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Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 (COVID-19) at a Tertiary Care Medical Center in New York City

Our take —

In a small case series from New York, a sizable proportion of children presenting to hospital for SARS-CoV-2 testing required admission and ICU care. Further study is needed to understand what proportion of all infected children develop clinical disease.

Study design

Case Series

Study population and setting

The study included 67 children with laboratory-confirmed SARS-CoV-2 infection diagnosed at a tertiary care center in New York City between March 15 and April 13, 2020.

Summary of Main Findings

Among children presenting for care, 31% (21/67) were managed as outpatients. 46 children were admitted to the hospital and had a median age of 13.1 years (67% male). Of the admitted patients, 28% (13/46) were admitted to the ICU. Obesity and asthma were not associated with the need for ICU admission, while shortness of breath and higher levels of C-reactive protein, procalcitonin, blood urea nitrogen, and pro-Brain Natriuretic Peptides (pro-BNP) were associated with ICU admission. All patients who did not require ICU admission were discharged home. Acute Respiratory Distress Syndrome (ARDS) was diagnosed in 77% (10/13) of patients requiring ICU care, six of whom required mechanical ventilation. 62% (8/13) of patients requiring ICU admission were discharged home, 4 remained in the ICU at day 14, and one died (with underlying metastatic malignancy).

Study Strengths

NA

Limitations

The small sample size limited the ability to draw inferences. Associations were not adjusted for common confounders, and it is unclear whether factors associated with severe disease are causes or consequences of COVID-19 severity. Given recent interest in non-pulmonary manifestations of COVID-19 in children, further discussion of immunologic parameters, and dermatologic and gastrointestinal presentation, would have been useful.

Value added

This study presents data on a group of children who required hospitalization, many of whom had severe disease.