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Infant COVID-19 Infection: An Experience from Pediatric Intensive Care Unit of a Tertiary Care Dedicated Pediatric
Mihir Sarkar1, Manas Kumar Mahapatra1, Sanajit Ghosh1
1Department of Pediatrics, Medical College & Hospital, Kolkata, West Bengal, India.
Insights
Infants with COVID-19 admitted to the pediatric intensive care unit (PICU) often show respiratory distress and shock. Outcomes were good for infants without comorbidities, but severe illness occurred in those with underlying conditions.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Virology
Background:
- COVID-19 affects children, with infants being a vulnerable population.
- Pediatric intensive care unit (PICU) admissions for COVID-19 highlight severe pediatric cases.
- Understanding risk factors and outcomes in infants is crucial for pediatric COVID-19 management.
Purpose of the Study:
- To assess clinical, severity, laboratory, treatment, and outcome factors in infants with COVID-19 admitted to the PICU.
- To compare these parameters between infants and older children (1-12 years) requiring PICU admission for COVID-19.
- To identify predictors of severe disease and outcomes in pediatric COVID-19 patients.
Main Methods:
- Retrospective observational study in a dedicated pediatric COVID-19 facility.
- Analysis of clinical, epidemiological, laboratory data, and treatment outcomes of COVID-19 positive infants and noninfants (1-12 years) in the PICU.
- Exclusion of malignancy and specific coinfections (dengue, scrub typhus) for comparative analysis.
Main Results:
- Infants comprised 37.4% of PICU admissions; common symptoms included respiratory issues (83.7%) and fever (60.5%).
- Fifteen percent of infants presented with shock, 23.3% had myocardial dysfunction, and 53.5% had comorbidities.
- Infants showed significantly higher rates of respiratory distress, pediatric sequential organ failure assessment scores, and acute respiratory distress syndrome (ARDS) compared to noninfants.
Conclusions:
- Infants represent a vulnerable group requiring PICU admission for severe COVID-19, primarily due to respiratory involvement.
- While outcomes were generally good for infants without comorbidities, those with severe underlying conditions faced worse prognoses.
- Higher rates of respiratory distress, organ dysfunction, and ARDS underscore the severity of COVID-19 in admitted infants.
Abstract:
This study aimed to assess different clinical, disease severity, laboratory, treatment, and outcome-related factors of COVID-19 positive infants admitted to a pediatric intensive care unit (PICU) and to compare these parameters with COVID-19 positive noninfants (1-12 years of age) who also required intensive care admission. This retrospective observational study was conducted in a PICU of a tertiary care, dedicated pediatric COVID facility. The clinical, epidemiological, laboratory parameters, and treatment outcomes of COVID-19 infected infants admitted to the PICU were recorded and analyzed. During comparison with the noninfant group, malignancy and coinfection with dengue and scrub typhus were excluded from both groups. A total 313 COVID-19 positive children aged from 1 month to 12 years old were admitted, of which 115 (36.7%) children required PICU admission. Infants constituted 37.4% of total PICU admissions. Most common symptoms were respiratory (83.7%) followed by fever (60.5%). Fifteen (34.9%) infants presented with shock. Ten infants (23.3%) had myocardial dysfunction. C-reactive protein (CRP) and ferritin were high in 60.5 and 16.7% infants, respectively. Fourteen infants needed invasive mechanical ventilation. Nine patients had acute respiratory distress syndrome (ARDS) and five had MIS-C. However, 53.5% infants had different comorbidities. Four infants died and all of them had severe comorbidities. Respiratory distress ( p = 0.009), pediatric sequential organ failure assessment score ( p = 0.032) and number of ARDS cases ( p = 0.044) were significantly higher in infants than noninfants. Infants are one of the most vulnerable groups of children suffering from serious illness from COVID-19 infection requiring PICU admission due to predominantly respiratory involvement. Overall outcome was good among infants without significant comorbidity.
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