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Factors Associated with Adverse Outcomes among SARS-CoV-2 Positive Children in a Tertiary Government COVID-19
Mark Jason Dc Milan1, Al Joseph R Molina2, Anna Lisa T Ong-Lim3
1Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila.
Insights
This study found that while most pediatric COVID-19 cases were mild, respiratory distress signs like retractions and seizures, along with corticosteroid use, increased mortality risk in Filipino children. Alar flaring showed a protective effect.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Critical Care Medicine
Background:
- The epidemiology of pediatric COVID-19 and factors influencing severe outcomes remain under-researched.
- Understanding these factors is crucial for managing hospitalized children with SARS-CoV-2 infection.
Purpose of the Study:
- To describe the clinical and demographic characteristics of Filipino pediatric COVID-19 patients.
- To identify factors associated with adverse outcomes, including mortality, mechanical ventilation, and ICU admission.
Main Methods:
- A retrospective cohort study of 180 pediatric COVID-19 patients hospitalized between April 2020 and August 2021.
- Statistical analyses included chi-squared/Fisher's exact tests, Mann-Whitney tests, and Cox proportional hazards regression for mortality prediction.
Main Results:
- The majority of patients were young males with comorbidities and mild disease; however, 9.44% died, 17.78% required mechanical ventilation, and 20% needed ICU admission.
- Adjusted Cox analysis identified retractions, seizures, and corticosteroid use as significant mortality predictors, while alar flaring appeared protective.
Conclusions:
- Hospitalized pediatric COVID-19 patients, predominantly young males with comorbidities, had low rates of severe outcomes.
- Respiratory distress signs (retractions), seizures, and corticosteroid administration were linked to increased mortality risk, with alar flaring showing a protective association.
Background And Objective:
Pediatric COVID-19 epidemiology and factors associated with adverse outcomes - mortality, need for invasive mechanical ventilation, and ICU admission, are largely unstudied. We described the clinico-demographic characteristics of Filipino pediatric COVID-19 patients and determined the factors associated with adverse outcomes.
Methods:
This is a retrospective cohort study of 180 hospitalized SARS-CoV-2-confirmed cases 0-18 years old from April 2020 to August 2021 in a tertiary COVID-19 referral hospital in Manila, National Capital Region. Crude associations were determined using chi-squared or Fisher's exact tests; and medians were compared using the Mann-Whitney test. Factors predictive of mortality were determined using Cox proportional hazards regression analysis. The survivor functions were depicted in graphs.
Results:
About 41.67% had mild disease, 58.33% were males, 39.4% aged 0-4 years, and 69.44% had at least one comorbidity. About 9.44% died (adjusted 9.2 persons per 1000 patient-days, 95% CI 5.5%-15.2%), 17.78% needed invasive mechanical ventilation, and 20% needed ICU admission. Independently, severe-critical COVID-19 (HRc 11.51, 95% CI 3.23, 41.06), retractions (HRc 10.30, 95% CI 3.27, 32.47), alar flaring (HRc 4.39, 95% CI 1.53, 12.58), cyanosis (HRc 4.39, 95% CI 1.72, 14.11), difficulty of breathing (HRc 7.99, 95% CI 2.25, 28.71), poor suck/appetite (HRc 4.46, 95% CI 1.59, 12.40), ferritin (HRc 1.01, 95% CI 1.00, 1.01), IL-6 (HRc 1.01, 95% CI 1.00, 1.01), aPTT (HRc 1.05, 95% CI 1.01, 1.10), IVIg (HRc 4.00, 95% CI 1.07, 14.92) and corticosteroid (HRc 6.01, 95% CI 2.04, 17.67) were significant hazards for mortality. In adjusted Cox analysis, only retractions (HRa 34.96, 95% CI 3.36, 363.79), seizure (HRa 9.98, 95% CI 1.76, 56.55), and corticosteroids (HRa 8.21, 95% CI 1.12, 60.38) were significantly associated with mortality while alar flaring appeared to be protective (HRa 0.10, 95% CI 0.01, 0.95). Several clinical characteristics were consistently associated with adverse outcomes.
Conclusions:
Majority of hospitalized pediatric COVID-19 patients were very young, males, had mild disease, and had at least one comorbidity. Mortality, invasive mechanical ventilation, and ICU admission were relatively low. Except for alar flaring which appeared to be protective, retractions, seizure, and use of corticosteroids were associated with adverse outcomes.
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