Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study
Dan Sun, Hui Li, Xiao-Xia Lu, et al.
- Observational study of 8 pediatric COVID-19 cases in Wuhan Children’s Hospital ICU 1/24-2/24/20
- Definition of severe: ≥ 1 of 3 criteria: (1) RR > 30/min, (2) SaO2 < 93% resting, (3) arterial O2 partial pressure (PaO2) / oxygen concentration (FiO2) ≤ 300 mmHg
- Definition of critical: ≥ 1 of 3 criteria: (1) respiratory failure requiring mechanical ventilation, (2) septic shock, (3) any other organ failure requiring ICU level of care
- Demographics: age range 2 mo-15 yo. 6/8 male. 5 severe, 3 critical.
- Epidemiology: 5 family cluster; 1 nosocomial (8 yo M PMH of ALL hospitalized for blood transfusion); 2 unknown. Incubation 5-10 days.
- Symptomatology: Most common polypnea (8/8) > fever, cough (6/8)
- Also sputum production, N/V, diarrhea, fatigue, myalgias, headache, constipation
- Physical exam: Rales or crackles in lower lung lobes
- Lab trends: Nl/increased WBCs (⅞ except for ALL pt); increased CRP, procalcitonin, LDH (6/8); elevated ALT (4/8)
- Evidence of cytokine storm on TBNK lymphocyte marker test and cytokine assays (increased CD3 (2/8), CD4 (4/8) and CD8 (1/8), IL-6 (2/8), IL-10 (5/8) and IFN-γ (2/8) with decreased CD16 + CD56 (4/8) and Th/Ts*(1/8))
- Imaging: chest CT with multiple patchy shadows (⅞), ground-glass opacities (6/8).
- Treatment: All received supportive/respiratory care and ribavirin, oseltamivir, and IFN. 2/8 intubated, 6/8 high-flow O2. Some received abx, IV steroids, IVIG, TCM.
- Course/prognosis: ⅝ recovered and discharged home; ⅜ still in ICU 2/24/20
- Duration of disease > 10 days; > 20 d. if critical
- Complications: Most commonly septic shock and MODS in critical cases
- #observationalstudy #ICU
Accepted March 19
SARS-CoV2 Infection in children
Xiaoxia Lu, Liqiong Zhang, Hui Du, Jinging Zhang, Yuan Y. Li, Jingyu Qu, Wenxin Zhang, Youjie Wang, Shuangshuang Bao, Ying Li, Chuansha Wu, Hongxia Liu, Di Liu, Jianbo Shao, Xuehua Peng, Yonghong Yang, Zhisheng Liu, Yun Xiang, Furong Zhang, Rona M. Silva, Kent E. Pinkerton, Kunling Shen, Han Xiao, Shunqing Xu, Gary W. K. Wong
- Analysis of evaluated children infected with COVID-19 and treated at Wuhan Children’s Hospital (n=1391), 171 (12.3%) tested positive for infection
- Median age: 6.7 years, Male: 60.8%
- Symptoms: Fever in 41.5%, Cough in 48.5%, PNA in 64.9%, pharyngeal erythema in 46.2%
- 3 patients with comorbidities required ICU level of care, 1 death
- Most children appear mildly asymptomatic