Texas Children's Hospital, Baylor College of Medicine, Houston.
Children's Healthcare of Atlanta, Atlanta, Georgia.
JAMA Pediatr. 2020 Sep 1;174(9):868-873. doi: 10.1001/jamapediatrics.2020.1948.
The recent and ongoing coronavirus disease 2019 (COVID-19) pandemic has taken an unprecedented toll on adults critically ill with COVID-19 infection. While there is evidence that the burden of COVID-19 infection in hospitalized children is lesser than in their adult counterparts, to date, there are only limited reports describing COVID-19 in pediatric intensive care units (PICUs).
To provide an early description and characterization of COVID-19 infection in North American PICUs, focusing on mode of presentation, presence of comorbidities, severity of disease, therapeutic interventions, clinical trajectory, and early outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included children positive for COVID-19 admitted to 46 North American PICUs between March 14 and April 3, 2020. with follow-up to April 10, 2020.
Prehospital characteristics, clinical trajectory, and hospital outcomes of children admitted to PICUs with confirmed COVID-19 infection.
Of the 48 children with COVID-19 admitted to participating PICUs, 25 (52%) were male, and the median (range) age was 13 (4.2-16.6) years. Forty patients (83%) had significant preexisting comorbidities; 35 (73%) presented with respiratory symptoms and 18 (38%) required invasive ventilation. Eleven patients (23%) had failure of 2 or more organ systems. Extracorporeal membrane oxygenation was required for 1 patient (2%). Targeted therapies were used in 28 patients (61%), with hydroxychloroquine being the most commonly used agent either alone (11 patients) or in combination (10 patients). At the completion of the follow-up period, 2 patients (4%) had died and 15 (31%) were still hospitalized, with 3 still requiring ventilatory support and 1 receiving extracorporeal membrane oxygenation. The median (range) PICU and hospital lengths of stay for those who had been discharged were 5 (3-9) days and 7 (4-13) days, respectively.
This early report describes the burden of COVID-19 infection in North American PICUs and confirms that severe illness in children is significant but far less frequent than in adults. Prehospital comorbidities appear to be an important factor in children. These preliminary observations provide an important platform for larger and more extensive studies of children with COVID-19 infection.
最近和正在进行的 2019 年冠状病毒病（COVID-19）大流行对患有 COVID-19 感染的重症成人造成了前所未有的影响。虽然有证据表明，住院儿童的 COVID-19 感染负担小于其成年患者，但迄今为止，仅有有限的报告描述了儿科重症监护病房（PICU）中的 COVID-19 感染。
提供对北美 PICU 中 COVID-19 感染的早期描述和特征，重点是发病方式、合并症存在情况、疾病严重程度、治疗干预措施、临床病程和早期结局。
设计、地点和参与者：这项横断面研究纳入了 2020 年 3 月 14 日至 4 月 3 日期间在北美 46 家 PICU 住院且 COVID-19 检测呈阳性的 48 名儿童，随访至 2020 年 4 月 10 日。
确诊为 COVID-19 感染并住院的儿童的院外特征、临床病程和住院结局。
在入组的 48 名 COVID-19 感染患儿中，25 名（52%）为男性，中位（范围）年龄为 13（4.2-16.6）岁。40 名患儿（83%）存在显著的既往合并症；35 名（73%）表现为呼吸系统症状，18 名（38%）需要有创通气。11 名患儿（23%）存在 2 个或更多器官系统衰竭。1 名患儿（2%）需要体外膜氧合治疗。28 名患儿（61%）使用了靶向治疗，其中羟氯喹是最常用的药物，单独使用 11 例，联合使用 10 例。在随访结束时，2 名患儿（4%）死亡，15 名患儿（31%）仍在住院，其中 3 名仍需要通气支持，1 名需要体外膜氧合治疗。已出院患儿的 PICU 中位（范围）住院时间和总住院时间分别为 5（3-9）天和 7（4-13）天。
本初步报告描述了北美 PICU 中 COVID-19 感染的负担，并证实儿童中的重症疾病虽然显著，但远低于成人。院外合并症似乎是儿童的一个重要因素。这些初步观察结果为研究 COVID-19 感染儿童提供了一个重要的平台，以便开展更大规模和更广泛的研究。
