This retrospective review describes the epidemiology, clinical, and laboratory features of patients with COVID-19 hospitalized at a children’s hospital in NYC.
The authors reviewed all electronic medical records from hospitalized children and adolescents (≤21 years) who were tested based on suspicion for COVID-19 between March 1 to April 15, 2020, and had positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
They extracted data for 387 unique patients who were tested for SARS-CoV-2 from the emergency department or an inpatient location between March 1 and April 15, 2020, with a total of 73 positive results (15%). Among those with positive test results, 54 (74.0%) were hospitalized 1 day or longer. Four (5.5%) did not have symptoms consistent with COVID-19. Of the remaining 50 patients:
- 27 (54%) were boys
- 25 (50%) were Hispanic
- The median days from onset of symptoms to admission was 2 days (interquartile range, 1-5 days)
- Most (40 [80%]) had fever or respiratory symptoms (32 [64%])
- 3 (6%) had only gastrointestinal tract presentations
- Obesity (11 [22%]) was the most prevalent comorbidity
- Respiratory support was required for 16 patients (32%), including 9 (18%) who required mechanical ventilation
- One patient (2%) died
- None of 14 infants and 1 of 8 immunocompromised patients had severe disease
- Obesity was significantly associated with mechanical ventilation in children 2 years or older (6 of 9 [67%] vs 5 of 25 [20%]; P = .03).
- Lymphopenia was commonly observed at admission (36 [72%]) but did not differ significantly between those with and without severe disease
- Those with severe disease had significantly higher C-reactive protein (median, 8.978 mg/dL [to convert to milligrams per liter, multiply by 10] vs 0.64 mg/dL) and procalcitonin levels (median, 0.31 ng/mL vs 0.17 ng/mL) at admission (P < .001), as well as elevated peak interleukin 6, ferritin, and D-dimer levels during hospitalization
- Hydroxychloroquine was administered to 15 patients (30%) but could not be completed for 3
- Prolonged test positivity (maximum of 27 days) was observed in 4 patients (8%)
In conclusion, this case series study of children and adolescents hospitalized with COVID-19, found that the disease had diverse manifestations. Infants and immunocompromised patients were not at increased risk of severe disease. Obesity was significantly associated with disease severity. Elevated inflammatory markers were seen in those with severe disease.