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Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in New York City, New York

Educational Objective
To understand the epidemiology, clinical features, and disease severity in patients with COVID-19 in a Children’s hospital
1 Credit CME
Key Points

Question  What are the clinical manifestations of children and adolescents hospitalized with coronavirus disease 2019 (COVID-19)?

Findings  In this case series of 50 children and adolescents hospitalized with COVID-19 infection, respiratory symptoms, while common, were not always present. Children hospitalized with COVID-19 commonly had comorbidities, infants had less severe disease, those with obesity were likely to receive mechanical ventilation, and elevated markers of inflammation at admission and during hospitalization were associated with severe disease.

Meaning  Expanded testing, maintaining a high suspicion for severe acute respiratory syndrome coronavirus 2 infection given the variable presentation of COVID-19, risk stratification, and recognition of findings suggestive of immune dysregulation are crucial to effective COVID-19 management in children.

Abstract

Importance  Descriptions of the coronavirus disease 2019 (COVID-19) experience in pediatrics will help inform clinical practices and infection prevention and control for pediatric facilities.

Objective  To describe the epidemiology, clinical, and laboratory features of patients with COVID-19 hospitalized at a children’s hospital and to compare these parameters between patients hospitalized with and without severe disease.

Design, Setting, and Participants  This retrospective review of electronic medical records from a tertiary care academically affiliated children’s hospital in New York City, New York, included 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).

Exposures  Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription–polymerase chain reaction assay.

Main Outcomes and Measures  Severe disease as defined by the requirement for mechanical ventilation.

Results  Among 50 patients, 27 (54%) were boys and 25 (50%) were Hispanic. The median days from onset of symptoms to admission was 2 days (interquartile range, 1-5 days). Most patients (40 [80%]) had fever or respiratory symptoms (32 [64%]), but 3 patients (6%) with only gastrointestinal tract presentations were identified. Obesity (11 [22%]) was the most prevalent comorbidity. Respiratory support was required for 16 patients (32%), including 9 patients (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%).

Conclusions and Relevance  In this case series study of children and adolescents hospitalized with COVID-19, 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.

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Article Information

Accepted for Publication: May 13, 2020.

Corresponding Author: Philip Zachariah, MD, MSc, Department of Pediatrics, Columbia University Irving Medical Center, 622 W 168th St, PH 4 West Room 473, New York, NY 10032 (pz2177@cumc.columbia.edu).

Published Online: June 3, 2020. doi:10.1001/jamapediatrics.2020.2430

Correction: This article was corrected on June 21, 2021, to add a supplement that lists of all the nonauthor collaborators.

Author Contributions: Dr Zachariah had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Zachariah, Johnson, Camille Halabi, Giordano, Schweickert, Babineau, Fenster, Orange, Saiman.

Acquisition, analysis, or interpretation of data: Zachariah, Johnson, Camille Halabi, Ahn, Sen, Fischer, Banker, Giordano, Manice, Diamond, Sewell, Carter, Fenster, Orange, McCann, Kernie, Saiman.

Drafting of the manuscript: Zachariah, Camille Halabi, Ahn, Saiman.

Critical revision of the manuscript for important intellectual content: Zachariah, Johnson, Camille Halabi, Sen, Fischer, Banker, Giordano, Manice, Diamond, Sewell, Schweickert, Babineau, Carter, Fenster, Orange, McCann, Kernie, Saiman.

Statistical analysis: Zachariah, Giordano.

Administrative, technical, or material support: Zachariah, Johnson, Camille Halabi, Fischer, Giordano, Manice, Diamond, Schweickert, Carter, Fenster, Orange, McCann.

Supervision: Zachariah, Babineau, Fenster, Orange, Kernie, Saiman.

Conflict of Interest Disclosures: Dr Orange reported personal fees from Takeda and ADMA Biologics and being a member of the scientific advisory board for Gigagen outside the submitted work. Dr Saiman reported grants from Merck, the CF Foundation, the National Institute of Allergy and Infectious Diseases, and the Bill and Melinda Gates Foundation and serving on the scientific advisory boards of Merck and AstraZeneca outside the submitted work. No other disclosures were reported.

Group Information: The Columbia Pediatric COVID-19 Management Group members are listed in Supplement 1.

Additional Contributions: We acknowledge the extraordinary work of physicians, nurses, respiratory therapists, and all staff at Columbia University Irving Medical Center, Weill Cornell Medicine, and NewYork-Presbyterian Hospital. Specifically, we would like to thank our nursing leadership: Tammy Compagnone, DNP, RN, Donna Johnson, MS, MBA, RN, Kenya Robinson, MSN, RN, Vepuka Kauari, MSN, RN, and Bernadette Khan, DNP, RN (NewYork-Presbyterian Hospital). We thank the families of the children included in this study. None of these individuals received compensation for their contributions.

References
1.
NYC Department of Health. Coronavirus disease 2019 (COVID-19). Accessed March 26, 2020. https://www1.nyc.gov/site/doh/covid/covid-19-main.page
2.
Harcourt  J , Tamin  A , Lu  X ,  et al.  Severe acute respiratory syndrome coronavirus 2 from patient with coronavirus disease, United States.   Emerg Infect Dis. 2020;26(6):1266-1273. doi:10.3201/eid2606.200516 PubMedGoogle ScholarCrossref
3.
Arentz  M , Yim  E , Klaff  L ,  et al.  Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State.   JAMA. Published online March 19, 2020. doi:10.1001/jama.2020.4326 PubMedGoogle Scholar
4.
Tagarro  A , Epalza  C , Santos  M ,  et al.  Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain.   JAMA Pediatr. Published online April 08, 2020. PubMedGoogle Scholar
5.
Dong  Y , Mo  X , Hu  Y ,  et al.  Epidemiology of COVID-19 among children in China.   Pediatrics. 2020:e20200702. doi:10.1542/peds.2020-0702 PubMedGoogle Scholar
6.
Lu  X , Zhang  L , Du  H ,  et al; Chinese Pediatric Novel Coronavirus Study Team.  SARS-CoV-2 infection in children.   N Engl J Med. 2020;382(17):1663-1665. doi:10.1056/NEJMc2005073 PubMedGoogle ScholarCrossref
7.
Livingston  E , Bucher  K .  Coronavirus Disease 2019 (COVID-19) in Italy.   JAMA. 2020;323(14):1335. doi:10.1001/jama.2020.4344 PubMedGoogle ScholarCrossref
8.
Centers for Disease Control and Prevention. COVID-19 situation summary. Accessed March 25, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
9.
World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Accessed May 27, 2020. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
10.
Centers for Disease Control and Prevention. Evaluating and testing persons for coronavirus disease 2019 (COVID-19). Accessed May 8, 2020. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
11.
Centers for Disease Control and Prevention. Defining childhood obesity. Accessed April 18, 2020. https://www.cdc.gov/obesity/childhood/defining.html
12.
Régent  A , Kluger  N , Bérezné  A , Lassoued  K , Mouthon  L .  Lymphocytopenia: aetiology and diagnosis, when to think about idiopathic CD4(+) lymphocytopenia?.  Article in French.  Rev Med Interne. 2012;33(11):628-634.PubMedGoogle ScholarCrossref
13.
Cheung  KS , Hung  IF , Chan  PP ,  et al.  Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from the Hong Kong cohort and systematic review and meta-analysis.   Gastroenterology. 2020;S0016-5085(20)30448-0. Published online April 3, 2020. PubMedGoogle Scholar
14.
Mao  L , Jin  H , Wang  M ,  et al.  Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China.   JAMA Neurol. Published online April 10, 2020. PubMedGoogle Scholar
15.
Lighter  J , Phillips  M , Hochman  S ,  et al.  Obesity in patients younger than 60 years is a risk factor for Covid-19 hospital admission.   Clin Infect Dis. Published online April 9, 2020. PubMedGoogle Scholar
16.
Huang  C , Wang  Y , Li  X ,  et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.   Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5 PubMedGoogle ScholarCrossref
17.
Zhou  F , Yu  T , Du  R ,  et al.  Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.   Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3 PubMedGoogle ScholarCrossref
18.
Xia  W , Shao  J , Guo  Y , Peng  X , Li  Z , Hu  D .  Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults.   Pediatr Pulmonol. 2020;55(5):1169-1174. doi:10.1002/ppul.24718 PubMedGoogle ScholarCrossref
19.
Borba  MGS , Val  FFA , Sampaio  VS ,  et al.  Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.   JAMA Network Open. 2020;3(4):e208857. doi:10.1001/jamanetworkopen.2020.8857 Google Scholar
20.
Magagnoli  J , Narendran  S , Pereira  F ,  et al.  Outcomes of hydroxychloroquine usage in United States veterans hospitalized with COVID-19.   medRxiv. Preprint. Posted online April 23, 2020. https://www.medrxiv.org/content/10.1101/2020.04.16.20065920v2.full.pdfGoogle Scholar
21.
He  X , Lau  EHY , Wu  P ,  et al.  Temporal dynamics in viral shedding and transmissibility of COVID-19.   Nat Med. 2020;26(5):672-675. doi:10.1038/s41591-020-0869-5 PubMedGoogle ScholarCrossref
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