Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City.
Identifieur interne : 001589 ( Main/Exploration ); précédent : 001588; suivant : 001590Clinical Manifestations and Outcomes of Critically Ill Children and Adolescents with Coronavirus Disease 2019 in New York City.
Auteurs : Kim R. Derespina [États-Unis] ; Shubhi Kaushik [États-Unis] ; Anna Plichta [États-Unis] ; Edward E. Conway [États-Unis] ; Asher Bercow [États-Unis] ; Jaeun Choi [États-Unis] ; Ruth Eisenberg [États-Unis] ; Jennifer Gillen [États-Unis] ; Anita I. Sen [États-Unis] ; Claire M. Hennigan [États-Unis] ; Lillian M. Zerihun [États-Unis] ; Sule Doymaz [États-Unis] ; Michael A. Keenaghan [États-Unis] ; Stephanie Jarrin [États-Unis] ; Franscene Oulds [États-Unis] ; Manoj Gupta [États-Unis] ; Louisdon Pierre [États-Unis] ; Melissa Grageda [États-Unis] ; H Michael Ushay [États-Unis] ; Vinay M. Nadkarni [États-Unis] ; Michael S D. Agus [États-Unis] ; Shivanand S. Medar [États-Unis]Source :
- 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
Affiliations:
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<author><name sortKey="Choi, Jaeun" sort="Choi, Jaeun" uniqKey="Choi J" first="Jaeun" last="Choi">Jaeun Choi</name>
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<author><name sortKey="Eisenberg, Ruth" sort="Eisenberg, Ruth" uniqKey="Eisenberg R" first="Ruth" last="Eisenberg">Ruth Eisenberg</name>
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<author><name sortKey="Gillen, Jennifer" sort="Gillen, Jennifer" uniqKey="Gillen J" first="Jennifer" last="Gillen">Jennifer Gillen</name>
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<author><name sortKey="Sen, Anita I" sort="Sen, Anita I" uniqKey="Sen A" first="Anita I" last="Sen">Anita I. Sen</name>
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<author><name sortKey="Hennigan, Claire M" sort="Hennigan, Claire M" uniqKey="Hennigan C" first="Claire M" last="Hennigan">Claire M. Hennigan</name>
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<author><name sortKey="Zerihun, Lillian M" sort="Zerihun, Lillian M" uniqKey="Zerihun L" first="Lillian M" last="Zerihun">Lillian M. Zerihun</name>
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<affiliation wicri:level="2"><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
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<wicri:cityArea>Department of Pediatrics, Division of Critical Care Medicine, State University of New York Downstate Health Sciences University, Brooklyn</wicri:cityArea>
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<author><name sortKey="Keenaghan, Michael A" sort="Keenaghan, Michael A" uniqKey="Keenaghan M" first="Michael A" last="Keenaghan">Michael A. Keenaghan</name>
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<author><name sortKey="Jarrin, Stephanie" sort="Jarrin, Stephanie" uniqKey="Jarrin S" first="Stephanie" last="Jarrin">Stephanie Jarrin</name>
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<author><name sortKey="Oulds, Franscene" sort="Oulds, Franscene" uniqKey="Oulds F" first="Franscene" last="Oulds">Franscene Oulds</name>
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<author><name sortKey="Gupta, Manoj" sort="Gupta, Manoj" uniqKey="Gupta M" first="Manoj" last="Gupta">Manoj Gupta</name>
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<author><name sortKey="Pierre, Louisdon" sort="Pierre, Louisdon" uniqKey="Pierre L" first="Louisdon" last="Pierre">Louisdon Pierre</name>
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<author><name sortKey="Grageda, Melissa" sort="Grageda, Melissa" uniqKey="Grageda M" first="Melissa" last="Grageda">Melissa Grageda</name>
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<author><name sortKey="Ushay, H Michael" sort="Ushay, H Michael" uniqKey="Ushay H" first="H Michael" last="Ushay">H Michael Ushay</name>
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<author><name sortKey="Nadkarni, Vinay M" sort="Nadkarni, Vinay M" uniqKey="Nadkarni V" first="Vinay M" last="Nadkarni">Vinay M. Nadkarni</name>
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<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>
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<author><name sortKey="Medar, Shivanand S" sort="Medar, Shivanand S" uniqKey="Medar S" first="Shivanand S" last="Medar">Shivanand S. Medar</name>
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<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
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<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 wicri:level="2"><nlm:affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx</wicri:cityArea>
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<author><name sortKey="Kaushik, Shubhi" sort="Kaushik, Shubhi" uniqKey="Kaushik S" first="Shubhi" last="Kaushik">Shubhi Kaushik</name>
<affiliation wicri:level="2"><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
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<author><name sortKey="Plichta, Anna" sort="Plichta, Anna" uniqKey="Plichta A" first="Anna" last="Plichta">Anna Plichta</name>
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<author><name sortKey="Conway, Edward E" sort="Conway, Edward E" uniqKey="Conway E" first="Edward E" last="Conway">Edward E. Conway</name>
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<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Pediatrics, Division of Critical Care Medicine, Jacobi Medical Center, Bronx</wicri:cityArea>
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<author><name sortKey="Bercow, Asher" sort="Bercow, Asher" uniqKey="Bercow A" first="Asher" last="Bercow">Asher Bercow</name>
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<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
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<author><name sortKey="Choi, Jaeun" sort="Choi, Jaeun" uniqKey="Choi J" first="Jaeun" last="Choi">Jaeun Choi</name>
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<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Eisenberg, Ruth" sort="Eisenberg, Ruth" uniqKey="Eisenberg R" first="Ruth" last="Eisenberg">Ruth Eisenberg</name>
<affiliation wicri:level="2"><nlm:affiliation>Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Gillen, Jennifer" sort="Gillen, Jennifer" uniqKey="Gillen J" first="Jennifer" last="Gillen">Jennifer Gillen</name>
<affiliation wicri:level="2"><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Pediatrics, Division of Critical Care Medicine, Kravis Children's Hospital at Mount Sinai, New York</wicri:cityArea>
</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 wicri:level="2"><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Columbia University Medical Center, New York, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Pediatrics, Division of Critical Care Medicine, Columbia University Medical Center, New York</wicri:cityArea>
</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 wicri:level="2"><nlm:affiliation>Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, New York</wicri:cityArea>
</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 wicri:level="2"><nlm:affiliation>Columbia University Vagelos College of Physicians and Surgeons, New York, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Columbia University Vagelos College of Physicians and Surgeons, New York</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Doymaz, Sule" sort="Doymaz, Sule" uniqKey="Doymaz S" first="Sule" last="Doymaz">Sule Doymaz</name>
<affiliation wicri:level="2"><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Pediatrics, Division of Critical Care Medicine, State University of New York Downstate Health Sciences University, Brooklyn</wicri:cityArea>
</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 wicri:level="2"><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>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Wisconsin</region>
</placeName>
<wicri:cityArea>Department of Pediatrics, Division of Critical Care Medicine, Kings County Medical Center, Brooklyn, NY; Department of Pediatrics, St George's University, Grenada</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Jarrin, Stephanie" sort="Jarrin, Stephanie" uniqKey="Jarrin S" first="Stephanie" last="Jarrin">Stephanie Jarrin</name>
<affiliation wicri:level="2"><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>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Pediatrics, Division of Critical Care Medicine, Kings County Medical Center, Brooklyn, NY; Department of Pediatrics, State University of New York Downstate, Brooklyn</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Oulds, Franscene" sort="Oulds, Franscene" uniqKey="Oulds F" first="Franscene" last="Oulds">Franscene Oulds</name>
<affiliation wicri:level="2"><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Lincoln Medical and Mental Health Center, Bronx, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Pediatrics, Division of Critical Care Medicine, Lincoln Medical and Mental Health Center, Bronx</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Gupta, Manoj" sort="Gupta, Manoj" uniqKey="Gupta M" first="Manoj" last="Gupta">Manoj Gupta</name>
<affiliation wicri:level="2"><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>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>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</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Pierre, Louisdon" sort="Pierre, Louisdon" uniqKey="Pierre L" first="Louisdon" last="Pierre">Louisdon Pierre</name>
<affiliation wicri:level="2"><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, The Brooklyn Hospital Center, Brooklyn, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Pediatrics, Division of Critical Care Medicine, The Brooklyn Hospital Center, Brooklyn</wicri:cityArea>
</affiliation>
</author>
<author><name sortKey="Grageda, Melissa" sort="Grageda, Melissa" uniqKey="Grageda M" first="Melissa" last="Grageda">Melissa Grageda</name>
<affiliation wicri:level="2"><nlm:affiliation>Department of Pediatrics, Division of Critical Care Medicine, Richmond University Medical Center, Staten Island, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Department of Pediatrics, Division of Critical Care Medicine, Richmond University Medical Center, Staten Island</wicri:cityArea>
</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 wicri:level="2"><nlm:affiliation>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx</wicri:cityArea>
</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 wicri:level="2"><nlm:affiliation>Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Pennsylvanie</region>
</placeName>
<wicri:cityArea>Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia</wicri:cityArea>
</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 wicri:level="2"><nlm:affiliation>Division of Medical Critical Care, Boston Children's Hospital, Boston, MA.</nlm:affiliation>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Massachusetts</region>
</placeName>
<wicri:cityArea>Division of Medical Critical Care, Boston Children's Hospital, Boston</wicri:cityArea>
</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 wicri:level="2"><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>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">État de New York</region>
</placeName>
<wicri:cityArea>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</wicri:cityArea>
</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>
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<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. Electronic address: smedar@montefiore.org.</Affiliation>
</AffiliationInfo>
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<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2020</Year>
<Month>07</Month>
<Day>16</Day>
</ArticleDate>
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<Keyword MajorTopicYN="N">pediatric respiratory failure</Keyword>
<Keyword MajorTopicYN="N">pediatric viral sepsis</Keyword>
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<name sortKey="Choi, Jaeun" sort="Choi, Jaeun" uniqKey="Choi J" first="Jaeun" last="Choi">Jaeun Choi</name>
<name sortKey="Conway, Edward E" sort="Conway, Edward E" uniqKey="Conway E" first="Edward E" last="Conway">Edward E. Conway</name>
<name sortKey="Doymaz, Sule" sort="Doymaz, Sule" uniqKey="Doymaz S" first="Sule" last="Doymaz">Sule Doymaz</name>
<name sortKey="Eisenberg, Ruth" sort="Eisenberg, Ruth" uniqKey="Eisenberg R" first="Ruth" last="Eisenberg">Ruth Eisenberg</name>
<name sortKey="Gillen, Jennifer" sort="Gillen, Jennifer" uniqKey="Gillen J" first="Jennifer" last="Gillen">Jennifer Gillen</name>
<name sortKey="Grageda, Melissa" sort="Grageda, Melissa" uniqKey="Grageda M" first="Melissa" last="Grageda">Melissa Grageda</name>
<name sortKey="Gupta, Manoj" sort="Gupta, Manoj" uniqKey="Gupta M" first="Manoj" last="Gupta">Manoj Gupta</name>
<name sortKey="Hennigan, Claire M" sort="Hennigan, Claire M" uniqKey="Hennigan C" first="Claire M" last="Hennigan">Claire M. Hennigan</name>
<name sortKey="Jarrin, Stephanie" sort="Jarrin, Stephanie" uniqKey="Jarrin S" first="Stephanie" last="Jarrin">Stephanie Jarrin</name>
<name sortKey="Kaushik, Shubhi" sort="Kaushik, Shubhi" uniqKey="Kaushik S" first="Shubhi" last="Kaushik">Shubhi Kaushik</name>
<name sortKey="Keenaghan, Michael A" sort="Keenaghan, Michael A" uniqKey="Keenaghan M" first="Michael A" last="Keenaghan">Michael A. Keenaghan</name>
<name sortKey="Medar, Shivanand S" sort="Medar, Shivanand S" uniqKey="Medar S" first="Shivanand S" last="Medar">Shivanand S. Medar</name>
<name sortKey="Nadkarni, Vinay M" sort="Nadkarni, Vinay M" uniqKey="Nadkarni V" first="Vinay M" last="Nadkarni">Vinay M. Nadkarni</name>
<name sortKey="Oulds, Franscene" sort="Oulds, Franscene" uniqKey="Oulds F" first="Franscene" last="Oulds">Franscene Oulds</name>
<name sortKey="Pierre, Louisdon" sort="Pierre, Louisdon" uniqKey="Pierre L" first="Louisdon" last="Pierre">Louisdon Pierre</name>
<name sortKey="Plichta, Anna" sort="Plichta, Anna" uniqKey="Plichta A" first="Anna" last="Plichta">Anna Plichta</name>
<name sortKey="Sen, Anita I" sort="Sen, Anita I" uniqKey="Sen A" first="Anita I" last="Sen">Anita I. Sen</name>
<name sortKey="Ushay, H Michael" sort="Ushay, H Michael" uniqKey="Ushay H" first="H Michael" last="Ushay">H Michael Ushay</name>
<name sortKey="Zerihun, Lillian M" sort="Zerihun, Lillian M" uniqKey="Zerihun L" first="Lillian M" last="Zerihun">Lillian M. Zerihun</name>
</country>
</tree>
</affiliations>
</record>
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