J Pediatr Intensive Care 2023; 12(04): 256-263
DOI: 10.1055/s-0041-1731785
Original Article

Infant COVID-19 Infection: An Experience from Pediatric Intensive Care Unit of a Tertiary Care Dedicated Pediatric COVID Hospital

Mihir Sarkar
1   Department of Pediatrics, Medical College & Hospital, Kolkata, West Bengal, India
,
1   Department of Pediatrics, Medical College & Hospital, Kolkata, West Bengal, India
,
Sanajit Ghosh
1   Department of Pediatrics, Medical College & Hospital, Kolkata, West Bengal, India
,
1   Department of Pediatrics, Medical College & Hospital, Kolkata, West Bengal, India
,
1   Department of Pediatrics, Medical College & Hospital, Kolkata, West Bengal, India
,
Kalpana Datta
1   Department of Pediatrics, Medical College & Hospital, Kolkata, West Bengal, India
› Author Affiliations

Abstract

This study aimed to assess different clinical, disease severity, laboratory, treatment, and outcome-related factors of COVID-19 positive infants admitted to a pediatric intensive care unit (PICU) and to compare these parameters with COVID-19 positive noninfants (1–12 years of age) who also required intensive care admission. This retrospective observational study was conducted in a PICU of a tertiary care, dedicated pediatric COVID facility. The clinical, epidemiological, laboratory parameters, and treatment outcomes of COVID-19 infected infants admitted to the PICU were recorded and analyzed. During comparison with the noninfant group, malignancy and coinfection with dengue and scrub typhus were excluded from both groups. A total 313 COVID-19 positive children aged from 1 month to 12 years old were admitted, of which 115 (36.7%) children required PICU admission. Infants constituted 37.4% of total PICU admissions. Most common symptoms were respiratory (83.7%) followed by fever (60.5%). Fifteen (34.9%) infants presented with shock. Ten infants (23.3%) had myocardial dysfunction. C-reactive protein (CRP) and ferritin were high in 60.5 and 16.7% infants, respectively. Fourteen infants needed invasive mechanical ventilation. Nine patients had acute respiratory distress syndrome (ARDS) and five had MIS-C. However, 53.5% infants had different comorbidities. Four infants died and all of them had severe comorbidities. Respiratory distress (p = 0.009), pediatric sequential organ failure assessment score (p = 0.032) and number of ARDS cases (p = 0.044) were significantly higher in infants than noninfants. Infants are one of the most vulnerable groups of children suffering from serious illness from COVID-19 infection requiring PICU admission due to predominantly respiratory involvement. Overall outcome was good among infants without significant comorbidity.



Publication History

Received: 29 January 2021

Accepted: 28 May 2021

Article published online:
06 July 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Li Q, Guan X, Wu P. et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med 2020; 382 (13) 1199-1207
  • 2 Stockman LJ, Massoudi MS, Helfand R. et al. Severe acute respiratory syndrome in children. Pediatr Infect Dis J 2007; 26 (01) 68-74
  • 3 Leung CW, Kwan YW, Ko PW. et al. Severe acute respiratory syndrome among children. Pediatrics 2004; 113 (06) e535-e543
  • 4 Bartenfeld M, Griese S, Uyeki T, Gerber SI, Peacock G. Middle east respiratory syndrome coronavirus and children. Clin Pediatr (Phila) 2017; 56 (02) 187-189
  • 5 Li W, Moore MJ, Vasilieva N. et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003; 426 (6965): 450-454
  • 6 Muus C, Luecken MD, Eraslan G. et al. Integrated analyses of single-cell atlases reveal age, gender, and smoking status associations with cell type-specific expression of mediators of SARS-CoV-2 viral entry and highlights inflammatory programs in putative target cells. Accessed 2020 at: https//www.biorxiv.org/content/10.1101/2020.04.19.049254v1
  • 7 Soraya GV, Ulhaq ZS. Interleukin-6 levels in children developing SARS-CoV-2 infection. Pediatr Neonatol 2020; 61 (03) 253-254
  • 8 WHO coronavirus disease (COVID-19) Dashboard. Accessed January 9, 2021 at https://covid19.who.int/?gclid=Cj0KCQiA6Or_BRC_ARIsAPzuer8CeRcMO6Pt0-QEQs9tTMXfosmvWfA7OZ7xnnBx42le37OFzu4PbJkaArNpEALw_wcB
  • 9 Dong Y, Mo X, Hu Y. et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics 2020; 58 (04) 712-713
  • 10 Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395 (10237): 1607-1608
  • 11 World Health Organization. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. Accessed 2020 at https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19
  • 12 CDC COVID-19 Response Team. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (14) 422-426
  • 13 Swann OV, Holden KA, Turtle L. et al; ISARIC4C Investigators. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. BMJ 2020; 370: m3249
  • 14 Goldstein B, Giroir B, Randolph A. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6 (01) 2-8
  • 15 Bardella IJ. American Heart Association. Pediatric advanced life support: a review of the AHA recommendations. Am Fam Physician 1999; 60 (06) 1743-1750
  • 16 Webb BJ, Peltan ID, Jensen P. et al. Clinical criteria for COVID-19-associated hyperinflammatory syndrome: a cohort study. Lancet Rheumatol 2020; 2 (12) e754-e763
  • 17 Pollack MM, Patel KM, Ruttimann UE. PRISM III an updated pediatric risk of mortality score. Crit Care Med 1996; 24 (05) 743-752
  • 18 Matics TJ, Sanchez-Pinto LN. Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill children. JAMA Pediatr 2017; 171 (10) e172352
  • 19 McIntosh AM, Tong S, Deakyne SJ, Davidson JA, Scott HF. Validation of the vasoactive-inotropic score in pediatric sepsis. Pediatr Crit Care Med 2017; 18 (08) 750-757
  • 20 Singer M, Deutschman CS, Seymour CW. et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016; 315 (08) 801-810
  • 21 Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05) 428-439
  • 22 Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012; 120 (04) c179-c184
  • 23 Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 2020; 323 (13) 1239-1242
  • 24 European Centre for Disease Prevention and Control. Pediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children – 15 May 2020. ECDC: Stockholm. 2020 . Accessed 2020 at: https://www.ecdc.europa.eu/en/publications-data/paediatric-inflammatory-multisystem-syndrome-and-sars-cov-2-rapid-risk-assessment#no-link
  • 25 Wang E, Brar K. COVID-19 in Children: an epidemiology study from China. J Allergy Clin Immunol Pract 2020; 8 (06) 2118-2120
  • 26 Götzinger F, Santiago-García B, Noguera-Julián A. et al; ptbnet COVID-19 Study Group. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health 2020; 4 (09) 653-661
  • 27 Shekerdemian LS, Mahmood NR, Wolfe KK. et al; International COVID-19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care Units. JAMA Pediatr 2020; 174 (09) 868-873
  • 28 Prata-Barbosa A, Lima-Setta F, Santos GRD. et al; Brazilian Research Network in Pediatric Intensive Care, (BRnet-PIC). Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter study. J Pediatr (Rio J) 2020; 96 (05) 582-592
  • 29 Davies P, Evans C, Kanthimathinathan HK. et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health 2020; 4 (09) 669-677
  • 30 Namasivayam A, Soe T, Palman J. Atypical case of COVID-19 in a critically unwell 5-week old infant. BMJ Case Rep 2020; 13 (09) e237142
  • 31 Derespina KR, Kaushik S, Plichta A. et al. Clinical manifestations and outcomes of critically ill children and adolescents with coronavirus disease 2019 in New York City. J Pediatr 2020; 226: 55-63.e2