Characteristics and management of patients with SARS-CoV2 infection admitted to pediatric intensive care units: Data analysis of the Spanish national multicenter registry

Abstract

Introduction: The purpose of this study is to describe the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) disease characteristics and management in children admitted to the pediatric intensive care units (PICU). Methods: The present study was based on a national multicentric prospective registry including PICU patients with SARS-CoV2 infection or symptoms of multisystem inflammatory syndrome in children (MIS-C). Results: A total of 298 patients were admitted to 41 different Spanish PICUs. A total of 76% of them were previously healthy. The most frequent manifestation was MIS-C (69.8%). On admission, 59.4% of patients did not have respiratory distress, and only 17.4% needed conventional mechanical ventilation (MV). The need for MV was associated with age (incidence rate ratios [IRR] 1.21, p <.012), pediatric sequential organ failure assessment score (p-SOFA) Score (IRR 1.12, p =.001), and need for transfusion (IRR 4.5, p <.004) in MIS-C patients, and with vasoactive drug use (IRR 2.73, p =.022) and the diagnosis of acute respiratory distress syndrome (IRR 2.83, p =.018) in patients admitted for other reasons. During the first day of admission, 56% of patients met shock criteria and 50.7% needed vasoactive drugs. In MIS-C patients, their use was associated with higher p-SOFA score (IRR 1.06, p <.001) and with the diagnosis of shock (IRR 5.78, p <.001). In patients without MIS-C, it was associated with higher p-SOFA score (IRR 1.05, p =.022). The mortality rate was 3%, being lower in MIS-C patients compared to patients admitted for other reasons (0.5% vs. 9.4%, p <.001). It was also lower in previously healthy patients compared to patients with previous comorbidities (0.9% vs. 9.7%, p <.001). Conclusions: Severe SARS-CoV2 infection is uncommon in the pediatric population. In our series, respiratory distress was rare, being MIS-C the most frequent cause of PICU admission related to SARS-CoV2. In most cases, the course of the disease was mild except in children with previous diseases.