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Published on: September 24, 2020
Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study
Arnaldo Prata-Barbosa1, Fernanda Lima-Setta1, Gustavo Rodrigues Dos Santos1
1Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil.
Insights
In Brazilian pediatric intensive care units, COVID-19 had low mortality. Comorbidities, not age under one year, independently predicted severity in children and adolescents with COVID-19.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 affects children and adolescents, with some developing severe illness requiring intensive care.
- Multisystemic Inflammatory Syndrome in Children (MIS-C) is a recognized complication of SARS-CoV-2 infection.
- Understanding risk factors for severe COVID-19 in pediatric populations is crucial for clinical management.
Purpose of the Study:
- To characterize clinical presentations and outcomes of pediatric patients admitted to intensive care with COVID-19.
- To identify predictors of severity and invasive mechanical ventilation in this cohort.
- To compare characteristics between patients with and without MIS-C.
Main Methods:
- Prospective, multicenter observational study in 19 Brazilian pediatric intensive care units.
- Inclusion of patients aged 1 month to 19 years admitted between March and May 2020.
- Data collection on demographics, clinical features, treatments, and outcomes, with subgroup analyses and multivariable logistic regression for severity predictors.
Main Results:
- Seventy-nine patients were included; 10 had MIS-C. Median age was 4 years; 41% had comorbidities.
- Fever, cough, and tachypnea were common. MIS-C patients exhibited more severe symptoms, higher inflammatory markers, and more pleural effusions.
- 18% required invasive mechanical ventilation; 3% mortality. Comorbidities were independently associated with ventilation need (OR 5.5).
Conclusions:
- COVID-19 in Brazilian pediatric ICUs had low mortality.
- Age under one year was not a predictor of worse prognosis.
- Comorbidities and chronic diseases were independent predictors of severity, while MIS-C patients presented with more severe symptoms.
Objective:
To describe the clinical characteristics of children and adolescents admitted to intensive care with confirmed COVID-19.
Method:
Prospective, multicenter, observational study, in 19 pediatric intensive care units. Patients aged 1 month to 19 years admitted consecutively (March-May 2020) were included. Demographic, clinical-epidemiological features, treatment, and outcomes were collected. Subgroups were compared according to comorbidities, age < 1 year, and need for invasive mechanical ventilation. A multivariable logistic regression model was used for predictors of severity.
Results:
Seventy-nine patients were included (ten with multisystemic inflammatory syndrome). Median age 4 years; 54% male (multisystemic inflammatory syndrome, 80%); 41% had comorbidities (multisystemic inflammatory syndrome, 20%). Fever (76%), cough (51%), and tachypnea (50%) were common in both groups. Severe symptoms, gastrointestinal symptoms, and higher inflammatory markers were more frequent in multisystemic inflammatory syndrome. Interstitial lung infiltrates were common in both groups, but pleural effusion was more prevalent in the multisystemic inflammatory syndrome group (43% vs. 14%). Invasive mechanical ventilation was used in 18% (median 7.5 days); antibiotics, oseltamivir, and corticosteroids were used in 76%, 43%, and 23%, respectively, but not hydroxychloroquine. The median pediatric intensive care unit length-of-stay was five days; there were two deaths (3%) in the non- multisystemic inflammatory syndrome group. Patients with comorbidities were older and comorbidities were independently associated with the need for invasive mechanical ventilation (OR 5.5; 95% CI, 1.43-21.12; p = 0.01).
Conclusions:
In Brazilian pediatric intensive care units, COVID-19 had low mortality, age less than 1 year was not associated with a worse prognosis, and patients with multisystemic inflammatory syndrome had more severe symptoms, higher inflammatory biomarkers, and a greater predominance of males, but only comorbidities and chronic diseases were independent predictors of severity.
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