Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City

Autor: Manoj Gupta, Edward E. Conway, Shubhi Kaushik, Jennifer Gillen, Kim R. Derespina, Shivanand S. Medar, Melissa Grageda, Anna Plichta, Anita Sen, Michael S. D. Agus, Lillian M. Zerihun, Stephanie Jarrin, Vinay M. Nadkarni, Louisdon Pierre, Franscene Oulds, Sule Doymaz, Asher Bercow, Michael A. Keenaghan, Jaeun Choi, H. Michael Ushay, Ruth Eisenberg, Claire M. Hennigan
Rok vydání: 2020
Předmět:
Male
Respiratory Therapy
medicine.medical_specialty
ARDS
Adolescent
Critical Care
Critical Illness
medicine.medical_treatment
Pediatric ARDS
Comorbidity
Antiviral Agents
Article
Young Adult
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Tocilizumab
030225 pediatrics
Internal medicine
Intensive care
pediatric respiratory failure
medicine
Extracorporeal membrane oxygenation
Humans
Pediatrics
Perinatology
and Child Health
030212 general & internal medicine
Child
Letters to the Editor
Retrospective Studies
Mechanical ventilation
pediatric viral sepsis
business.industry
Acute kidney injury
COVID-19
Infant
Hydroxychloroquine
Retrospective cohort study
Length of Stay
medicine.disease
Combined Modality Therapy
Treatment Outcome
chemistry
Child
Preschool
Pediatrics
Perinatology and Child Health
Female
New York City
business
Follow-Up Studies
medicine.drug
Zdroj: The Journal of Pediatrics
ISSN: 0022-3476
DOI: 10.1016/j.jpeds.2020.07.039
Popis: Objectives To describe the clinical manifestations and outcomes of critically ill children with coronavirus disease-19 (COVID-19) in New York City. Study design Retrospective observational study of children 1 month to 21 years admitted March 14 to May 2, 2020, to 9 New York City pediatric intensive care units (PICUs) with severe acute respiratory syndrome coronavirus 2 infection. Results Of 70 children admitted to PICUs, median age was 15 (IQR 9, 19) years; 61.4% male; 38.6% Hispanic; 32.9% black; and 74.3% with comorbidities. Fever (72.9%) and cough (71.4%) were the common presenting symptoms. Twelve patients (17%) met severe sepsis criteria; 14 (20%) required vasopressor support; 21 (30%) developed acute respiratory distress syndrome (ARDS); 9 (12.9%) met acute kidney injury criteria; 1 (1.4%) required renal-replacement therapy, and 2 (2.8%) had cardiac arrest. For treatment, 27 (38.6%) patients received hydroxychloroquine; 13 (18.6%) remdesivir; 23 (32.9%) corticosteroids; 3 (4.3%) tocilizumab; and 1 (1.4%) anakinra; no patient was given immunoglobulin or convalescent plasma. Forty-nine (70%) patients required respiratory support: 14 (20.0%) noninvasive mechanical ventilation, 20 (28.6%) invasive mechanical ventilation (IMV), 7 (10%) prone position, 2 (2.8%) inhaled nitric oxide, and 1 (1.4%) extracorporeal membrane oxygenation. Nine (45%) of the 20 patients requiring IMV were extubated by day 14 with median IMV duration of 218 (IQR 79, 310.4) hours. Presence of ARDS was significantly associated with duration of PICU and hospital stay, and lower probability of PICU and hospital discharge at hospital day 14 (P Conclusions Critically ill children with COVID-19 predominantly are adolescents, have comorbidities, and require some form of respiratory support. The presence of ARDS is significantly associated with prolonged PICU and hospital stay.
Databáze: OpenAIRE
Externí odkaz: