Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City.
Identifieur interne : 001111 ( Main/Corpus ); précédent : 001110; suivant : 001112Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City.
Auteurs : Kim R. Derespina ; Shubhi Kaushik ; Anna Plichta ; Edward E. Conway ; Asher Bercow ; Jaeun Choi ; Ruth Eisenberg ; Jennifer Gillen ; Anita I. Sen ; Claire M. Hennigan ; Lillian M. Zerihun ; Sule Doymaz ; Michael A. Keenaghan ; Stephanie Jarrin ; Franscene Oulds ; Manoj Gupta ; Louisdon Pierre ; Melissa Grageda ; H Michael Ushay ; Vinay M. Nadkarni ; Michael S D. Agus ; Shivanand S. MedarSource :
- The Journal of pediatrics [ 1097-6833 ] ; 2020.
Abstract
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 < .05 for all).
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.
DOI: 10.1016/j.jpeds.2020.07.039
PubMed: 32681989
PubMed Central: PMC7363610
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Derespina</name><affiliation><nlm:affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Kaushik, Shubhi" sort="Kaushik, Shubhi" uniqKey="Kaushik S" first="Shubhi" last="Kaushik">Shubhi Kaushik</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Plichta, Anna" sort="Plichta, Anna" uniqKey="Plichta A" first="Anna" last="Plichta">Anna Plichta</name><affiliation><nlm:affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Conway, Edward E" sort="Conway, Edward E" uniqKey="Conway E" first="Edward E" last="Conway">Edward E. Conway</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Jacobi Medical Center, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Bercow, Asher" sort="Bercow, Asher" uniqKey="Bercow A" first="Asher" last="Bercow">Asher Bercow</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Jacobi Medical Center, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Choi, Jaeun" sort="Choi, Jaeun" uniqKey="Choi J" first="Jaeun" last="Choi">Jaeun Choi</name><affiliation><nlm:affiliation>Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Eisenberg, Ruth" sort="Eisenberg, Ruth" uniqKey="Eisenberg R" first="Ruth" last="Eisenberg">Ruth Eisenberg</name><affiliation><nlm:affiliation>Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Gillen, Jennifer" sort="Gillen, Jennifer" uniqKey="Gillen J" first="Jennifer" last="Gillen">Jennifer Gillen</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Sen, Anita I" sort="Sen, Anita I" uniqKey="Sen A" first="Anita I" last="Sen">Anita I. Sen</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Columbia University Medical Center, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Hennigan, Claire M" sort="Hennigan, Claire M" uniqKey="Hennigan C" first="Claire M" last="Hennigan">Claire M. Hennigan</name><affiliation><nlm:affiliation>Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Zerihun, Lillian M" sort="Zerihun, Lillian M" uniqKey="Zerihun L" first="Lillian M" last="Zerihun">Lillian M. Zerihun</name><affiliation><nlm:affiliation>Columbia University Vagelos College of Physicians and Surgeons, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Doymaz, Sule" sort="Doymaz, Sule" uniqKey="Doymaz S" first="Sule" last="Doymaz">Sule Doymaz</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Keenaghan, Michael A" sort="Keenaghan, Michael A" uniqKey="Keenaghan M" first="Michael A" last="Keenaghan">Michael A. Keenaghan</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kings County Medical Center, Brooklyn, NY; Department of Pediatrics, St George's University, Grenada, WI.</nlm:affiliation></affiliation></author><author><name sortKey="Jarrin, Stephanie" sort="Jarrin, Stephanie" uniqKey="Jarrin S" first="Stephanie" last="Jarrin">Stephanie Jarrin</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kings County Medical Center, Brooklyn, NY; Department of Pediatrics, State University of New York Downstate, Brooklyn, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Oulds, Franscene" sort="Oulds, Franscene" uniqKey="Oulds F" first="Franscene" last="Oulds">Franscene Oulds</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Gupta, Manoj" sort="Gupta, Manoj" uniqKey="Gupta M" first="Manoj" last="Gupta">Manoj Gupta</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Lincoln Medical and Mental Health Center, Bronx, NY; Division of Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Pierre, Louisdon" sort="Pierre, Louisdon" uniqKey="Pierre L" first="Louisdon" last="Pierre">Louisdon Pierre</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, The Brooklyn Hospital Center, Brooklyn, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Grageda, Melissa" sort="Grageda, Melissa" uniqKey="Grageda M" first="Melissa" last="Grageda">Melissa Grageda</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Richmond University Medical Center, Staten Island, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Ushay, H Michael" sort="Ushay, H Michael" uniqKey="Ushay H" first="H Michael" last="Ushay">H Michael Ushay</name><affiliation><nlm:affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Nadkarni, Vinay M" sort="Nadkarni, Vinay M" uniqKey="Nadkarni V" first="Vinay M" last="Nadkarni">Vinay M. Nadkarni</name><affiliation><nlm:affiliation>Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Agus, Michael S D" sort="Agus, Michael S D" uniqKey="Agus M" first="Michael S D" last="Agus">Michael S D. Agus</name><affiliation><nlm:affiliation>Division of Medical Critical Care, Boston Children's Hospital, Boston, MA.</nlm:affiliation></affiliation></author><author><name sortKey="Medar, Shivanand S" sort="Medar, Shivanand S" uniqKey="Medar S" first="Shivanand S" last="Medar">Shivanand S. Medar</name><affiliation><nlm:affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY; Division of Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY. Electronic address: smedar@montefiore.org.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:32681989</idno><idno type="pmid">32681989</idno><idno type="doi">10.1016/j.jpeds.2020.07.039</idno><idno type="pmc">PMC7363610</idno><idno type="wicri:Area/Main/Corpus">001111</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">001111</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City.</title><author><name sortKey="Derespina, Kim R" sort="Derespina, Kim R" uniqKey="Derespina K" first="Kim R" last="Derespina">Kim R. Derespina</name><affiliation><nlm:affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Kaushik, Shubhi" sort="Kaushik, Shubhi" uniqKey="Kaushik S" first="Shubhi" last="Kaushik">Shubhi Kaushik</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Plichta, Anna" sort="Plichta, Anna" uniqKey="Plichta A" first="Anna" last="Plichta">Anna Plichta</name><affiliation><nlm:affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Conway, Edward E" sort="Conway, Edward E" uniqKey="Conway E" first="Edward E" last="Conway">Edward E. Conway</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Jacobi Medical Center, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Bercow, Asher" sort="Bercow, Asher" uniqKey="Bercow A" first="Asher" last="Bercow">Asher Bercow</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Jacobi Medical Center, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Choi, Jaeun" sort="Choi, Jaeun" uniqKey="Choi J" first="Jaeun" last="Choi">Jaeun Choi</name><affiliation><nlm:affiliation>Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Eisenberg, Ruth" sort="Eisenberg, Ruth" uniqKey="Eisenberg R" first="Ruth" last="Eisenberg">Ruth Eisenberg</name><affiliation><nlm:affiliation>Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Gillen, Jennifer" sort="Gillen, Jennifer" uniqKey="Gillen J" first="Jennifer" last="Gillen">Jennifer Gillen</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Sen, Anita I" sort="Sen, Anita I" uniqKey="Sen A" first="Anita I" last="Sen">Anita I. Sen</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Columbia University Medical Center, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Hennigan, Claire M" sort="Hennigan, Claire M" uniqKey="Hennigan C" first="Claire M" last="Hennigan">Claire M. Hennigan</name><affiliation><nlm:affiliation>Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Zerihun, Lillian M" sort="Zerihun, Lillian M" uniqKey="Zerihun L" first="Lillian M" last="Zerihun">Lillian M. Zerihun</name><affiliation><nlm:affiliation>Columbia University Vagelos College of Physicians and Surgeons, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Doymaz, Sule" sort="Doymaz, Sule" uniqKey="Doymaz S" first="Sule" last="Doymaz">Sule Doymaz</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Keenaghan, Michael A" sort="Keenaghan, Michael A" uniqKey="Keenaghan M" first="Michael A" last="Keenaghan">Michael A. Keenaghan</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kings County Medical Center, Brooklyn, NY; Department of Pediatrics, St George's University, Grenada, WI.</nlm:affiliation></affiliation></author><author><name sortKey="Jarrin, Stephanie" sort="Jarrin, Stephanie" uniqKey="Jarrin S" first="Stephanie" last="Jarrin">Stephanie Jarrin</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kings County Medical Center, Brooklyn, NY; Department of Pediatrics, State University of New York Downstate, Brooklyn, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Oulds, Franscene" sort="Oulds, Franscene" uniqKey="Oulds F" first="Franscene" last="Oulds">Franscene Oulds</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Gupta, Manoj" sort="Gupta, Manoj" uniqKey="Gupta M" first="Manoj" last="Gupta">Manoj Gupta</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Lincoln Medical and Mental Health Center, Bronx, NY; Division of Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Pierre, Louisdon" sort="Pierre, Louisdon" uniqKey="Pierre L" first="Louisdon" last="Pierre">Louisdon Pierre</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, The Brooklyn Hospital Center, Brooklyn, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Grageda, Melissa" sort="Grageda, Melissa" uniqKey="Grageda M" first="Melissa" last="Grageda">Melissa Grageda</name><affiliation><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Richmond University Medical Center, Staten Island, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Ushay, H Michael" sort="Ushay, H Michael" uniqKey="Ushay H" first="H Michael" last="Ushay">H Michael Ushay</name><affiliation><nlm:affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Nadkarni, Vinay M" sort="Nadkarni, Vinay M" uniqKey="Nadkarni V" first="Vinay M" last="Nadkarni">Vinay M. Nadkarni</name><affiliation><nlm:affiliation>Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.</nlm:affiliation></affiliation></author><author><name sortKey="Agus, Michael S D" sort="Agus, Michael S D" uniqKey="Agus M" first="Michael S D" last="Agus">Michael S D. Agus</name><affiliation><nlm:affiliation>Division of Medical Critical Care, Boston Children's Hospital, Boston, MA.</nlm:affiliation></affiliation></author><author><name sortKey="Medar, Shivanand S" sort="Medar, Shivanand S" uniqKey="Medar S" first="Shivanand S" last="Medar">Shivanand S. Medar</name><affiliation><nlm:affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY; Division of Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY. Electronic address: smedar@montefiore.org.</nlm:affiliation></affiliation></author></analytic><series><title level="j">The Journal of pediatrics</title><idno type="eISSN">1097-6833</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>To describe the clinical manifestations and outcomes of critically ill children with coronavirus disease-19 (COVID-19) in New York City.</p></div><div type="abstract" xml:lang="en"><p><b>STUDY DESIGN</b></p><p>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.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>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 < .05 for all).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>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.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">32681989</PMID><DateRevised><Year>2021</Year><Month>04</Month><Day>22</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1097-6833</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Jul</Month><Day>16</Day></PubDate></JournalIssue><Title>The Journal of pediatrics</Title><ISOAbbreviation>J Pediatr</ISOAbbreviation></Journal><ArticleTitle>Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">S0022-3476(20)30888-X</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jpeds.2020.07.039</ELocationID><Abstract><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">To describe the clinical manifestations and outcomes of critically ill children with coronavirus disease-19 (COVID-19) in New York City.</AbstractText><AbstractText Label="STUDY DESIGN" NlmCategory="METHODS">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.</AbstractText><AbstractText Label="RESULTS" NlmCategory="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 < .05 for all).</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="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.</AbstractText><CopyrightInformation>Copyright © 2020 Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Derespina</LastName><ForeName>Kim R</ForeName><Initials>KR</Initials><AffiliationInfo><Affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kaushik</LastName><ForeName>Shubhi</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Plichta</LastName><ForeName>Anna</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Conway</LastName><ForeName>Edward E</ForeName><Initials>EE</Initials><Suffix>Jr</Suffix><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, Jacobi Medical Center, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bercow</LastName><ForeName>Asher</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, Jacobi Medical Center, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Choi</LastName><ForeName>Jaeun</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Eisenberg</LastName><ForeName>Ruth</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gillen</LastName><ForeName>Jennifer</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sen</LastName><ForeName>Anita I</ForeName><Initials>AI</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, Columbia University Medical Center, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hennigan</LastName><ForeName>Claire M</ForeName><Initials>CM</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zerihun</LastName><ForeName>Lillian M</ForeName><Initials>LM</Initials><AffiliationInfo><Affiliation>Columbia University Vagelos College of Physicians and Surgeons, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Doymaz</LastName><ForeName>Sule</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Keenaghan</LastName><ForeName>Michael A</ForeName><Initials>MA</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kings County Medical Center, Brooklyn, NY; Department of Pediatrics, St George's University, Grenada, WI.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jarrin</LastName><ForeName>Stephanie</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kings County Medical Center, Brooklyn, NY; Department of Pediatrics, State University of New York Downstate, Brooklyn, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Oulds</LastName><ForeName>Franscene</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Gupta</LastName><ForeName>Manoj</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, Lincoln Medical and Mental Health Center, Bronx, NY; Division of Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pierre</LastName><ForeName>Louisdon</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, The Brooklyn Hospital Center, Brooklyn, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Grageda</LastName><ForeName>Melissa</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Pediatrics, Division of Critical Care Medicine, Richmond University Medical Center, Staten Island, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ushay</LastName><ForeName>H Michael</ForeName><Initials>HM</Initials><AffiliationInfo><Affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Nadkarni</LastName><ForeName>Vinay M</ForeName><Initials>VM</Initials><AffiliationInfo><Affiliation>Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Agus</LastName><ForeName>Michael S D</ForeName><Initials>MSD</Initials><AffiliationInfo><Affiliation>Division of Medical Critical Care, Boston Children's Hospital, Boston, MA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Medar</LastName><ForeName>Shivanand S</ForeName><Initials>SS</Initials><AffiliationInfo><Affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY; Division of Cardiology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY. 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