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Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units

Our take —

Most children admitted to intensive care for COVID-19 had significant underlying health conditions, and many had complex developmental and/or congenital disorders.  2 of 18 children requiring mechanical ventilation died by the end of follow-up, though 7 remained hospitalized.  This proportion is much smaller than that observed among adults.  Reinforcing existing evidence from North America and beyond, this study suggests a less severe clinical course for COVID-19 in children than in adults.

Study design

Case Series; Cross-Sectional

Study population and setting

This study included 48 children (median age 13 years, 52% male) with laboratory-confirmed COVID-19 admitted to pediatric intensive care units (PICUs) in 14 U.S. hospitals (out of 46 collaborating PICUs in North America) between March 14 and April 3, 2020.  Outcomes were ascertained through April 10, 2020.

Summary of Main Findings

35 children (73%) presented with respiratory symptoms.  40 children (83%) had at least one significant underlying medical condition. At admission, 69% of the pediatric patients were determined to have severe or critical illness. 18 patients (38%) required mechanical ventilation, and 21 (44%) required non-invasive respiratory support. Of the 18 patients who required mechanical ventilation, by the end of follow-up, 2 died (4.2% of all patients), 3 remained on mechanical ventilation, 7 others remained hospitalized, and 6 were discharged alive.  Among all patients who died or were discharged, the median hospital stay was 7 days, and the median ICU stay was 5 days.

Study Strengths

The study drew from a large group of institutions throughout North America.

Limitations

Few patients were included in the study, a reflection of the apparently lower likelihood of severe disease in pediatric COVID-19.  Follow-up duration was short; the fatality ratio may change with time.  Inadequate testing in North America may have resulted in missed COVID-19 diagnoses among hospitalized children.

Value added

This is the largest study to date of severe pediatric COVID-19 in the North America.