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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.
JAMA Pediatr. 2020 Oct 01; 174(10):e202430.JP

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.

Authors+Show Affiliations

Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York.Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York.Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.Department of Pediatrics, Columbia University Irving Medical Center, New York, New York. Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32492092

Citation

Zachariah, Philip, et al. "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." JAMA Pediatrics, vol. 174, no. 10, 2020, pp. e202430.
Zachariah P, Johnson CL, Halabi KC, et al. 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. JAMA Pediatr. 2020;174(10):e202430.
Zachariah, P., Johnson, C. L., Halabi, K. C., Ahn, D., Sen, A. I., Fischer, A., Banker, S. L., Giordano, M., Manice, C. S., Diamond, R., Sewell, T. B., Schweickert, A. J., Babineau, J. R., Carter, R. C., Fenster, D. B., Orange, J. S., McCann, T. A., Kernie, S. G., & Saiman, L. (2020). 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. JAMA Pediatrics, 174(10), e202430. https://doi.org/10.1001/jamapediatrics.2020.2430
Zachariah P, et al. 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. JAMA Pediatr. 2020 Oct 1;174(10):e202430. PubMed PMID: 32492092.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Zachariah,Philip, AU - Johnson,Candace L, AU - Halabi,Katia C, AU - Ahn,Danielle, AU - Sen,Anita I, AU - Fischer,Avital, AU - Banker,Sumeet L, AU - Giordano,Mirna, AU - Manice,Christina S, AU - Diamond,Rebekah, AU - Sewell,Taylor B, AU - Schweickert,Adam J, AU - Babineau,John R, AU - Carter,R Colin, AU - Fenster,Daniel B, AU - Orange,Jordan S, AU - McCann,Teresa A, AU - Kernie,Steven G, AU - Saiman,Lisa, AU - ,, Y1 - 2020/10/05/ PY - 2020/6/4/pubmed PY - 2020/11/13/medline PY - 2020/6/4/entrez SP - e202430 EP - e202430 JF - JAMA pediatrics JO - JAMA Pediatr VL - 174 IS - 10 N2 - 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. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/32492092/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_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2020.2430 DB - PRIME DP - Unbound Medicine ER -