Pediatric patients with COVID-19 admitted to intensive care units in Brazil: a prospective multicenter studyϯ

Prata-Barbosa, Arnaldo; Lima-Setta, Fernanda; Santos, Gustavo Rodrigues dos; Lanziotti, Vanessa Soares; de Castro, Roberta Esteves Vieira; de Souza, Daniela Carla; Raymundo, Carlos Eduardo; de Oliveira, Felipe Rezende Caino; de Lima, Lucio Flavio Peixoto; Tonial, Cristian Tedesco; Colleti, José; Bellinat, Ana Paula Novaes; Lorenzo, Vivian Botelho; de Seixas Zeitel, Raquel; Pulcheri, Lucas; da Costa, Fernanda Ciuffo Monte; Torre, Fabíola Peixoto Ferreira La; das Neves Figueiredo, Elaine Augusta; da Silva, Thiago Peres; Riveiro, Paula Marins; da Mota, Isabele Coelho Fonseca; Brandão, Igor Bromonschenkel; de Azevedo, Zina Maria Almeida; Gregory, Simone Camera; Boedo, Fernanda Raquel Oliveira; de Carvalho, Rosana Novais; de Arnaldo Silva Rodriguez Castro, Natália Almeida; Genu, Daniel Hilário Santos; Foronda, Flavia Andrea Krepel; Cunha, Antonio José Ledo A; de Magalhães-Barbosa, Maria Clara

Abstract Objective: To describe the clinical characteristics of children and adolescents admitted to intensive care with confirmed COVID-19. Method: Prospective, multicenter, observational study, in 19 pediatric intensive care units. Patients aged 1 month to 19 years admitted consecutively (March–May, 2020) were included. Demographic, clinical-epidemiological features, treatment, and outcomes were collected. Subgroups were compared according to comorbidities, age < 1 year, and need for invasive mechanical ventilation. A multivariable logistic regression model was used for predictors of severity. Results: Seventy-nine patients were included (ten with multisystemic inflammatory syndrome). Median age 4 years; 54% male (multisystemic inflammatory syndrome, 80%); 41% had comorbidities (multisystemic inflammatory syndrome, 20%). Fever (76%), cough (51%), and tachypnea (50%) were common in both groups. Severe symptoms, gastrointestinal symptoms, and higher inflammatory markers were more frequent in multisystemic inflammatory syndrome. Interstitial lung infiltrates were common in both groups, but pleural effusion was more prevalent in the multisystemic inflammatory syndrome group (43% vs. 14%). Invasive mechanical ventilation was used in 18% (median 7.5 days); antibiotics, oseltamivir, and corticosteroids were used in 76%, 43%, and 23%, respectively, but not hydroxychloroquine. The median pediatric intensive care unit length-of-stay was five days; there were two deaths (3%) in the non- multisystemic inflammatory syndrome group. Patients with comorbidities were older, and comorbidities were independently associated with the need for invasive mechanical ventilation (OR 5.5; 95% CI, 1.43–21.12; p = 0.01). Conclusions: In Brazilian pediatric intensive care units, COVID-19 had low mortality, age less than 1 year was not associated with a worse prognosis, and patients with multisystemic inflammatory syndrome had more severe symptoms, higher inflammatory biomarkers, and a greater predominance of males, but only comorbidities and chronic diseases were independent predictors of severity.