University of Michigan - Ann Arbor

"Of the 48 children with COVID-19 admitted to participating PICUs, 25 (52%) were male, and the median (range) age was 13 (4.2-16.6) years. Of the 46 hospitals in this convenience sample, 40 were located in the US and 6 in Canada. Of these, 30 pediatric hospitals had not admitted any critically ill patients with confirmed COVID-19 infection during the study period, including all of the 6 Canadian hospitals. 14 hospitals, all in the US, admitted a total of 58 patients to the PICU with confirmed COVID-19 infection between March 14 and April 3, 2020. The number of critically ill patients admitted to individual PICUs in this sample ranged from 1 to 17, with a median of 3 admissions per unit. The age range of patients admitted was between 26 days and 45 years. A total of 48 of 58 patients (83%) were children 21 years or younger. Ten patients were adults older than 21 years and were admitted to 3 of the participating PICUs: 2 admitted 1 adult each, and 1 admitted 8 adults. The pediatric data will be presented in this review."

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

Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. Published online May 11, 2020. doi:10.1001/jamapediatrics.2020.1948

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2766037

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

COVID-19 infection was confirmed by PCR from nasal swabs. One patient was confirmed to be positive for COVID-19 on a routine surveillance swab but remained asymptomatic over the course of the study. Most presented with respiratory symptoms, while those categorized with other presentations included 4 young patients with serious comorbidities. Significant comorbidities were prevalent in this pediatric cohort, with 24 patients (50%) having 1 comorbidity, 8 (17%) with 2, and 9 (19%) with 3 or more significant comorbidities. 

On admission, 33 (69%) were severely or critically ill, 12 (25%) required vasoactive drugs, and, while single organ failure (respiratory) affected most, 11 (23%) experienced failure of 2 or more organ systems. A total of 39 patients (81%) required respiratory support that exceeded their baseline, of whom 21 (44%) were managed noninvasively. The remaining 18 patients (38%) required endotracheal or tracheostomy ventilation. Adjunctive ventilatory interventions or extracorporeal therapies were required in 6 children (13%). Continuous renal replacement therapy was not required in the pediatric cohort.

Patient Characteristics and Clinical Trajectories for Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units

"Clinicians targeted the viral infection with a variety of specific therapies in 28 patients (61%). The most common of these was hydroxychloroquine, either as a single agent or in combination. Azithromycin was used in 8 children as a single agent in 1 patient and in combination with hydroxychloroquine in the remaining 7 patients. Remdisivir was used in 8 patients, including as a single agent in 2 and in combination in 6. Tocilizumab was used in 5 children, including as a single agent in 1 patient, in combination with hydroxychloroquine in 1, in combination with hydroxychloroquine and azithromycin in 1, in combination with hydroxychloroquine and remdisivir in 1, and in combination with convalescent plasma in 1."

Targeted Therapies for Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units

"At the time of this report, of the 18 critically ill children requiring invasive ventilation, 2 have died, 3 still require mechanical ventilation, 7 have discontinued mechanical ventilation but remain hospitalized, and 6 have been discharged from the hospital. 

The overall case fatality rate in this cross-sectional study was 4.2% up to the time of the report. The patients who died were aged 12 and 17 years; both had preexisting comorbidities and developed multisystem organ failure, and 1 had gram-negative sepsis prior to developing COVID-19. 

Fifteen children (31%) were still hospitalized, including 5 in critical condition with 1 still receiving ECMO. For those patients with completed PICU and hospital admissions (they either died or were discharged), the median (interquartile range) PICU and hospital lengths of stay were 5 (3-9) days and 7 (4-13) days, respectively."

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

Table 1.  Presentation and Demographic Characteristics of 48 Children Treated in Pediatric Intensive Care Units for Coronavirus Disease 2019 (COVID-19)

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