therapy, antiplatelet therapy, and intravenous immunoglobulin (IVIG).

Steroids were used twice as often for lower respiratory tract symptoms as compared to 20% of other patients. Methylprednisolone was commonly used in older children, but their use did not change with age.

Younger children had a higher mortality rate. Death was associated with cardiac arrest in 85% of cases. Risk factors for death included other respiratory and cardiac illnesses, malnutrition, and hospitalization with hypoxemia or pulmonary symptoms. Conversely, treatment with IVIG, the presence of MIS-C, and symptoms with mucosal or intestinal symptoms reduced the risk of death.

As expected with these risk factors, older children had lower mortality rates in those who received methylprednisolone, prophylactic anticoagulants, and IVIG, or who showed MIS-C or similar symptoms. rice field.

What is the impact?

The risk of death was higher among infants under 2 years of age due to other illnesses, primarily respiratory illness. This study shows that, unlike previous studies primarily by HMIC, important pediatric COVID-19 in LMIC may be associated with mortality in up to one-tenth of cases.

Higher mortality may be explained by including only high-risk, seriously ill children in this study. Age-related differences were observed, including the lack of effectiveness of some treatments for infant mortality risk. Acute organ dysfunction in young children was also at increased risk of death.

Increased use of IMV in young children may have contributed to the mortality rate of this group, especially due to iatrogenic complications. This intervention may have been due to the respiratory symptoms and hypoxia of these children’s symptoms, but can cause cardiac arrest if there are not enough resources.

This study focuses not only on the new MIS-C, but also on the need to improve the management of important COVID-19 in children. The former causes a higher mortality rate. Vaccine supply in most LMICs is limited, but vaccination of children has not yet been approved. Management of serious pediatric infections requires further research to develop optimal guidelines.

*Important Notices

medRxiv Publish preliminary scientific reports that should not be considered definitive as they are not peer-reviewed, guide clinical practice / health-related behaviors, and should not be treated as established information.