Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 (COVID-19) at a Tertiary Care Medical Center in New York City.

To describe the clinical profiles and risk factors for critical illness in hospitalized children and adolescents with COVID-19.

Children 1 month to 21 years with COVID-19 from a single tertiary care children's hospital between March 15-April 13, 2020 were included. Demographic and clinical data were collected.

67 children tested positive for COVID-19; 21 (31.3%) were managed as outpatients. Of 46 admitted patients, 33 (72%) were admitted to the general pediatric medical unit and 13 (28%) to the pediatric intensive care unit (PICU). Obesity and asthma were highly prevalent but not significantly associated with PICU admission (p=0.99). Admission to the PICU was significantly associated with higher C-reactive protein, procalcitonin, and pro-B type natriuretic peptide levels and platelet counts (p<0.05 for all). Patients in the PICU were more likely to require high-flow nasal cannula (p=0.0001) and were more likely to have received Remdesivir through compassionate release (p<0.05). Severe sepsis and septic shock syndromes were observed in 7 (53.8%) PICU patients. Acute respiratory distress syndrome (ARDS) was observed in 10 (77%) PICU patients, 6 of whom (46.2%) required invasive mechanical ventilation for a median of 9 days. Of the 13 patients in the PICU, 8 (61.5%) were discharged home, and 4 (30.7%) patients remain hospitalized on ventilatory support at day 14. One patient died after withdrawal of life-sustaining therapy because of metastatic cancer.

We describe a higher than previously recognized rate of severe disease requiring PICU admission in pediatric patients admitted to the hospital with COVID-19.

The Journal of pediatrics. 2020 May 11 [Epub ahead of print]

Jerry Y Chao, Kim R Derespina, Betsy C Herold, David L Goldman, Margaret Aldrich, Jacqueline Weingarten, Henry M Ushay, Michael D Cabana, Shivanand S Medar

Department of Anesthesiology, Albert Einstein College of Medicine, Montefiore Medical Center., Department of Pediatrics, Division of Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore., Department of Pediatrics, Division of Infectious Diseases, Albert Einstein College of Medicine, Children's Hospital at Montefiore., Department of Pediatrics, Division of General Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore., Department of Pediatrics, Division of Critical Care Medicine, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Department of Pediatrics, Division of Pediatric Cardiology, Albert Einstein College of Medicine, Children's Hospital at Montefiore.

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