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COVID-19 Pandemic Experiences in Pediatric Intensive Care Unit: An Iranian Referral Hospital-Based Study
Masoud Mohammadpour1, Seyed Abbas Hassani1, Meisam Sharifzadeh1
1Division of Pediatric Intensive Care Unit, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Critically ill children with COVID-19 admitted to the Pediatric Intensive Care Unit (PICU) often have underlying conditions. Comorbidities increase the risk of severe disease, PICU admission, and mortality in pediatric COVID-19 patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Limited data exists on critically ill children requiring Pediatric Intensive Care Unit (PICU) admission for COVID-19.
- The study addresses the need to understand the clinical profile of pediatric patients with severe SARS-CoV-2 infection.
Purpose of the Study:
- To describe the clinical characteristics, laboratory parameters, treatment, and outcomes of pediatric patients with COVID-19 admitted to the PICU.
- To identify risk factors associated with severe COVID-19 in children.
Main Methods:
- Retrospective study of 99 pediatric patients admitted to a COVID PICU in Tehran, Iran, from February to May 2020.
- Data collected included demographics, symptoms, underlying diseases, SARS-CoV-2 RT-PCR results, laboratory findings, imaging (CXR, CT), ventilation requirements, and outcomes.
- Patients were assessed for noninvasive ventilation (NIV) or mechanical ventilation and length of PICU stay.
Main Results:
- Out of 99 patients, 66 tested positive for SARS-CoV-2. Fever was the only significant symptom difference between positive and negative RT-PCR groups.
- 82% of admitted patients had underlying diseases. 34 patients received NIV, and 35 required mechanical ventilation.
- Mortality was 31% among mechanically ventilated patients (11 out of 35).
Conclusions:
- No specific laboratory or radiological findings were diagnostic for COVID-19 in critically ill children.
- Underlying health conditions significantly increase the risk of severe COVID-19, PICU admission, and mortality in the pediatric population.
Introduction:
In late February 2020, after we had informed about the presence of some cases of COVID-19 in Iran and its rapid spread throughout the country, we decided to make the necessary arrangements for patients with critical conditions in Pediatric Intensive Care Unit (PICU) at Children's Medical Center. There are a little data on critically ill children with COVID-19 infection with ICU requirements. The aim of this study was to describe clinical characteristics, laboratory parameters, treatment, and outcomes of the pediatrics population infected by SARS-CoV-2 admitted to PICU.
Materials And Methods:
This study was performed between February 2020 and May 2020 in the COVID PICU of the Children's Medical Center Hospital in Tehran, Iran. Patients were evaluated in terms of demographic categories, primary symptoms and signs at presentation, underlying disease, SARS-CoV-2 RT-PCR test result, laboratory findings at PICU admission, chest X-ray (CXR) and lung CT findings, and treatment. Moreover, the need to noninvasive ventilation (NIV) or mechanical ventilation, the length of hospital stay in the PICU, and outcomes were assessed.
Results:
In total, 99 patients were admitted to COVID PICU, 42.4% (42 patients) were males, and 66 patients had positive SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR). There was no statistically significant difference in the frequency of clinical signs and symptoms (except for fever) among patients with positive SARS-CoV-2 RT-PCR and negative ones. Among all admitted patients, the presence of underlying diseases was noticed in 81 (82%) patients. Of 99 patients, 34 patients were treated with NIV during their admission. Furthermore, 35 patients were intubated and treated with mechanical ventilation. Unfortunately, 11 out of 35 mechanically ventilated patients (31%) passed away.
Conclusion:
No laboratory and radiological findings in children infected with COVID-19 were diagnostic in cases with COVID-19 admitted to PICU. There are higher risks of severe COVID-19, PICU admission, and mortality in children with comorbidities.
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