Abstract
Objective
To study clinical characteristics and outcome of children with admitted to a paediatric hospital in Mumbai, India.
Method
Review of medical records of 969 children admitted between 19 March and 7 August, 2020, to assess the clinico-demographic characteristics, disease severity and factors predicting outcome in COVID-19 children. Variables were compared between children who were previously healthy (Group I) and those with co-morbidity (Group II).
Results
123 (71 boys) children with median (IQR) age of 3 (0.7–6) years were admitted, of which 47 (38%) had co-morbidities. 39 (32 %) children required intensive care and 14 (11.4%) died. Male sex, respiratory manifestation, oxygen saturation <94% at admission, mechanical ventilation, inotrope, hospital stay of <10 days were independent predictors of mortality. Oxygen saturation <94% at admission (OR 35.9, 95% CI 1.5–856) and hospital stay <10 days (OR 9.1, 95% CI 1.04–99.1) were significant.
Conclusion
COVID-19 in children with co-morbidities causes severe disease. Association of mortality with oxygen saturation by pulse oximeter <94% on admission, and hospital stay <10 days, needs further evaluation.
Keywords: Co-morbidities, Mortality, Multisystem inflammatory syndrome in children (MIS-C), Prognosis
Footnotes
Contributors
SR,SSP,SBP: conceived, designed the study, finalised the manuscript; SR,VG,RM, LRD,SBP,SSP,MB: data collection, data analysis; SR,VG,RM,LRD,SSP,SBP: Literature search, interpretation of data, writing manuscript. All authors approved the final manuscript.
Ethics clearance
Institutional Ethics Committee Bai Jerbai Wadia Hospital for Children; No. IEC-BJWHC/89/2020, dated 26 August, 2020.
Funding
None
Competing interests
None stated.
References
- 1.Directorate General of Health Services. Revised National Clinical Management Guideline for COVID-19. New Delhi (IN): Ministry of Health & Family Welfare. Available at www.mohfw.gov.in.
- 2.National Centre for Disease Control. COVID-19 Outbreak Guidelines for Setting up. New Delhi (IN): Ministry of Health & Family Welfare. Available at www.mohfw.gov.in.
- 3.Jiang L, Tang K, Levin M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis. 2020;20:e276–88. doi: 10.1016/S1473-3099(20)30651-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Singh S, Jindal AK, Pilania RK. Diagnosis of Kawasaki disease. Int J Rheum Dis. 2018;21:36–44. doi: 10.1111/1756-185X.13224. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Shobhavat L, Solomon R, Rao S, et al. Multisystem inflammatory syndrome in children: Clinical features and management—Intensive care experience from a pediatric public hospital in Western India. Indian J Crit Care Med. 2020;24:1089–94. doi: 10.5005/jp-journals-10071-23658. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Zachariah P, Johnson CL, Halabi KC, et al. 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. doi: 10.1001/jamapediatrics.2020.2430. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.De Luca CD, Esposito E, Cristiani L, et al. Covid-19 in children: A brief overview after three months experience. Paediatr Respir Rev. 2020;35:9–14. doi: 10.1016/j.prrv.2020.05.006. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical features and outcome of sars-cov-2 infection in children: A systematic review and meta-analysis. Indian Pediatr. 2020;57:820–26. doi: 10.1007/s13312-020-1961-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145:e20200702. doi: 10.1542/peds.2020-0702. [DOI] [PubMed] [Google Scholar]
- 10.Sarangi B, Reddy VS, Oswal JS, et al. Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic: A cross-sectional study. Indian Pediatr. 2020;57:914–17. doi: 10.1007/s13312-020-1994-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Götzinger F, Santiago-García B, Noguera-Julián A, et al. COVID-19 in children and adolescents in Europe: A multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020;4:653–61. doi: 10.1016/S2352-4642(20)30177-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Guo CX, He L, Yin JY, et al. Epidemiological and clinical features ofpediatric COVID-19. BMC Med. 2020;18:250. doi: 10.1186/s12916-020-01719-2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Yonker LM, Neilan AM, Bartsch Y, et al. Pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Clinical presentation, infectivity, and immune responses. J Pediatr. 2020;227:45–52. doi: 10.1016/j.jpeds.2020.08.037. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Kim L, Whitaker M, O’Halloran A, et al. Hospitalization rates and characteristics of children aged <18 years hospitalized with laboratory-confirmed COVID-19 — COVID-NET, 14 States, March 1-July 25, 2020. Morb Mortal Wkly Rep. 2020;69:1081–88. doi: 10.15585/mmwr.mm6932e3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–81. doi: 10.1016/S2213-2600(20)30079-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Shekerdemian LS, Mahmood NR, Wolfe KK, et al. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174:868–73. doi: 10.1001/jamapediatrics.2020.1948. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol. 2020;215:108427. doi: 10.1016/j.clim.2020.108427. [DOI] [PMC free article] [PubMed] [Google Scholar]