Early Experience of COVID-19 in a US Children's Hospital

Abstract

Objectives: We aim to describe the demographics, clinical presentation, hospital course, and severity of pediatric inpatients with coronavirus disease 2019 (COVID-19), with an emphasis on healthy, immunocompromised, and chronically ill children.

Methods: We conducted a single-center retrospective cohort study of hospitalized children aged younger than 22 years with COVID-19 infection at Steven and Alexandra Cohen Children's Medical Center at Northwell Health. Cases were identified from patients with fever and/or respiratory symptoms who underwent a nucleic acid amplification-based test for severe acute respiratory syndrome coronavirus 2.

Results: Sixty-five patients were identified. The median age was 10.3 years (interquartile range, 1.4 months to 16.3 years), with 48% of patients older than 12 years and 29% of patients younger than 60 days of age. Fever was present in 86% of patients, lower respiratory symptoms or signs in 60%, and gastrointestinal symptoms in 62%. Thirty-five percent of patients required ICU care. The white blood cell count was elevated in severe disease (P = .0027), as was the C-reactive protein level (P = .0192), compared with mild and moderate disease. Respiratory support was required in 34% of patients. Severity was lowest in infants younger than 60 days of age and highest in chronically ill children; 79% of immunocompromised children had mild disease. One death was reported.

Conclusions: Among children who are hospitalized for COVID-19, most are younger than 60 days or older than 12 years of age. Children may have severe infection requiring intensive care support. The clinical course of immunocompromised patients was not more severe than that of other children. Elevated white blood cell count and C-reactive protein level are associated with greater illness severity.

FIGURE 1

Epidemic curve of pediatric hospital admissions during peak of COVID-19 pandemic in a New York City children's hospital. Dates have not been specified to protect patient-protected health information. Data include 1 patient who had been hospitalized for 7 weeks at the time of symptoms and SARS-CoV-2 testing. ^a The admission date for 1 patient admitted in February was amended to the date of the COVD-19 test.

FIGURE 2

Age distribution of hospitalized pediatric patients with COVID-19 by severity. Illness severity was classified as follows: (1) mild (no requirement for supplemental oxygen), (2) moderate (supplemental oxygen with or without noninvasive respiratory support or need for frequent bronchodilator therapy), and (3) severe (mechanical ventilation with or without use of vasopressors and/or inotropes, ECMO, and RRT).

FIGURE 3

Clinical group of hospitalized patients according to severity. Illness severity was classified as follows: (1) mild (no requirement for supplemental oxygen), (2) moderate (supplemental oxygen with or without noninvasive respiratory support or need for frequent bronchodilator therapy), and (3) severe (mechanical ventilation with or without use of vasopressors and/or inotropes, ECMO, and RRT). HIs were aged <60 days. HC were aged ≥60 days. IC had cancer or primary immunodeficiency or received immunosuppression. CI had a condition (other than immunocompromise) for >1 year that interfered with activities of daily life.