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Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C

Fink, Ericka L; 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; Czech, Theresa; Even, Katelyn M; Brunow de Carvalho, Werther; Rodriguez, Isadora Souza; 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 Egeria; Vargas, Wendy S; Topjian, Alexis; Alcamo, Alicia M; McGuire, Jennifer L; Domínguez Rojas, Jesus Angel; Muñoz, Jaime Tasayco; 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; Francoeur, Conall; Appavu, Brian; Guilliams, Kristin P; Agner, Shannon C; Walson, Karen H; Rasmussen, Lindsey; Janas, Anna; Ferrazzano, Peter; Farias-Moeller, Raquel; Snooks, Kellie C; Chang, Chung-Chou H; Yun, James; Schober, Michelle E
BACKGROUND:Our objective was to characterize the frequency, early impact, and risk factors for neurological manifestations in hospitalized children with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or multisystem inflammatory syndrome in children (MIS-C). METHODS:Multicenter, cross-sectional study of neurological manifestations in children aged <18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020 and April 2021. Multivariable logistic regression to identify risk factors for neurological manifestations was performed. RESULTS:Of 1493 children, 1278 (86%) were diagnosed with acute SARS-CoV-2 and 215 (14%) with MIS-C. Overall, 44% of the cohort (40% acute SARS-CoV-2 and 66% MIS-C) had at least one neurological manifestation. The most common neurological findings in children with acute SARS-CoV-2 and MIS-C diagnosis were headache (16% and 47%) and acute encephalopathy (15% and 22%), both P < 0.05. Children with neurological manifestations were more likely to require intensive care unit (ICU) care (51% vs 22%), P < 0.001. In multivariable logistic regression, children with neurological manifestations were older (odds ratio [OR] 1.1 and 95% confidence interval [CI] 1.07 to 1.13) and more likely to have MIS-C versus acute SARS-CoV-2 (OR 2.16, 95% CI 1.45 to 3.24), pre-existing neurological and metabolic conditions (OR 3.48, 95% CI 2.37 to 5.15; and OR 1.65, 95% CI 1.04 to 2.66, respectively), and pharyngeal (OR 1.74, 95% CI 1.16 to 2.64) or abdominal pain (OR 1.43, 95% CI 1.03 to 2.00); all P < 0.05. CONCLUSIONS:In this multicenter study, 44% of children hospitalized with SARS-CoV-2-related conditions experienced neurological manifestations, which were associated with ICU admission and pre-existing neurological condition. Posthospital assessment for, and support of, functional impairment and neuroprotective strategies are vitally needed.
PMCID:8713420
PMID: 35066369
ISSN: 1873-5150
CID: 5139372

The Impact of Obesity on Disease Severity and Outcomes Among Hospitalized Children With COVID-19

Tripathi, Sandeep; Christison, Amy L; Levy, Emily; McGravery, Jeremy; Tekin, Aysun; Bolliger, Dawn; Kumar, Vishakha K; Bansal, Vikas; Chiotos, Kathleen; Gist, Katja M; Dapul, Heda R; Bhalala, Utpal S; Gharpure, Varsha P; Heneghan, Julia A; Gupta, Neha; Bjornstad, Erica C; Montgomery, Vicki L; Walkey, Allan; Kashyap, Rahul; Arteaga, Grace M
OBJECTIVE:To describe the impact of obesity on disease severity and outcomes of coronavirus disease 2019 (COVID-19) among hospitalized children. METHODS:This retrospective cohort study from the Society of Critical Care Medicine Viral Respiratory Illness Universal Study registry included all children hospitalized with COVID-19 from March 2020 to January 2021. Obesity was defined by Centers for Disease Control and Prevention BMI or World Health Organization weight for length criteria. Critical illness definition was adapted from National Institutes of Health criteria of critical COVID. Multivariate mixed logistic and linear regression was performed to calculate the adjusted odds ratio of critical illness and the adjusted impact of obesity on hospital length of stay. RESULTS:= .38). CONCLUSION:In a large, multicenter cohort, a high proportion of hospitalized children from COVID-19 had obesity as comorbidity. Furthermore, obesity had a significant independent association with critical illness.
PMID: 34168067
ISSN: 2154-1671
CID: 5037562

Data-driven clustering identifies features distinguishing multisystem inflammatory syndrome from acute COVID-19 in children and adolescents

Geva, Alon; Patel, Manish M; Newhams, Margaret M; Young, Cameron C; Son, Mary Beth F; Kong, Michele; Maddux, Aline B; Hall, Mark W; Riggs, Becky J; Singh, Aalok R; Giuliano, John S; Hobbs, Charlotte V; Loftis, Laura L; McLaughlin, Gwenn E; Schwartz, Stephanie P; Schuster, Jennifer E; Babbitt, Christopher J; Halasa, Natasha B; Gertz, Shira J; Doymaz, Sule; Hume, Janet R; Bradford, Tamara T; Irby, Katherine; Carroll, Christopher L; McGuire, John K; Tarquinio, Keiko M; Rowan, Courtney M; Mack, Elizabeth H; Cvijanovich, Natalie Z; Fitzgerald, Julie C; Spinella, Philip C; Staat, Mary A; Clouser, Katharine N; Soma, Vijaya L; Dapul, Heda; Maamari, Mia; Bowens, Cindy; Havlin, Kevin M; Mourani, Peter M; Heidemann, Sabrina M; Horwitz, Steven M; Feldstein, Leora R; Tenforde, Mark W; Newburger, Jane W; Mandl, Kenneth D; Randolph, Adrienne G
Background/UNASSIGNED:Multisystem inflammatory syndrome in children (MIS-C) consensus criteria were designed for maximal sensitivity and therefore capture patients with acute COVID-19 pneumonia. Methods/UNASSIGNED:We performed unsupervised clustering on data from 1,526 patients (684 labeled MIS-C by clinicians) <21 years old hospitalized with COVID-19-related illness admitted between 15 March 2020 and 31 December 2020. We compared prevalence of assigned MIS-C labels and clinical features among clusters, followed by recursive feature elimination to identify characteristics of potentially misclassified MIS-C-labeled patients. Findings/UNASSIGNED: = 583; 19% labeled MIS-C) were younger (2·8 ± 2·0 y), PCR positive (86%), with less inflammation. Radiographic findings of pulmonary infiltrates and positive SARS-CoV-2 PCR accurately distinguished cluster 2 MIS-C labeled patients from cluster 1 patients. Interpretation/UNASSIGNED:Using a data driven, unsupervised approach, we identified features that cluster patients into a group with high likelihood of having MIS-C. Other features identified a cluster of patients more likely to have acute severe COVID-19 pulmonary disease, and patients in this cluster labeled by clinicians as MIS-C may be misclassified. These data driven phenotypes may help refine the diagnosis of MIS-C.
PMCID:8405351
PMID: 34485878
ISSN: 2589-5370
CID: 5067082

Coronavirus Disease 2019-Associated PICU Admissions: A Report From the Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study Registry

Tripathi, Sandeep; Gist, Katja M; Bjornstad, Erica C; Kashyap, Rahul; Boman, Karen; Chiotos, Kathleen; Gharpure, Varsha P; Dapul, Heda; Sayed, Imran A; Kuehne, Joshua; Heneghan, Julia A; Gupta, Manoj; Khandhar, Paras B; Menon, Shina; Gupta, Neha; Kumar, Vishakha K; Retford, Lynn; Zimmerman, Jerry; Bhalala, Utpal S
OBJECTIVES/OBJECTIVE:To compare clinical characteristics and outcomes of children admitted to the PICU for severe acute respiratory syndrome coronavirus 2-related illness with or without multisystem inflammatory syndrome in children. The secondary objective was to identify explanatory factors associated with outcome of critical illness defined by a composite index of in-hospital mortality and organ system support requirement. DESIGN/METHODS:Retrospective cohort study. SETTING/METHODS:Thirty-eight PICUs within the Viral Infection and Respiratory Illness Universal Study registry from March 2020 to January 2021. PATIENTS/METHODS:Children less than 18 years with severe acute respiratory syndrome coronavirus 2-related illness with or without multisystem inflammatory syndrome in children. MEASUREMENTS AND MAIN RESULTS/RESULTS:Of 394 patients, 171 (43.4%) had multisystem inflammatory syndrome in children. Children with multisystem inflammatory syndrome in children were more likely younger (2-12 yr vs adolescents; p < 0.01), Black (35.6% vs 21.9%; p < 0.01), present with fever/abdominal pain than cough/dyspnea (p < 0.01), and less likely to have comorbidities (33.3% vs 61.9%; p < 0.01) compared with those without multisystem inflammatory syndrome in children. Inflammatory marker levels, use of inotropes/vasopressors, corticosteroids, and anticoagulants were higher in multisystem inflammatory syndrome in children patients (p < 0.01). Overall mortality was 3.8% (15/394), with no difference in the two groups. Diagnosis of multisystem inflammatory syndrome in children was associated with longer duration of hospitalization as compared to nonmultisystem inflammatory syndrome in children (7.5 d[interquartile range, 5-11] vs 5.3 d [interquartile range, 3-11 d]; p < 0.01). Critical illness occurred in 164 patients (41.6%) and was more common in patients with multisystem inflammatory syndrome in children compared with those without (55.6% vs 30.9%; p < 0.01). Multivariable analysis failed to show an association between critical illness and age, race, sex, greater than or equal to three signs and symptoms, or greater than or equal to two comorbidities among the multisystem inflammatory syndrome in children cohort. Among nonmultisystem inflammatory syndrome in children patients, the presence of greater than or equal to two comorbidities was associated with greater odds of critical illness (odds ratio 2.95 [95% CI, 1.61-5.40]; p < 0.01). CONCLUSIONS:This study delineates significant clinically relevant differences in presentation, explanatory factors, and outcomes among children admitted to PICU with severe acute respiratory syndrome coronavirus 2-related illness stratified by multisystem inflammatory syndrome in children.
PMID: 33965987
ISSN: 1529-7535
CID: 4878182

Implementation of Pediatric ECMO Safety Rounds for Real-time Quality Improvement [Meeting Abstract]

Toy, B; Beaulieu, T; LoRe, K; Cicalese, E; Dapul, H; Maldonado, M; McKinstry, J; Verma, S; Chopra, A; Fisher, J C
Study: Our Pediatric ECMO Program implemented ECMO Safety Rounds (ESR) as a quality improvement (QI) initiative. Objectives were to ensure implementation of protocols, immediately correct quality/safety deficiencies, and provide real-time education to nurses and perfusionists. Our specific aim was to track compliance with this process-improvement bundle and identify areas to target with QI efforts, with a long-term global aim of reducing quality/safety variances and patient harm over time. XXMethod(s): Our team initiated Pediatric ESR in September 2019. Two process- based QI bundles were developed: (1) Circuit Safety - 35 bundle elements, including maintenance and emergency checks; (2) Patient Safety - 13 bundle elements focused on nursing practices specific to minimizing patient harm. Pediatric ESR consisted of these two bundle assessments performed by designated ESR clinicians at the bedside with the patient's nurse and perfusionist. Credit for bundle compliance was awarded only if all elements were properly met. Noncompliant elements were addressed in real-time. All data was recorded in REDCap database. XXResult(s): 36 Pediatric ESRs were completed (Sept. 2019 - Jan. 2021). Monthly bundle compliance was reported using run charts. Median compliance with both bundles appeared to improve over time, with their most recent centerlines both at 67% compliance (Figure 1). Analysis of individual bundle elements revealed that 19/48 (40%) safety items were deficient at least once during the 36 ESRs (Table 1). Any individual bundle element with greater than 2 noncompliance events prompted our team to target interventions addressing these lapses, including new protocols and education, conducting multidisciplinary reviews, and collaborating with ancillary departments. We conclude that Pediatric ESR provides real-time assessment of compliance, immediate corrective and education measures, and actionable data to drive performance improvement around observed vulnerabilities in ECMO protocols
EMBASE:635362843
ISSN: 1538-943x
CID: 4929602

Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome

LaRovere, Kerri L; Riggs, Becky J; Poussaint, Tina Y; Young, Cameron C; Newhams, Margaret M; Maamari, Mia; Walker, Tracie C; Singh, Aalok R; Dapul, Heda; Hobbs, Charlotte V; McLaughlin, Gwenn E; Son, Mary Beth F; Maddux, Aline B; Clouser, Katharine N; Rowan, Courtney M; McGuire, John K; Fitzgerald, Julie C; Gertz, Shira J; Shein, Steven L; Munoz, Alvaro Coronado; Thomas, Neal J; Irby, Katherine; Levy, Emily R; Staat, Mary A; Tenforde, Mark W; Feldstein, Leora R; Halasa, Natasha B; Giuliano, John S; Hall, Mark W; Kong, Michele; Carroll, Christopher L; Schuster, Jennifer E; Doymaz, Sule; Loftis, Laura L; Tarquinio, Keiko M; Babbitt, Christopher J; Nofziger, Ryan A; Kleinman, Lawrence C; Keenaghan, Michael A; Cvijanovich, Natalie Z; Spinella, Philip C; Hume, Janet R; Wellnitz, Kari; Mack, Elizabeth H; Michelson, Kelly N; Flori, Heidi R; Patel, Manish M; Randolph, Adrienne G
Importance/UNASSIGNED:Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear. Objective/UNASSIGNED:To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19. Setting, Design, and Participants/UNASSIGNED:Case series of patients (age <21 years) hospitalized between March 15, 2020, and December 15, 2020, with positive severe acute respiratory syndrome coronavirus 2 test result (reverse transcriptase-polymerase chain reaction and/or antibody) at 61 US hospitals in the Overcoming COVID-19 public health registry, including 616 (36%) meeting criteria for multisystem inflammatory syndrome in children. Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening involvement was adjudicated by experts based on clinical and/or neuroradiologic features. Exposures/UNASSIGNED:Severe acute respiratory syndrome coronavirus 2. Main Outcomes and Measures/UNASSIGNED:Type and severity of neurologic involvement, laboratory and imaging data, and outcomes (death or survival with new neurologic deficits) at hospital discharge. Results/UNASSIGNED:Of 1695 patients (909 [54%] male; median [interquartile range] age, 9.1 [2.4-15.3] years), 365 (22%) from 52 sites had documented neurologic involvement. Patients with neurologic involvement were more likely to have underlying neurologic disorders (81 of 365 [22%]) compared with those without (113 of 1330 [8%]), but a similar number were previously healthy (195 [53%] vs 723 [54%]) and met criteria for multisystem inflammatory syndrome in children (126 [35%] vs 490 [37%]). Among those with neurologic involvement, 322 (88%) had transient symptoms and survived, and 43 (12%) developed life-threatening conditions clinically adjudicated to be associated with COVID-19, including severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), central nervous system infection/demyelination (n = 8), Guillain-Barré syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4). Compared with those without life-threatening conditions (n = 322), those with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios (median, 12.2 vs 4.4) and higher reported frequency of D-dimer greater than 3 μg/mL fibrinogen equivalent units (21 [49%] vs 72 [22%]). Of 43 patients who developed COVID-19-related life-threatening neurologic involvement, 17 survivors (40%) had new neurologic deficits at hospital discharge, and 11 patients (26%) died. Conclusions and Relevance/UNASSIGNED:In this study, many children and adolescents hospitalized for COVID-19 or multisystem inflammatory syndrome in children had neurologic involvement, mostly transient symptoms. A range of life-threatening and fatal neurologic conditions associated with COVID-19 infrequently occurred. Effects on long-term neurodevelopmental outcomes are unknown.
PMID: 33666649
ISSN: 2168-6157
CID: 4801932

Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19

Feldstein, Leora R; Tenforde, Mark W; Friedman, Kevin G; Newhams, Margaret; Rose, Erica Billig; Dapul, Heda; Soma, Vijaya L; Maddux, Aline B; Mourani, Peter M; Bowens, Cindy; Maamari, Mia; Hall, Mark W; Riggs, Becky J; Giuliano, John S; Singh, Aalok R; Li, Simon; Kong, Michele; Schuster, Jennifer E; McLaughlin, Gwenn E; Schwartz, Stephanie P; Walker, Tracie C; Loftis, Laura L; Hobbs, Charlotte V; Halasa, Natasha B; Doymaz, Sule; Babbitt, Christopher J; Hume, Janet R; Gertz, Shira J; Irby, Katherine; Clouser, Katharine N; Cvijanovich, Natalie Z; Bradford, Tamara T; Smith, Lincoln S; Heidemann, Sabrina M; Zackai, Sheemon P; Wellnitz, Kari; Nofziger, Ryan A; Horwitz, Steven M; Carroll, Ryan W; Rowan, Courtney M; Tarquinio, Keiko M; Mack, Elizabeth H; Fitzgerald, Julie C; Coates, Bria M; Jackson, Ashley M; Young, Cameron C; Son, Mary Beth F; Patel, Manish M; Newburger, Jane W; Randolph, Adrienne G
Importance/UNASSIGNED:Refinement of criteria for multisystem inflammatory syndrome in children (MIS-C) may inform efforts to improve health outcomes. Objective/UNASSIGNED:To compare clinical characteristics and outcomes of children and adolescents with MIS-C vs those with severe coronavirus disease 2019 (COVID-19). Setting, Design, and Participants/UNASSIGNED:Case series of 1116 patients aged younger than 21 years hospitalized between March 15 and October 31, 2020, at 66 US hospitals in 31 states. Final date of follow-up was January 5, 2021. Patients with MIS-C had fever, inflammation, multisystem involvement, and positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) or antibody test results or recent exposure with no alternate diagnosis. Patients with COVID-19 had positive RT-PCR test results and severe organ system involvement. Exposure/UNASSIGNED:SARS-CoV-2. Main Outcomes and Measures/UNASSIGNED:Presenting symptoms, organ system complications, laboratory biomarkers, interventions, and clinical outcomes. Multivariable regression was used to compute adjusted risk ratios (aRRs) of factors associated with MIS-C vs COVID-19. Results/UNASSIGNED:Of 1116 patients (median age, 9.7 years; 45% female), 539 (48%) were diagnosed with MIS-C and 577 (52%) with COVID-19. Compared with patients with COVID-19, patients with MIS-C were more likely to be 6 to 12 years old (40.8% vs 19.4%; absolute risk difference [RD], 21.4% [95% CI, 16.1%-26.7%]; aRR, 1.51 [95% CI, 1.33-1.72] vs 0-5 years) and non-Hispanic Black (32.3% vs 21.5%; RD, 10.8% [95% CI, 5.6%-16.0%]; aRR, 1.43 [95% CI, 1.17-1.76] vs White). Compared with patients with COVID-19, patients with MIS-C were more likely to have cardiorespiratory involvement (56.0% vs 8.8%; RD, 47.2% [95% CI, 42.4%-52.0%]; aRR, 2.99 [95% CI, 2.55-3.50] vs respiratory involvement), cardiovascular without respiratory involvement (10.6% vs 2.9%; RD, 7.7% [95% CI, 4.7%-10.6%]; aRR, 2.49 [95% CI, 2.05-3.02] vs respiratory involvement), and mucocutaneous without cardiorespiratory involvement (7.1% vs 2.3%; RD, 4.8% [95% CI, 2.3%-7.3%]; aRR, 2.29 [95% CI, 1.84-2.85] vs respiratory involvement). Patients with MIS-C had higher neutrophil to lymphocyte ratio (median, 6.4 vs 2.7, P < .001), higher C-reactive protein level (median, 152 mg/L vs 33 mg/L; P < .001), and lower platelet count (<150 ×103 cells/μL [212/523 {41%} vs 84/486 {17%}, P < .001]). A total of 398 patients (73.8%) with MIS-C and 253 (43.8%) with COVID-19 were admitted to the intensive care unit, and 10 (1.9%) with MIS-C and 8 (1.4%) with COVID-19 died during hospitalization. Among patients with MIS-C with reduced left ventricular systolic function (172/503, 34.2%) and coronary artery aneurysm (57/424, 13.4%), an estimated 91.0% (95% CI, 86.0%-94.7%) and 79.1% (95% CI, 67.1%-89.1%), respectively, normalized within 30 days. Conclusions and Relevance/UNASSIGNED:This case series of patients with MIS-C and with COVID-19 identified patterns of clinical presentation and organ system involvement. These patterns may help differentiate between MIS-C and COVID-19.
PMID: 33625505
ISSN: 1538-3598
CID: 4794702

Multisystem inflammatory syndrome in children (MIS-C) and retropharyngeal edema: A case series

Daube, Ariel; Rickert, Scott; Madan, Rebecca Pellett; Kahn, Philip; Rispoli, Joanne; Dapul, Heda
Multisystem inflammatory syndrome in children (MIS-C) is thought to follow SARS-CoV-2 infection and presents with fever and multisystem dysfunction. We report three children with suspected MIS-C found to have retropharyngeal edema without evidence of a bacterial etiology. We raise the possibility that an association between MIS-C and retropharyngeal edema exists.
PMCID:7931672
PMID: 33752089
ISSN: 1872-8464
CID: 4822422

Morbidity of conversion from venovenous to venoarterial ECMO in neonates with meconium aspiration or persistent pulmonary hypertension

Choi, Beatrix Hyemin; Verma, Sourabh; Cicalese, Erin; Dapul, Heda; Toy, Bridget; Chopra, Arun; Fisher, Jason C
BACKGROUND:Outcomes in neonates receiving extracorporeal membrane oxygenation (ECMO) for meconium aspiration syndrome (MAS) and/or persistent pulmonary hypertension (PPHN) are favorable. Infants with preserved perfusion are often offered venovenous (VV) support to spare morbidities of venoarterial (VA) ECMO. Worsening perfusion or circuit complications can prompt conversion from VV-to-VA support. We examined whether outcomes in infants requiring VA ECMO for MAS/PPHN differed if they underwent VA support initially versus converting to VA after a VV trial, and what factors predicted conversion. METHODS:We reviewed the Extracorporeal Life Support Organization registry from 2007 to 2017 for neonates with primary diagnoses of MAS/PPHN. Propensity score analysis matched VA single-runs (controls) 4:1 against VV-to-VA conversions based on age, pre-ECMO pH, and precannulation arrests. Primary outcomes were complications and survival. Data were analyzed using Mann-Whitney U and Fisher's exact testing. Multivariate regression identified independent predictors of conversion for VV patients. RESULTS:3831 neonates underwent ECMO for MAS/PPHN, including 2129 (55%) initially requiring VA support. Of 1702 patients placed on VV ECMO, 98 (5.8%) required VV-to-VA conversion. Compared with 364 propensity-matched isolated VA controls, conversion runs were longer (190 vs. 127 h, P < 0.001), were associated with more complications, and decreased survival to discharge (70% vs. 83%, P = 0.01). On multivariate regression, conversion was more likely if neonates on VV ECMO did not receive surfactant (OR = 1.7;95%CI = 1.1-2.7;P = 0.03) or required high-frequency ventilation (OR = 1.9;95%CI = 1.2-3.3;P = 0.01) before ECMO. CONCLUSION/CONCLUSIONS:Conversion from VV-to-VA ECMO in infants with MAS/PPHN conveys increased morbidity and mortality compared to similar patients placed initially onto VA ECMO. VV patients not receiving surfactant or requiring high-frequency ventilation before cannulation may have increased risk of conversion. While conversions remain rare, decisions to offer VV ECMO for MAS/PPHN must be informed by inferior outcomes observed should conversion be required. LEVEL OF EVIDENCE/METHODS:Level of evidence 3 Retrospective comparative study.
PMID: 33645507
ISSN: 1531-5037
CID: 4800052

Pediatric COVID-19: A report from viral infection and respiratory illness universal study (VIRUS) [Meeting Abstract]

Bhalala, U; Gist, K; Tripathi, S; Chiotos, K; Dapul, H; Gharpure, V; Bansal, V; Kumar, V; Boman, K; Retford, L; Kashyap, R
INTRODUCTION: Coronavirus disease (COVID-19) has affected all age groups across the world. There is limited multi-center data on characteristics and outcomes of COVID-19 in hospitalized children. Using Society of Critical Care Medicine (SCCM) Viral Infection and Respiratory Illness Universal Study (VIRUS) registry - a large, multicenter, international database, we sought to describe the characteristics, pre-existing conditions, need for pediatric intensive care unit (PICU) admission and outcomes in children hospitalized with COVID-19.
METHOD(S): We conducted a retrospective review of data submitted to SCCM VIRUS database and included COVID-19 positive children hospitalized between February 2020 to July 2020. We collected data on demographics, symptoms and signs, pre-existing conditions, occurrence of MIS-C (multi-system inflammatory syndrome in children), need for PICU admission, hospital mortality and length of stay (LOS) among children hospitalized with COVID-19. We reported findings using descriptive analysis with median and interquartile range (IQR).
RESULT(S): A total 419 children (<18 years) were admitted to 49 participating hospitals due to COVID-19. The median age was 7 (1-15) years (N=413) and male: female ratio was 1.2:1. A majority were White (48%), followed by African American (23%) and other race (22%) (out of N=412). The ethnic distribution consisted of 52% Non-Hispanic, 39% Hispanic and 9% unknown (out of N=410). The median (IQR) weight was 27 (9-64.5) kgs (out of N=407) and height was 120 (67-161) cm (out of N=377). A majority of children presented with fever (61%), followed by nausea/vomiting (29%), dry cough (24%) and abdominal pain (19%). Half (51%) of children had pre-existing conditions (out of N=336), 28% children had CDC criteria of MIS-C (out of N=365) and 45% children needed PICU care (out of N=402). The hospital mortality was 3.5% (out of N=313) and LOS [median (IQR)] was 4 (1.8-8.1) days (N=313) with majority (93%) children discharged to home without assistance (out of N=296).
CONCLUSION(S): This report describes the characteristics and outcomes of children hospitalized with COVID-19 from one of the largest COVID-19 global database. Though a good proportion of children hospitalized with COVID-19 had pre-existing conditions and needed PICU care, overall hospital mortality was low
EMBASE:634766977
ISSN: 1530-0293
CID: 4869392