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Examining severe COVID-19 cases in children


COVID-19 had previously appeared to lead to a mild disease course in children, but recent news has altered that view. A new study looked at severe complications of the disease in children.

Although early data for COVID-19 appeared to indicate that the disease was mostly mild in children, the recent news of pediatric multisystem inflammatory syndrome (PMIS) in children with COVID-19 indicates that the disease could be more harmful to pediatric patients than previously thought. A study just released in JAMA Pediatrics examines COVID-19 cases that have required treatment in pediatric intensive care units (PICUs).1

Investigators looked at 46 PICUs in North America between March 14, 2020, and April 3, 2020, to find 48 children who had been admitted to 14 PICUs in the United States for COVID-19 infection. The sample was 52% male and the median age was 13 years.

Among the patients, 40 had significant preexisting comorbidities. Thirty-five patients had respiratory symptoms and 18 needed invasive ventilation. Extracorporeal membrane oxygenation was required for 1 patient. Failure in 2 or more organ systems happened in 11 patients. Twenty-eight patients were given targeted therapies. Hydroxychloroquine was the most common therapy used either alone, in 11 patients, or in combination with other therapies, in 10 patients.

At follow-up on April 10, 2020, investigators found that 2 patients had died and 15 were still in the hospital. Among those 15 patients, 3 were still using ventilation support and 1 was receiving extracorporeal membrane oxygenation. The median length of stay in the PICU was 5 days and overall hospital stay was 7 days.

The findings confirm that severe COVID-19 is possible in children and the disease burden can be quite severe. Investigators believe that the study is a solid foundation for more extensive studies on COVID-19 in pediatric cases.


1. Shekerdemian LS, Mahmood NR, Wolfe KK, et al; International COVID-19 PICU Collaborative. Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. May 11, 2020. Epub ahead of print. doi: 10.1001/jamapediatrics.2020.1948

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Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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