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Children in Critical Care Due to Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Experience in a Spanish
Alberto García-Salido1, Inés Leoz-Gordillo, Amelia Martínez de Azagra-Garde
1All authors: Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Insights
This study observed children with coronavirus disease 2019 (COVID-19) in Spain. Most previously healthy children required respiratory support, with some needing mechanical ventilation shortly after PICU admission.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Spain experienced severe impacts from the coronavirus disease 2019 (COVID-19) pandemic.
- Pediatric intensive care units (PICUs) managed children with severe COVID-19.
- Understanding COVID-19's pediatric impact is crucial for effective treatment.
Purpose of the Study:
- To describe the clinical characteristics and outcomes of children admitted to a PICU with COVID-19.
- To analyze the management and therapeutic interventions for severe pediatric COVID-19 cases.
- To identify factors associated with critical illness in children with COVID-19.
Main Methods:
- Prospective observational study conducted in a tertiary hospital in Madrid, Spain.
- Inclusion criteria: Children admitted to the PICU with confirmed or suspected COVID-19 between March 1 and April 15, 2020.
- Data collected: Epidemiologic, clinical, laboratory, imaging, and therapeutic information.
Main Results:
- Eleven children were admitted to the PICU; seven tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
- The majority were previously healthy, with respiratory symptoms and fever being prevalent.
- Respiratory support was essential, with two patients requiring mechanical ventilation on admission; no deaths occurred.
Conclusions:
- Children admitted to the PICU for COVID-19 were generally healthy and over one year old.
- Respiratory failure was the primary reason for PICU admission, necessitating significant respiratory support.
- Close monitoring and further multicenter studies are recommended for severe pediatric COVID-19 cases.
Objectives:
Spain has been one of the countries most severely affected by the coronavirus disease 2019. This study aims to describe a series of children admitted to a PICU due to coronavirus disease 2019 infection.
Design:
Prospective observational study.
Setting:
Tertiary hospital in Madrid, Spain.
Patients:
Children admitted to the PICU with severe acute respiratory syndrome coronavirus 2 (severe acute respiratory syndrome coronavirus 2) infection, from March 1, 2020, to April 15, 2020.
Interventions:
Observational study.
Measurements And Main Results:
Epidemiologic data, previous clinical characteristics, support therapy needed, imaging tests, laboratory observations on admission, and pharmacologic therapy. Eleven children were admitted to the PICU, with suspected coronavirus disease 2019; the polymerase chain reaction test was positive in seven. The median age was 100.7 months (range, 0.5-162). Five were admitted from the emergency department and two from the ward. The Pediatric Sequential Organ Failure Assessment score was 3 (range, 0-9), and Pediatric Risk of Mortality II score was 4 (range, 0-16). All children were previously healthy except one (allogeneic hematopoietic stem cell transplantation). Respiratory symptoms and fever were prevalent. A chest radiograph led to a pneumonia diagnosis. Not all patients presented with lymphopenia on admission. D-Dimer and ferritin were elevated. All patients needed oxygen therapy through a nasal cannula; five patients received high-flow nasal cannula therapy, which was later substituted with noninvasive ventilation in four. Mechanical ventilation was necessary in two patients on the first day of PICU admission. Two children required mechanical ventilation and inotropic support. Tocilizumab was applied in two intubated children. Also, four children received heparin. No patients died.
Conclusions:
On the whole, the children were previously healthy and are more than 1 year old. Respiratory symptoms were the leading cause of PICU admission, making respiratory support the principal therapy. Patients requiring mechanical ventilation showed deterioration on the first day of admission. These children seemed to require close monitoring, and multicenter studies are necessary.
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