62-Patterns of COVID-19 Illness in Hospitalized Children
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Pediatrics, Crisis Management, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Meghana Nadiger, MD


Introduction/Hypothesis: The patterns and hospital course of COVID-19 in children appears distinct from adult experience and requires clear delineation. The objective of this study is to describe the clinical course of children admitted with COVID-19 to a tertiary care pediatric center and to evaluate the frequency of MIS-C in various COVID-19 illness patterns.

Methods: Children(68) admitted with COVID-19 till June 2020 were included in an IRB approved, retrospective single center study. Serious COVID-19 illness was defined as any child requiring invasive respiratory or cardiovascular support or renal replacement therapy. COVID-related Kawasaki-like disease(CKLD) was defined as any patient with COVID-19, fever ≥5d, elevated inflammatory markers and mucocutaneous lesions. Remaining patients were mild to moderate illness. CDC criteria were used to identify multisystem inflammatory syndrome in children (MIS-C).

Results: The median age was 6.4Y. 31(45.6%) were male. 60(88.2%) were positive for SARS-CoV-2. Eight cases were antibody positive or epidemiologically linked. MIS-C was present in 39(57.4%), serious COVID-19 illness in 11(16.2%), CKLD in 9(13.2%) and rest had mild to moderate illness(n=49;72%). MIS-C was present in all cases admitted to PICU(n=17) or who had severe illness and CKLD cases. Most common organs involved were hematologic(51.5%), hepatic(50%), respiratory(41.2%) and cardiac(23.5%). Children with serious illness were adolescents with elevated BMI(73%), premorbid conditions(82%) and ARDS(72%). Children with CKLD were 2-12 years old with no premorbid condition. Of PICU admissions, 11 needed supplemental oxygen, 6 non-invasive ventilation and 3 invasive ventilation. ARDS (S/F≤264) was present in 8. The presence of lymphopenia, thrombocytopenia, CRP>3mg/dL, admission D-dimer>0.41μg/mL or elevated BNP levels had a sensitivity of 0.84 and specificity of 0.75 for MIS-C diagnosis with COVID-19(AUC:0.80;95%CI:0.68-0.91;p<0.001).One child died.

Conclusions: The 3 patterns of COVID-19 in hospitalized children were (1)severe illness seen in obese adolescents with premorbidity (2)CKLD in 2-12 year-olds with varying cardiac involvement (3)mild to moderate illness in younger children. Children<2 years are generally spared from severe disease. MIS-C is present in all children with severe illness and CKLD.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Crisis Management
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag COVID-19
Year 2021
COVID-19 illness
hospitalized children
Kawasaki-like disease
lab abnormalities


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