Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Mar:230:23-31.e10.
doi: 10.1016/j.jpeds.2020.11.016. Epub 2020 Nov 14.

Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth

Danielle M Fernandes  1 , Carlos R Oliveira  2 , Sandra Guerguis  3 , Ruth Eisenberg  3 , Jaeun Choi  3 , Mimi Kim  3 , Ashraf Abdelhemid  4 , Rabia Agha  5 , Saranga Agarwal  6 , Judy L Aschner  6 , Jeffrey R Avner  5 , Cathleen Ballance  7 , Joshua Bock  3 , Sejal M Bhavsar  6 , Melissa Campbell  2 , Katharine N Clouser  6 , Matthew Gesner  4 , David L Goldman  3 , Margaret R Hammerschlag  8 , Saul Hymes  9 , Ashley Howard  2 , Hee-Jin Jung  6 , Stephan Kohlhoff  8 , Tsoline Kojaoghlanian  5 , Rachel Lewis  6 , Sharon Nachman  9 , Srividya Naganathan  7 , Elijah Paintsil  2 , Harpreet Pall  7 , Sharlene Sy  3 , Stephen Wadowski  8 , Elissa Zirinsky  2 , Michael D Cabana  3 , Betsy C Herold  3 ; Tri-State Pediatric COVID-19 Research Consortium
Affiliations
Multicenter Study

Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth

Danielle M Fernandes et al. J Pediatr. 2021 Mar.

Abstract

Objective: To characterize the demographic and clinical features of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) syndromes and identify admission variables predictive of disease severity.

Study design: We conducted a multicenter, retrospective, and prospective study of pediatric patients hospitalized with acute SARS-CoV-2 infections and multisystem inflammatory syndrome in children (MIS-C) at 8 sites in New York, New Jersey, and Connecticut.

Results: We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into 3 groups based on clinical features. Overall, 143 (51%) had respiratory disease, 69 (25%) had MIS-C, and 69 (25%) had other manifestations including gastrointestinal illness or fever. Patients with MIS-C were more likely to identify as non-Hispanic black compared with patients with respiratory disease (35% vs 18%, P = .02). Seven patients (2%) died and 114 (41%) were admitted to the intensive care unit. In multivariable analyses, obesity (OR 3.39, 95% CI 1.26-9.10, P = .02) and hypoxia on admission (OR 4.01; 95% CI 1.14-14.15; P = .03) were predictive of severe respiratory disease. Lower absolute lymphocyte count (OR 8.33 per unit decrease in 109 cells/L, 95% CI 2.32-33.33, P = .001) and greater C-reactive protein (OR 1.06 per unit increase in mg/dL, 95% CI 1.01-1.12, P = .017) were predictive of severe MIS-C. Race/ethnicity or socioeconomic status were not predictive of disease severity.

Conclusions: We identified variables at the time of hospitalization that may help predict the development of severe SARS-CoV-2 disease manifestations in children and youth. These variables may have implications for future prognostic tools that inform hospital admission and clinical management.

Keywords: COVID-19; biomarkers.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Hospitalized cases by syndrome during the study period.
Figure 2
Figure 2
Signs and symptoms on admission by clinical syndrome.
Figure 3
Figure 3
Peak and nadir laboratory results by syndrome. ESR, erythrocyte sedimentation rate; Pro-BNP, pro-B-type natriuretic peptide.
See this image and copyright information in PMC

References

    1. Shekerdemian L.S., Mahmood N.R., Wolfe K.K., Riggs B.J., Ross C.E., McKiernan C.A. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174:868–873. - PMC - PubMed
    1. Dufort E.M., Koumans E.H., Chow E.J., Rosenthal E.M., Muse A., Rowlands J. Multisystem inflammatory syndrome in children in New York State. N Engl J Med. 2020;383:347–358. - PMC - PubMed
    1. Feldstein L.R., Rose E.B., Horwitz S.M., Collins J.P., Newhams M.M., Son M.B.F. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383:334–346. - PMC - PubMed
    1. Dong Y., Mo X., Hu Y., Qi X., Jiang F., Jiang Z. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145:e20200702. - PubMed
    1. Zachariah P., Johnson C.L., Halabi K.C., Ahn D., Sen A.I., Fischer A. Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a children's hospital in New York City, New York. JAMA Pediatr. 2020;174:e202430. - PMC - PubMed

Publication types

MeSH terms

Supplementary concepts