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2020 ; 174
(10
): e202430
Nephropedia Template TP
gab.com Text
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English Wikipedia
Epidemiology, Clinical Features, and Disease Severity in Patients With
Coronavirus Disease 2019 (COVID-19) in a Children s Hospital in New York City,
New York
#MMPMID32492092
Zachariah P
; Johnson CL
; Halabi KC
; Ahn D
; Sen AI
; Fischer A
; Banker SL
; Giordano M
; Manice CS
; Diamond R
; Sewell TB
; Schweickert AJ
; Babineau JR
; Carter RC
; Fenster DB
; Orange JS
; McCann TA
; Kernie SG
; Saiman L
JAMA Pediatr
2020[Oct]; 174
(10
): e202430
PMID32492092
show ga
IMPORTANCE: Descriptions of the coronavirus disease 2019 (COVID-19) experience in
pediatrics will help inform clinical practices and infection prevention and
control for pediatric facilities. OBJECTIVE: To describe the epidemiology,
clinical, and laboratory features of patients with COVID-19 hospitalized at a
children's hospital and to compare these parameters between patients hospitalized
with and without severe disease. DESIGN, SETTING, AND PARTICIPANTS: This
retrospective review of electronic medical records from a tertiary care
academically affiliated children's hospital in New York City, New York, included
hospitalized children and adolescents (?21 years) who were tested based on
suspicion for COVID-19 between March 1 to April 15, 2020, and had positive
results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
EXPOSURES: Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse
transcription-polymerase chain reaction assay. MAIN OUTCOMES AND MEASURES: Severe
disease as defined by the requirement for mechanical ventilation. RESULTS: Among
50 patients, 27 (54%) were boys and 25 (50%) were Hispanic. The median days from
onset of symptoms to admission was 2 days (interquartile range, 1-5 days). Most
patients (40 [80%]) had fever or respiratory symptoms (32 [64%]), but 3 patients
(6%) with only gastrointestinal tract presentations were identified. Obesity (11
[22%]) was the most prevalent comorbidity. Respiratory support was required for
16 patients (32%), including 9 patients (18%) who required mechanical
ventilation. One patient (2%) died. None of 14 infants and 1 of 8
immunocompromised patients had severe disease. Obesity was significantly
associated with mechanical ventilation in children 2 years or older (6 of 9 [67%]
vs 5 of 25 [20%]; P?=?.03). Lymphopenia was commonly observed at admission (36
[72%]) but did not differ significantly between those with and without severe
disease. Those with severe disease had significantly higher C-reactive protein
(median, 8.978 mg/dL [to convert to milligrams per liter, multiply by 10] vs 0.64
mg/dL) and procalcitonin levels (median, 0.31 ng/mL vs 0.17 ng/mL) at admission
(P?.001), as well as elevated peak interleukin 6, ferritin, and D-dimer levels
during hospitalization. Hydroxychloroquine was administered to 15 patients (30%)
but could not be completed for 3. Prolonged test positivity (maximum of 27 days)
was observed in 4 patients (8%). CONCLUSIONS AND RELEVANCE: In this case series
study of children and adolescents hospitalized with COVID-19, the disease had
diverse manifestations. Infants and immunocompromised patients were not at
increased risk of severe disease. Obesity was significantly associated with
disease severity. Elevated inflammatory markers were seen in those with severe
disease.