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Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity

Francoeur, Conall; Alcamo, Alicia M; Robertson, Courtney L; Wainwright, Mark S; Roa, Juan D; Lovett, Marlina E; Stulce, Casey; Yacoub, Mais; Potera, Renee M; Zivick, Elizabeth; Holloway, Adrian; Nagpal, Ashish; Wellnitz, Kari; Even, Katelyn M; Brunow de Carvalho, Werther; Rodriguez, Isadora S; Schwartz, Stephanie P; Walker, Tracie C; Campos-Miño, Santiago; Dervan, Leslie A; Geneslaw, Andrew S; Sewell, Taylor B; Pryce, Patrice; Silver, Wendy G; Lin, Jieru E; Vargas, Wendy S; Topjian, Alexis; McGuire, Jennifer L; Domínguez Rojas, Jesus Angel; Tasayco-Muñoz, Jaime; Hong, Sue J; Muller, William J; Doerfler, Matthew; Williams, Cydni N; Drury, Kurt; Bhagat, Dhristie; Nelson, Aaron; Price, Dana; Dapul, Heda; Santos, Laura; Kahoud, Robert; Appavu, Brian; Guilliams, Kristin P; Agner, Shannon C; Walson, Karen H; Rasmussen, Lindsey; Pal, Ria; Janas, Anna; Ferrazzano, Peter; Farias-Moeller, Raquel; Snooks, Kellie C; Chang, Chung-Chou H; Iolster, Tomás; Erklauer, Jennifer C; Jorro Baron, Facundo; Wassmer, Evangeline; Yoong, Michael; Jardine, Michelle; Mohammad, Zoha; Deep, Akash; Kendirli, Tanil; Lidsky, Karen; Dallefeld, Samantha; Flockton, Helen; Agrawal, Shruti; Siruguppa, Krishna Sumanth; Waak, Michaela; Gutiérrez-Mata, Alfonso; Butt, Warwick; Bogantes-Ledezma, Sixto; Sevilla-Acosta, Fabricio; Umaña-Calderón, Andres; Ulate-Campos, Adriana; Yock-Corrales, Adriana; Talisa, Victor Brodzik; Kanthimathinathan, Hari Krishnan; Schober, Michelle E; Fink, Ericka L; ,
IMPORTANCE/UNASSIGNED:Neurological manifestations during acute SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity. OBJECTIVE/UNASSIGNED:To assess the association of severe neurological manifestations during a SARS-CoV-2-related hospital admission with new neurocognitive or functional morbidities at discharge. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021. EXPOSURE/UNASSIGNED:Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2-related condition. RESULTS/UNASSIGNED:Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P < .001). For survivors with MIS-C, 28.0% (n = 39) with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% (n = 68) of those without severe neurological manifestations (P = .002). When adjusting for risk factors in those with severe neurological manifestations, both patients with acute SARS-CoV-2 (odds ratio, 1.85 [95% CI, 1.27-2.70]; P = .001) and those with MIS-C (odds ratio, 2.18 [95% CI, 1.22-3.89]; P = .009) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge. CONCLUSIONS AND RELEVANCE/UNASSIGNED:The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery.
PMID: 38857050
ISSN: 2574-3805
CID: 5668852

Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak

Halasa, Natasha; Zambrano, Laura D; Amarin, Justin Z; Stewart, Laura S; Newhams, Margaret M; Levy, Emily R; Shein, Steven L; Carroll, Christopher L; Fitzgerald, Julie C; Michaels, Marian G; Bline, Katherine; Cullimore, Melissa L; Loftis, Laura; Montgomery, Vicki L; Jeyapalan, Asumthia S; Pannaraj, Pia S; Schwarz, Adam J; Cvijanovich, Natalie Z; Zinter, Matt S; Maddux, Aline B; Bembea, Melania M; Irby, Katherine; Zerr, Danielle M; Kuebler, Joseph D; Babbitt, Christopher J; Gaspers, Mary Glas; Nofziger, Ryan A; Kong, Michele; Coates, Bria M; Schuster, Jennifer E; Gertz, Shira J; Mack, Elizabeth H; White, Benjamin R; Harvey, Helen; Hobbs, Charlotte V; Dapul, Heda; Butler, Andrew D; Bradford, Tamara T; Rowan, Courtney M; Wellnitz, Kari; Staat, Mary Allen; Aguiar, Cassyanne L; Hymes, Saul R; Randolph, Adrienne G; Campbell, Angela P; ,
IMPORTANCE:Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide. OBJECTIVE:To evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission. DESIGN, SETTING, AND PARTICIPANTS:This cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states. Participants were infants admitted for 24 or more hours between October 17 and December 16, 2022, to a unit providing intensive care due to laboratory-confirmed RSV infection. EXPOSURE:Respiratory syncytial virus. MAIN OUTCOMES AND MEASURES:Data were captured on demographics, clinical characteristics, signs and symptoms, laboratory values, severity measures, and clinical outcomes, including receipt of noninvasive respiratory support, invasive mechanical ventilation, vasopressors or extracorporeal membrane oxygenation, and death. Mixed-effects multivariable log-binomial regression models were used to assess associations between intubation status and demographic factors, gestational age, and underlying conditions, including hospital as a random effect to account for between-site heterogeneity. RESULTS:The first 15 to 20 consecutive eligible infants from each site were included for a target sample size of 600. Among the 600 infants, the median (IQR) age was 2.6 (1.4-6.0) months; 361 (60.2%) were male, 169 (28.9%) were born prematurely, and 487 (81.2%) had no underlying medical conditions. Primary reasons for admission included LRTI (594 infants [99.0%]) and apnea or bradycardia (77 infants [12.8%]). Overall, 143 infants (23.8%) received invasive mechanical ventilation (median [IQR], 6.0 [4.0-10.0] days). The highest level of respiratory support for nonintubated infants was high-flow nasal cannula (243 infants [40.5%]), followed by bilevel positive airway pressure (150 infants [25.0%]) and continuous positive airway pressure (52 infants [8.7%]). Infants younger than 3 months, those born prematurely (gestational age <37 weeks), or those publicly insured were at higher risk for intubation. Four infants (0.7%) received extracorporeal membrane oxygenation, and 2 died. The median (IQR) length of hospitalization for survivors was 5 (4-10) days. CONCLUSIONS AND RELEVANCE:In this cross-sectional study, most US infants who required intensive care for RSV LRTIs were young, healthy, and born at term. These findings highlight the need for RSV preventive interventions targeting all infants to reduce the burden of severe RSV illness.
PMID: 37581884
ISSN: 2574-3805
CID: 5595542

Developing a new pediatric extracorporeal membrane oxygenation (ECMO) program

Cicalese, Erin; Meisler, Sarah; Kitchin, Michael; Zhang, Margaret; Verma, Sourabh; Dapul, Heda; McKinstry, Jaclyn; Toy, Bridget; Chopra, Arun; Fisher, Jason C
OBJECTIVES/OBJECTIVE:We aimed to critically evaluate the effectiveness of a designated ECMO team in our ECMO selection process and patient outcomes in the first 3 years of our low-volume pediatric ECMO program. METHODS:We conducted a retrospective chart review of patients who received an ECMO consultation between the start of our program in March 2015 and May 2018. We gathered clinical and demographic information on patients who did and did not receive ECMO, and described our selection process. We reflected on the processes used to initiate our program and our outcomes in the first 3 years. RESULTS:, lactate, and pH between the patients who went on ECMO and who did not. We improved our outcomes from 0% survival to discharge in 2015, to 60% in 2018, with an average of 63% survival to discharge over the first 3 years of our program. CONCLUSIONS:In a low-volume pediatric ECMO center, having a designated team to assist in the patient selection process and management can help provide safe and efficient care to these patients, and improve patient outcomes. Having a strict management protocol and simulation sessions involving all members of the medical team yields comfort for the providers and optimal care for patients. This study describes our novel structure, processes, and outcomes, which we hope will be helpful to others seeking to develop a new pediatric ECMO program.
PMID: 36508606
ISSN: 1619-3997
CID: 5381932

Extracorporeal Membrane Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs

Bembea, Melania M; Loftis, Laura L; Thiagarajan, Ravi R; Young, Cameron C; McCadden, Timothy P; Newhams, Margaret M; Kucukak, Suden; Mack, Elizabeth H; Fitzgerald, Julie C; Rowan, Courtney M; Maddux, Aline B; Kolmar, Amanda R; Irby, Katherine; Heidemann, Sabrina; Schwartz, Stephanie P; Kong, Michele; Crandall, Hillary; Havlin, Kevin M; Singh, Aalok R; Schuster, Jennifer E; Hall, Mark W; Wellnitz, Kari A; Maamari, Mia; Gaspers, Mary G; Nofziger, Ryan A; Lim, Peter Paul C; Carroll, Ryan W; Coronado Munoz, Alvaro; Bradford, Tamara T; Cullimore, Melissa L; Halasa, Natasha B; McLaughlin, Gwenn E; Pannaraj, Pia S; Cvijanovich, Natalie Z; Zinter, Matt S; Coates, Bria M; Horwitz, Steven M; Hobbs, Charlotte V; Dapul, Heda; Graciano, Ana Lia; Butler, Andrew D; Patel, Manish M; Zambrano, Laura D; Campbell, Angela P; Randolph, Adrienne G
OBJECTIVES:Extracorporeal membrane oxygenation (ECMO) has been used successfully to support adults with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cardiac or respiratory failure refractory to conventional therapies. Comprehensive reports of children and adolescents with SARS-CoV-2-related ECMO support for conditions, including multisystem inflammatory syndrome in children (MIS-C) and acute COVID-19, are needed. DESIGN:Case series of patients from the Overcoming COVID-19 public health surveillance registry. SETTING:Sixty-three hospitals in 32 U.S. states reporting to the registry between March 15, 2020, and December 31, 2021. PATIENTS:Patients less than 21 years admitted to the ICU meeting Centers for Disease Control criteria for MIS-C or acute COVID-19. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:The final cohort included 2,733 patients with MIS-C ( n = 1,530; 37 [2.4%] requiring ECMO) or acute COVID-19 ( n = 1,203; 71 [5.9%] requiring ECMO). ECMO patients in both groups were older than those without ECMO support (MIS-C median 15.4 vs 9.9 yr; acute COVID-19 median 15.3 vs 13.6 yr). The body mass index percentile was similar in the MIS-C ECMO versus no ECMO groups (89.9 vs 85.8; p = 0.22) but higher in the COVID-19 ECMO versus no ECMO groups (98.3 vs 96.5; p = 0.03). Patients on ECMO with MIS-C versus COVID-19 were supported more often with venoarterial ECMO (92% vs 41%) for primary cardiac indications (87% vs 23%), had ECMO initiated earlier (median 1 vs 5 d from hospitalization), shorter ECMO courses (median 3.9 vs 14 d), shorter hospital length of stay (median 20 vs 52 d), lower in-hospital mortality (27% vs 37%), and less major morbidity at discharge in survivors (new tracheostomy, oxygen or mechanical ventilation need or neurologic deficit; 0% vs 11%, 0% vs 20%, and 8% vs 15%, respectively). Most patients with MIS-C requiring ECMO support (87%) were admitted during the pre-Delta (variant B.1.617.2) period, while most patients with acute COVID-19 requiring ECMO support (70%) were admitted during the Delta variant period. CONCLUSIONS:ECMO support for SARS-CoV-2-related critical illness was uncommon, but type, initiation, and duration of ECMO use in MIS-C and acute COVID-19 were markedly different. Like pre-pandemic pediatric ECMO cohorts, most patients survived to hospital discharge.
PMID: 36995097
ISSN: 1529-7535
CID: 5502622

Association of Early Steroid Administration With Outcomes of Children Hospitalized for COVID-19 Without Multisystem Inflammatory Syndrome in Children

Tripathi, Sandeep; Nadiger, Meghana; McGarvey, Jeremy S; Harthan, Aaron A; Lombardo, Monica; Gharpure, Varsha P; Perkins, Nicholas; Chiotos, Kathleen; Sayed, Imran A; Bjornstad, Erica C; Bhalala, Utpal S; Raju, Umamaheswara; Miller, Aaron S; Dapul, Heda; Montgomery, Vicki; Boman, Karen; Arteaga, Grace M; Bansal, Vikas; Deo, Neha; Tekin, Aysun; Gajic, Ognjen; Kumar, Vishakha K; Kashyap, Rahul; Walkey, Allan J; ,
IMPORTANCE/UNASSIGNED:There is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C). OBJECTIVE/UNASSIGNED:To determine whether the use of steroids within 2 days of admission for non-MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non-MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry. EXPOSURE/UNASSIGNED:Administration of steroids within 2 days of admission. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Length of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching. RESULTS/UNASSIGNED:A total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score-matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators. CONCLUSIONS AND RELEVANCE/UNASSIGNED:Steroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.
PMID: 36190706
ISSN: 2168-6211
CID: 5598642

Gastrointestinal Manifestations in Hospitalized Children With Acute SARS-CoV-2 Infection and Multisystem Inflammatory Condition: An Analysis of the VIRUS COVID-19 Registry

Sayed, Imran A; Bhalala, Utpal; Strom, Larisa; Tripathi, Sandeep; Kim, John S; Michaud, Kristina; Chiotos, Kathleen; Dapul, Heda R; Gharpure, Varsha P; Bjornstad, Erica C; Heneghan, Julia A; Irby, Katherine; Montgomery, Vicki; Gupta, Neha; Gupta, Manoj; Boman, Karen; Bansal, Vikas; Kashyap, Rahul; Walkey, Allan J; Kumar, Vishakha K; Gist, Katja M
BACKGROUND:Describe the incidence and associated outcomes of gastrointestinal (GI) manifestations of acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in hospitalized children (MIS-C). METHODS:Retrospective review of the Viral Infection and Respiratory Illness Universal Study registry, a prospective observational, multicenter international cohort study of hospitalized children with acute COVID-19 or MIS-C from March 2020 to November 2020. The primary outcome measure was critical COVID-19 illness. Multivariable models were performed to assess for associations of GI involvement with the primary composite outcome in the entire cohort and a subpopulation of patients with MIS-C. Secondary outcomes included prolonged hospital length of stay defined as being >75th percentile and mortality. RESULTS:Of the 789 patients, GI involvement was present in 500 (63.3%). Critical illness occurred in 392 (49.6%), and 18 (2.3%) died. Those with GI involvement were older (median age of 8 yr), and 18.2% had an underlying GI comorbidity. GI symptoms and liver derangements were more common among patients with MIS-C. In the adjusted multivariable models, acute COVID-19 was no associated with the primary or secondary outcomes. Similarly, despite the preponderance of GI involvement in patients with MIS-C, it was also not associated with the primary or secondary outcomes. CONCLUSIONS:GI involvement is common in hospitalized children with acute COVID-19 and MIS-C. GI involvement is not associated with critical illness, hospital length of stay or mortality in acute COVID-19 or MIS-C.
PMID: 35622434
ISSN: 1532-0987
CID: 5248092

A Description of COVID-19-Directed Therapy in Children Admitted to US Intensive Care Units 2020

Schuster, Jennifer E; Halasa, Natasha B; Nakamura, Mari; Levy, Emily R; Fitzgerald, Julie C; Young, Cameron C; Newhams, Margaret M; Bourgeois, Florence; Staat, Mary A; Hobbs, Charlotte V; Dapul, Heda; Feldstein, Leora R; Jackson, Ashley M; Mack, Elizabeth H; Walker, Tracie C; Maddux, Aline B; Spinella, Philip C; Loftis, Laura L; Kong, Michele; Rowan, Courtney M; Bembea, Melania M; McLaughlin, Gwenn E; Hall, Mark W; Babbitt, Christopher J; Maamari, Mia; Zinter, Matt S; Cvijanovich, Natalie Z; Michelson, Kelly N; Gertz, Shira J; Carroll, Christopher L; Thomas, Neal J; Giuliano, John S; Singh, Aalok R; Hymes, Saul R; Schwarz, Adam J; McGuire, John K; Nofziger, Ryan A; Flori, Heidi R; Clouser, Katharine N; Wellnitz, Kari; Cullimore, Melissa L; Hume, Janet R; Patel, Manish; Randolph, Adrienne G
BACKGROUND:It is unclear how acute coronavirus disease 2019 (COVID-19)-directed therapies are used in children with life-threatening COVID-19 in US hospitals. We described characteristics of children hospitalized in the intensive care unit or step-down unit (ICU/SDU) who received COVID-19-directed therapies and the specific therapies administered. METHODS:Between March 15, 2020 and December 27, 2020, children <18 years of age in the ICU/SDU with acute COVID-19 at 48 pediatric hospitals in the United States were identified. Demographics, laboratory values, and clinical course were compared in children who did and did not receive COVID-19-directed therapies. Trends in COVID-19-directed therapies over time were evaluated. RESULTS:Of 424 children in the ICU/SDU, 235 (55%) received COVID-19-directed therapies. Children who received COVID-19-directed therapies were older than those who did not receive COVID-19-directed therapies (13.3 [5.6-16.2] vs 9.8 [0.65-15.9] years), more had underlying medical conditions (188 [80%] vs 104 [55%]; difference = 25% [95% CI: 16% to 34%]), more received respiratory support (206 [88%] vs 71 [38%]; difference = 50% [95% CI: 34% to 56%]), and more died (8 [3.4%] vs 0). Of the 235 children receiving COVID-19-directed therapies, 172 (73%) received systemic steroids and 150 (64%) received remdesivir, with rising remdesivir use over the study period (14% in March/April to 57% November/December). CONCLUSION/CONCLUSIONS:Despite the lack of pediatric data evaluating treatments for COVID-19 in critically ill children, more than half of children requiring intensive or high acuity care received COVID-19-directed therapies.
PMID: 35022779
ISSN: 2048-7207
CID: 5118872

Continuing Care For Critically Ill Children Beyond Hospital Discharge: Current State of Follow-up

Williams, Cydni N; Hall, Trevor A; Francoeur, Conall; Kurz, Jonathan; Rasmussen, Lindsey; Hartman, Mary E; O'meara, Am Iqbal; Ferguson, Nikki Miller; Fink, Ericka L; Walker, Tracie; Drury, Kurt; Carpenter, Jessica L; Erklauer, Jennifer; Press, Craig; Wainwright, Mark S; Lovett, Marlina; Dapul, Heda; Murphy, Sarah; Risen, Sarah; Guerriero, Rejean M; Woodruff, Alan; Guilliams, Kristin P
OBJECTIVES/OBJECTIVE:Survivors of the PICU face long-term morbidities across health domains. In this study, we detail active PICU follow-up programs (PFUPs) and identify perceptions and barriers about development and maintenance of PFUPs. METHODS:A web link to an adaptive survey was distributed through organizational listservs. Descriptive statistics characterized the sample and details of existing PFUPs. Likert responses regarding benefits and barriers were summarized. RESULTS:One hundred eleven respondents represented 60 institutions located in the United States (n = 55), Canada (n = 3), Australia (n = 1), and the United Kingdom (n = 1). Details for 17 active programs were provided. Five programs included broad PICU populations, while the majority were neurocritical care (53%) focused. Despite strong agreement on the need to assess and treat morbidity across multiple health domains, 29% were physician only programs, and considerable variation existed in services provided by programs across settings. More than 80% of all respondents agreed PFUPs provide direct benefits and are essential to advancing knowledge on long-term PICU outcomes. Respondents identified "lack of support" as the most important barrier, particularly funding for providers and staff, and lack of clinical space, though successful programs overcome this challenge using a variety of funding resources. CONCLUSIONS:Few systematic multidisciplinary PFUPs exist despite strong agreement about importance of this care and direct benefit to patients and families. We recommend stakeholders use our description of successful programs as a framework to develop multidisciplinary models to elevate continuity across inpatient and outpatient settings, improve patient care, and foster collaboration to advance knowledge.
PMID: 35314865
ISSN: 2154-1671
CID: 5217192

Frequency, Characteristics and Complications of COVID-19 in Hospitalized Infants

Hobbs, Charlotte V; Woodworth, Kate; Young, Cameron C; Jackson, Ashley M; Newhams, Margaret M; Dapul, Heda; Maamari, Mia; Hall, Mark W; Maddux, Aline B; Singh, Aalok R; Schuster, Jennifer E; Rowan, Courtney M; Fitzgerald, Julie C; Irby, Katherine; Kong, Michele; Mack, Elizabeth H; Staat, Mary A; Cvijanovich, Natalie Z; Bembea, Melania M; Coates, Bria M; Halasa, Natasha B; Walker, Tracie C; McLaughlin, Gwenn E; Babbitt, Christopher J; Nofziger, Ryan A; Loftis, Laura L; Bradford, Tamara T; Campbell, Angela P; Patel, Manish M; Randolph, Adrienne G
BACKGROUND:Previous studies of severe acute respiratory syndrome coronavirus 2 infection in infants have incompletely characterized factors associated with severe illness or focused on infants born to mothers with coronavirus disease 2019 (COVID-19). Here we highlight demographics, clinical characteristics and laboratory values that differ between infants with and without severe acute COVID-19. METHODS:Active surveillance was performed by the Overcoming COVID-19 network to identify children and adolescents with severe acute respiratory syndrome coronavirus 2-related illness hospitalized at 62 sites in 31 states from March 15 to December 27, 2020. We analyzed patients aged >7 days to <1 year hospitalized with symptomatic acute COVID-19. RESULTS:We report 232 infants aged >7 days to <1 year hospitalized with acute symptomatic COVID-19 from 37 US hospitals in our cohort from March 15 to December 27, 2020. Among 630 cases of severe COVID-19 in patients aged >7 days to <18 years, 128 (20.3%) were infants. In infants with severe illness from the entire study period, the median age was 2 months, 66% were from racial and ethnic minority groups, 66% were previously healthy, 73% had respiratory complications, 13% received mechanical ventilation and <1% died. CONCLUSIONS:Infants accounted for over a fifth of children aged <18 years hospitalized for severe acute COVID-19, commonly manifesting with respiratory symptoms and complications. Although most infants hospitalized with COVID-19 did not suffer significant complications, longer term outcomes remain unclear. Notably, 75% of infants with severe disease were <6 months of age in this cohort study period, which predated maternal COVID-19 vaccination, underscoring the importance of maternal vaccination for COVID-19 in protecting the mother and infant.
PMID: 34955519
ISSN: 1532-0987
CID: 5107982

Characterization and Outcomes of Hospitalized Children With Coronavirus Disease 2019: A Report From a Multicenter, Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) Registry

Bhalala, Utpal S; Gist, Katja M; Tripathi, Sandeep; Boman, Karen; Kumar, Vishakha K; Retford, Lynn; Chiotos, Kathleen; Blatz, Allison M; Dapul, Heda; Verma, Sourabh; Sayed, Imran A; Gharpure, Varsha P; Bjornstad, Erica; Tofil, Nancy; Irby, Katherine; Sanders, Ronald C; Heneghan, Julia A; Thomas, Melissa; Gupta, Manoj K; Oulds, Franscene E; Arteaga, Grace M; Levy, Emily R; Gupta, Neha; Kaufman, Margit; Abdelaty, Amr; Shlomovich, Mark; Medar, Shivanand S; Iqbal O'Meara, A M; Kuehne, Joshua; Menon, Shina; Khandhar, Paras B; Miller, Aaron S; Barry, Suzanne M; Danesh, Valerie C; Khanna, Ashish K; Zammit, Kimberly; Stulce, Casey; McGonagill, Patrick W; Bercow, Asher; Amzuta, Ioana G; Gupta, Sandeep; Almazyad, Mohammed A; Pierre, Louisdon; Sendi, Prithvi; Ishaque, Sidra; Anderson, Harry L; Nawathe, Pooja; Akhter, Murtaza; Lyons, Patrick G; Chen, Catherine; Walkey, Allan J; Bihorac, Azra; Wada Bello, Imam; Ben Ari, Judith; Kovacevic, Tanja; Bansal, Vikas; Brinton, John T; Zimmerman, Jerry J; Kashyap, Rahul
OBJECTIVES:Multicenter data on the characteristics and outcomes of children hospitalized with coronavirus disease 2019 are limited. Our objective was to describe the characteristics, ICU admissions, and outcomes among children hospitalized with coronavirus disease 2019 using Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 registry. DESIGN:Retrospective study. SETTING:Society of Critical Care Medicine Viral Infection and Respiratory Illness Universal Study (Coronavirus Disease 2019) registry. PATIENTS:Children (< 18 yr) hospitalized with coronavirus disease 2019 at participating hospitals from February 2020 to January 2021. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:The primary outcome was ICU admission. Secondary outcomes included hospital and ICU duration of stay and ICU, hospital, and 28-day mortality. A total of 874 children with coronavirus disease 2019 were reported to Viral Infection and Respiratory Illness Universal Study registry from 51 participating centers, majority in the United States. Median age was 8 years (interquartile range, 1.25-14 yr) with a male:female ratio of 1:2. A majority were non-Hispanic (492/874; 62.9%). Median body mass index (n = 817) was 19.4 kg/m2 (16-25.8 kg/m2), with 110 (13.4%) overweight and 300 (36.6%) obese. A majority (67%) presented with fever, and 43.2% had comorbidities. A total of 238 of 838 (28.2%) met the Centers for Disease Control and Prevention criteria for multisystem inflammatory syndrome in children, and 404 of 874 (46.2%) were admitted to the ICU. In multivariate logistic regression, age, fever, multisystem inflammatory syndrome in children, and pre-existing seizure disorder were independently associated with a greater odds of ICU admission. Hospital mortality was 16 of 874 (1.8%). Median (interquartile range) duration of ICU (n = 379) and hospital (n = 857) stay were 3.9 days (2-7.7 d) and 4 days (1.9-7.5 d), respectively. For patients with 28-day data, survival was 679 of 787, 86.3% with 13.4% lost to follow-up, and 0.3% deceased. CONCLUSIONS:In this observational, multicenter registry of children with coronavirus disease 2019, ICU admission was common. Older age, fever, multisystem inflammatory syndrome in children, and seizure disorder were independently associated with ICU admission, and mortality was lower among children than mortality reported in adults.
PMID: 34387240
ISSN: 1530-0293
CID: 5106612