ICU admission is linked to prolonged support needs in pediatric COVID-19

  • Götzinger F & et al
  • Lancet Child Adolesc Health
  • 26 Jun 2020

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Pediatric COVID-19 fatalities in Europe have been lower than in older adults, but some children develop severe illness requiring prolonged ICU support.

Why this matters

  • Most pediatric patients requiring COVID-19-associated intubation will need prolonged support. 

Key results

  • 582 confirmed cases, 77 institutions, 21 countries.
  • Median age, 5.0 (interquartile range [IQR], 0.5-5.12) years; range, 3 days-18 years.
  • 62% admitted to the hospital, 13% to ICU.
  • 5% had chronic pulmonary disease, 5% malignancy, 4% neurological disorders, 4% congenital heart disease, 2% chromosomal abnormality, 2% chronic kidney disease.
  • 13% required oxygen, 5% continuous positive airway pressure (CPAP), and 4% mechanical ventilation (MV).
  • Median MV duration: 7 (IQR, 2-11; range, 1-34) days.
  • ICU admission risk factors (ORs) on multivariate analysis:
    • Younger age (
    • Male sex: 2.12 (P=.033).
    • Lower respiratory tract infection at presentation: 10.46 (P<.0001>
    • Preexisting medical condition: 3.27 (P=.0015).
  • Treatment: hydroxychloroquine (7%), remdesivir (3%), lopinavir-ritonavir  (1%), oseltamivir (1%)
  • Case fatality rate: 0.69% (4 children; 95% CI, 0.20%-1.82%).

Study design

  • Multinational, multicenter cohort study.
  • Funding: None disclosed.

Limitations

  • Laboratory, ICU variables not collected.
  • Multiple in-house/commercial assays.
  • Small treatment group.