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Early Experience of COVID-19 in a US Children's Hospital
Mundeep K Kainth1,2,3, Pratichi K Goenka4,2, Kristy A Williamson4,2
1Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, Queens, New York; mkainth1@northwell.edu.
Insights
Pediatric COVID-19 patients often present with fever and respiratory or gastrointestinal symptoms. While most children experience mild illness, some require intensive care, with elevated inflammatory markers indicating severe disease.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Public Health
Background:
- Coronavirus disease 2019 (COVID-19) has emerged as a significant global health concern.
- Understanding the clinical spectrum of COVID-19 in pediatric populations is crucial for effective management.
- Specific demographic and clinical characteristics of hospitalized children warrant detailed investigation.
Purpose of the Study:
- To characterize the demographics, clinical presentation, hospital course, and severity of pediatric inpatients with COVID-19.
- To emphasize differences in disease severity among healthy, immunocompromised, and chronically ill children.
- To identify predictors of severe COVID-19 illness in children.
Main Methods:
- A retrospective cohort study was conducted at a single children's medical center.
- Inclusion criteria involved hospitalized children under 22 years old with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
- Data collection focused on demographics, symptoms, laboratory findings, and treatment requirements.
Main Results:
- Sixty-five pediatric patients with COVID-19 were identified, with a median age of 10.3 years.
- Fever (86%), lower respiratory symptoms (60%), and gastrointestinal symptoms (62%) were common.
- Thirty-five percent of patients required intensive care unit (ICU) admission, and 34% needed respiratory support.
- Elevated white blood cell count and C-reactive protein levels were associated with severe disease (P = .0027 and P = .0192, respectively).
- Infants under 60 days had the lowest severity, while chronically ill children had the highest.
- Immunocompromised children generally experienced mild disease (79%).
Conclusions:
- Hospitalized pediatric COVID-19 patients exhibit diverse clinical presentations and age distributions.
- Severe illness requiring intensive care can occur in children, with specific inflammatory markers predicting severity.
- The clinical course in immunocompromised children was not found to be more severe than in other pediatric groups.
Objectives:
We aim to describe the demographics, clinical presentation, hospital course, and severity of pediatric inpatients with coronavirus disease 2019 (COVID-19), with an emphasis on healthy, immunocompromised, and chronically ill children.
Methods:
We conducted a single-center retrospective cohort study of hospitalized children aged younger than 22 years with COVID-19 infection at Steven and Alexandra Cohen Children's Medical Center at Northwell Health. Cases were identified from patients with fever and/or respiratory symptoms who underwent a nucleic acid amplification-based test for severe acute respiratory syndrome coronavirus 2.
Results:
Sixty-five patients were identified. The median age was 10.3 years (interquartile range, 1.4 months to 16.3 years), with 48% of patients older than 12 years and 29% of patients younger than 60 days of age. Fever was present in 86% of patients, lower respiratory symptoms or signs in 60%, and gastrointestinal symptoms in 62%. Thirty-five percent of patients required ICU care. The white blood cell count was elevated in severe disease (P = .0027), as was the C-reactive protein level (P = .0192), compared with mild and moderate disease. Respiratory support was required in 34% of patients. Severity was lowest in infants younger than 60 days of age and highest in chronically ill children; 79% of immunocompromised children had mild disease. One death was reported.
Conclusions:
Among children who are hospitalized for COVID-19, most are younger than 60 days or older than 12 years of age. Children may have severe infection requiring intensive care support. The clinical course of immunocompromised patients was not more severe than that of other children. Elevated white blood cell count and C-reactive protein level are associated with greater illness severity.
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