Mortality in children with COVID-19: Lessons learned from a tertiary referral hospital in Indonesia

Dewi, Rismala; Kaswandani, Nastiti; Karyanti, Mulya Rahma; Setyant, Darmawan Budi; Pudjiadi, Antonius Hocky; Hendarto, Aryono; Djer, Mulyadi M.; Prayitno, Ari; Yuniar, Irene; Indawati, Wahyuni; Prawira, Yogi; Handryastuti, Setyo; Sjakti, Hikari Ambara; Hidayati, Eka Laksmi; Muktiarti, Dina; Soebadi, Amanda; Puspaningtyas, Niken Wahyu; Muhaimin, Riski; Rahmadhany, Anisa; Octavius, Gilbert Sterling; Puspitasari, Henny Adriani; Jasin, Madeleine Ramdhani; Tartila, Tartila; Putri, Nina Dwi

Background The incidence of COVID-19 is still rapidly increasing, but little is known about the prevalence and characteristics of fatal cases in children in Indonesia. This study aims to describe the characteristics of pediatric COVID-19 cases with fatal outcomes in Indonesia's tertiary referral hospital. Methods This is a cross-sectional study with data collected from the medical records of COVID-19 patients admitted to Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from March to October 2020. Results During the study period, 490 patients were admitted and diagnosed with suspected and probable COVID-19. Of these patients, 50 (10.2%) were confirmed to have COVID-19, of which 20 (40%) patients with positive tests for SARS-CoV-2 had a fatal outcome. The fatality was higher in patients ≥10 years old, categorized with severe disease upon admission, with PaO2/FiO2 ratios of ≤300 mmHg and chronic underlying diseases. The most common clinical manifestations were generalized symptoms, while acute respiratory distress syndrome (8/20) and septic shock (7/20) were the two most common causes of death. Increased procalcitonin, D-dimer, lactate dehydrogenase, and presepsin levels were found in all fatal COVID-19 cases. One patient met the criteria of multisystem inflammatory syndrome in children (MIS-C). Conclusion Our work highlights the high mortality rate in pediatric patients positive for the COVID-19 test. Further studies are needed to understand better the role of SARS-CoV-2 in elaborating the mechanisms leading to death in children with comorbidities.