A case report from New York City, New York, provides more data on COVID-19 in children and further information on severe disease in this vulnerable population.
As COVID-19 has spread around the world, the disease course in pediatric cases has morphed from nearly nonexistent to often mild, but it also can become severe or cause complications such as multisystem inflammatory syndrome. A new case study in JAMA Pediatrics looks at how COVID-19 presented in a hospital in New York City, New York.1
The investigators did a retrospective review of electronic health records from a tertiary care, academically affiliated children’s hospital in New York City. The sample included hospitalized children and adolescents aged 21 years and younger who were tested for COVID-19 between March 1, 2020, and April 15, 2020, and had positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The results came from a nasopharyngeal swab that was tested by reverse transcription-polymerase chain reaction assay.
The sample included 50 patients of which 54% were male and 50% were Hispanic. The median number of days between the onset of symptoms and admission was 2 days. Forty patients had fever or respiratory symptoms and 3 patients had only gastrointestinal symptoms. The most prevalent comorbidity was obesity. Sixteen patients needed respiratory support, which included 9 who needed mechanical ventilation. In children aged 2 years and older, obesity was significantly linked to mechanical ventilation. One patient died. No infant had severe disease and only 1 of the 8 immunocompromised patients did.
Patients with severe disease were found to have significantly higher procalcitonin levels and C-reactive protein at the time of admission. During hospitalization, those patients also had elevated peak interleukin 6, ferritin, and D-dimer levels. Fifteen patients were given hydroxychloroquine but the drug course could not be completed in 3 of the patients. Four patients demonstrated prolonged test positivity.
1. Zachariah P, Johnson CL, Halabi KC, et al; Columbia Pediatric COVID-19 Management Group. 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. June 03, 2020. Epub ahead of print. doi: 10.1001/jamapediatrics.2020.2430