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Paediatric critical COVID-19 and mortality in a multinational prospective cohort
Sebastian Gonzalez-Dambrauskas1, Pablo Vasquez-Hoyos2, Anna Camporesi3
1Red Colaborativa Pediátrica de Latinoamérica (LARed Network) and Cuidados Intensivos Pediátricos Especializados (CIPe) Casa de Galicia, Montevideo, Uruguay.
Insights
Critically ill children with COVID-19 had higher mortality if younger than two years old or with pulmonary disease. Treatments like methylprednisolone and IVIG were associated with lower mortality in older children.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- COVID-19 poses critical risks to children globally.
- Understanding mortality factors in pediatric critical illness is crucial for resource allocation and treatment strategies.
Purpose of the Study:
- To investigate factors associated with mortality in critically ill children hospitalized with COVID-19.
- To compare outcomes between high and low-middle income countries.
Main Methods:
- A prospective, observational study was conducted across 18 countries from April to December 2020.
- Logistic regression analysis was used to evaluate associations with mortality in 557 critically ill children.
Main Results:
- Hospital mortality was 10%, with higher rates in children under two years old (15%).
- Factors associated with increased mortality included younger age, cardiac/pulmonary comorbidities, hypoxemia, and lower respiratory symptoms.
- Multisystem Inflammatory Syndrome in Children (MIS-C) and treatments like methylprednisolone, IVIG, and anticoagulation were linked to lower mortality, particularly in children over two.
Conclusions:
- Younger age and pulmonary disease are significant risk factors for mortality in critically ill children with COVID-19.
- Further research is needed on optimal treatments for pediatric respiratory failure and younger children affected by COVID-19.
Background:
To understand critical paediatric coronavirus disease 2019 (COVID-19) and evaluate factors associated with mortality in children from high and low-middle income countries.
Methods:
Prospective, observational study of critically ill children hospitalised for COVID-19 in 18 countries throughout North America, Latin America, and Europe between April 1 and December 31, 2020. Associations with mortality were evaluated using logistic regression.
Findings:
557 patients (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Invasive (41%) or non-invasive (20%) ventilation and vasopressors (56%) were the most common support modalities. Hospital mortality was 10% and higher in children <2 years old (15%; odds ratio 1·94, 95%CI 1·08-3·49). Most who died had pulmonary disease. When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2·89; 95%CI 1·2-6·94) or pulmonary comorbidities (aOR 4·43; 95%CI 1·70-11·5), admission hypoxemia (aOR 2·44; 95%CI 1·30-4·57), and lower respiratory symptoms (aOR 2·96; 95%CI 1·57-5·59). MIS-C (aOR 0·25; 95%CI 0·1-0·61) and receiving methylprednisolone (aOR 0·5; 95%CI 0·25-0·99), IVIG (aOR 0·32; 95%CI 0·16-0·62), or anticoagulation (aOR 0·49; 95%CI 0·25-0·95) were associated with lower mortality although these associations might be limited to children >2 years old.
Interpretation:
We identified factors associated with COVID-19 mortality in critically ill children from both high and low-middle income countries, including higher mortality with younger age and COVID-related pulmonary disease but lower mortality in MIS-C. Further research is needed on optimal treatments for younger children and respiratory failure in paediatric COVID-19.
Funding:
None.
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