Predictors of invasive mechanical ventilation in children with severe COVID-19
DOI:
https://doi.org/10.18203/2349-3291.ijcp20231486Keywords:
COVID-19, SARS-CoV-2, IMV, Children, HypoxemiaAbstract
Background: To compare the demographic characteristics, clinical symptoms, laboratory findings, and comorbidities of hospitalized children with the Coronavirus disease (COVID-19) who required invasive mechanical ventilation (IMV) and analyse them to find out potential predictors for requirement of mechanical ventilation.
Methods: Study design was of single centre, retrospective record review. Settings were tertiary care hospital in New Delhi, India, between April, 2020 to October, 2020
Results: 100-laboratory confirmed COVID-19 cases were admitted during the study period. Thirty-five patients required IMV. Median age of ventilated patients was 65 (10.5, 126) months and median weight was 15 (8.5, 23.3) kg. Forty-three percent (43%) of patients were underweight (p=0.46) while 40% had chronic co-morbidity (p=0.015). Gastrointestinal symptoms (p<0.05), altered sensorium at presentation (p<0.001) and hypoxia at admission (p<0.00) were significantly greater in those who required ventilation. A statistically significant difference was also noted in inflammatory markers between ventilated and non-ventilated patients. Acute kidney injury (p=0.003) and transaminitis (p=0.05) at admission were 26 and 32% respectively in ventilated patients. The most common indicators for ventilation need were primary respiratory disease (35%) followed by shock (31%) and low Glasgow coma scale (23%). Nearly 70% of these were intubated within 48 hours of hospital admission. Multivariate analysis highlighted that presence of low SpO2 at admission (adjusted OR, 6.9; 95% CI, 1.3-36.6) was significantly associated with need of IMV.
Conclusions: Study highlights important characteristics of paediatric population from developing country with COVID-19 who required IMV. Presence of low oxygen saturation at admission significantly associated with need of IMV.
References
WHO Coronavirus Disease (COVID-19) Dashboard. Covid19.who.int. 202. Available at: https://covid19.who.int/. Accessed on 10 December, 2022.
Coronavirus Update: 63,175,234 Cases and 1,467,152 Deaths from COVID-19 Virus Pandemic - Worldometer. Worldometers.info. 2020. Available at: https://www.worldometers.info/coronavirus/. Accessed on 10 December, 2022.
Sharma AK, Chapagain RH, Bista KP, Bohara R, Chand B, Chaudhary NK et al. Epidemiological and clinical profile of COVID-19 in nepali children: An initial experience. J Nepal Paediatr Soc. 2020;40(3):202-9.
Sarangi B, Reddy VS, Oswal JS, Malshe N, Patil A, Chakraborty M et al. Epidemiological and Clinical Characteristics of COVID-19 in Indian Children in the Initial Phase of the Pandemic. Indian Pediatr. 2020;57(10):914-7.
Khan EA. COVID-19 in children: Epidemiology, presentation, diagnosis and management. J Pak Med Assoc. 2020;70(3)(5):S108-12.
Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical Features and Outcome of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-analysis. Indian Pediatr. 2020;S097475591600203.
Perikleous E, Tsalkidis A, Bush A, Paraskakis E. Coronavirus global pandemic: An overview of current findings among pediatric patients. Pediatr Pulmonol. 2020;55(12):3252-67.
Cui X, Zhao Z, Zhang T, Guo W, Guo W, Zheng J et al. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19). J Med Virol. 2021;93(2):1057-69.
Chao J, Derespina K, Herold B, Goldman D, Aldrich M, Weingarten J et al. Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 at a Tertiary Care Medical Center in New York City. J Pediatr. 2020;223:14-19.
Götzinger F, Santiago-García B, Noguera-Julián A, Lanaspa M, Lancella L, Calò Carducci FI et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Health. 2020;4:653-61
Wu Q, Xing Y, Shi L, Li W, Gao Y, Pan S et al. Coinfection and Other Clinical Characteristics of COVID-19 in Children. Pediatrics. 2020;146(1):e20200961.
Delahoy MJ, Ujamaa D, Whitaker M, O'Halloran A, Anglin O, Burns E et al. COVID-NET Surveillance Team. Hospitalizations Associated with COVID-19 Among Children and Adolescents - COVID-NET, 14 States, March 1, 2020-August 14, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(36):1255-60.
Revised Guidelines on Clinical Management of COVID-19 Gov-
remnant of India. Ministry of Health and Family Welfare Directo-
rate General of Health Services (EMR Division).
Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. Who.int. 2020. Available at: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. Accessed on 28 December 2020.
Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med. 2015;16(5):428-39.
Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145:e20200702.
Liu W, Zhang Q, Chen J, Xiang R, Song H, Shu S et al. Detection of COVID-19 in children in early January 2020 in Wuhan, China. N Eng J Med. 2020;382:1370-1.
Tagarro A, Epalza C, Santos M, Sanz-SantaeufemiaFJ,Otheo E, Moraleda C et al. Screening and severtyof coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr. 2020:e201346.
Angurana SK, Awasthi P, Thakur A, Randhawa MS, Nallasamy K, Kumar MR et al. Intensive Care Needs and Short-Term Outcome of Multisystem Inflammatory Syndrome in Children (MIS-C): Experience from North India. J Trop Pediatr. 2021;67(3):fmab055.
Prata-Barbosa A, Lima-Setta F, Santos GR, LAnziotti VS, Castro RE, Souza DC et al. Pediatric patients with COVID-19 admitted to intensive care unit in Brazil : a multicentre study. J Pediatr (Rio J). 2020;96:582-92.
Shekerdemian L, Mahmood N, Wolfe K, Riggs B, Ross C, McKiernan C. Children with Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatrics. 2019;174(9):868.
González-Dambrauskas S, Vásquez-Hoyos P, Camporesi A, Díaz-Rubio F, Pi˜neres-Olave BE, Fernández-Sarmiento J et al. Pediatric critical care and COVID19. Pediatrics. 2020; 324:259-69.
Oualha M, Bendavid M, Berteloot L, Corsia A, Lesage F, VedrenneM et al. Severe and fatal forms of COVID-19 in children. Arch Pediatr. 2020;27:235-8
Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL, AWARE Investigators. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults. N Engl J Med. 2017;376(1):11-20.
Bjornstad EC, Krallman KA, Askenazi D, Zappitelli M, Goldstein SL, Basu RK. Preliminary Assessment of Acute Kidney Injury in Critically Ill Children Associated with SARS-CoV-2 Infection: A Multicenter Cross-Sectional Analysis. Clin J Am Soc Nephrol. 2021;16(3):446-8.
Gonzalez-Dambrauskas S, Vasquez-Hoyos P, Camporesi A, Cantillano EM, Dallefeld S, Dominguez-Rojas J et al. Critical Coronavirus and Kids Epidemiological (CAKE) Study Investigators. Paediatric critical COVID-19 and mortality in a multinational prospective cohort. Lancet Reg Health Am. 2022;12:100272.
