Sun Tingting, He Yunhan, Wang Zeyu, Wang Lijie, Liu Chunfeng, Xu Wei, You Kai
Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
Front Cell Infect Microbiol. 2025 Apr 15;15:1495783. doi: 10.3389/fcimb.2025.1495783. eCollection 2025.
To describe the characteristics of severe and critically ill children with first-wave SARS-CoV-2 Omicron infection admitted to the pediatric intensive care unit (PICU) at the National Children's Regional Medical Center in Northeast China and to explore factors associated with poor outcomes.
This observational cohort study was conducted in a PICU in northeastern China and included children under 18 years of age who were severely and critically ill due to SARS-CoV-2 Omicron infection between December 2022 and February 2023. Patients were categorized into two groups: the invasive mechanical ventilation (IMV) group and the non-IMV group. The primary outcome measured was the need for IMV, while secondary outcomes included death or prolonged PICU stay. Univariate and multivariate logistic regression analyses were performed to identify risk factors for poor outcomes.
A total of 38 severe and critically ill children were included in the study. Of these, 25 (66%) were diagnosed with respiratory failure, and four (16%) developed acute respiratory distress syndrome. Additionally, 21 (55%) were diagnosed with COVID-19-associated neurological disorders, and 18 (47%) received IMV. Multivariate logistic regression analysis identified the chest computed tomography (CT) score, based on the COVID-19 Risk Assessment and Diagnosis System (CO-RADS), was statistically significant as an independent predictor for IMV in severe and critically ill children (odds ratio [OR]: 2.781 [95% confidence interval (CI): 1.021-7.571]). Furthermore, the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score and serum aspartate aminotransferase (AST) levels at admission were found to be independent predictors of death or prolonged PICU stay.
Respiratory failure and COVID-19-associated neurological disorders were the most common complications among severe and critically ill children with first-wave SARS-CoV-2 Omicron infection. Chest CT score, PELOD-2 score, and serum AST levels may serve as important indicators of poor outcomes in this patient population.
描述中国东北地区国家儿童区域医疗中心儿科重症监护病房（PICU）收治的首波新型冠状病毒奥密克戎感染重症及危重症儿童的特征，并探讨与不良预后相关的因素。
本观察性队列研究在中国东北地区的一家PICU进行，纳入了2022年12月至2023年2月因新型冠状病毒奥密克戎感染而重症及危重症的18岁以下儿童。患者分为两组：有创机械通气（IMV）组和非IMV组。主要观察指标是是否需要IMV，次要观察指标包括死亡或PICU住院时间延长。进行单因素和多因素逻辑回归分析以确定不良预后的危险因素。
本研究共纳入38例重症及危重症儿童。其中，25例（66%）被诊断为呼吸衰竭，4例（16%）发生急性呼吸窘迫综合征。此外，21例（55%）被诊断为新型冠状病毒肺炎相关神经系统疾病，18例（47%）接受了IMV。多因素逻辑回归分析确定，基于新型冠状病毒肺炎风险评估与诊断系统（CO-RADS）的胸部计算机断层扫描（CT）评分作为重症及危重症儿童IMV的独立预测因素具有统计学意义（比值比[OR]：2.781[95%置信区间（CI）：1.021 - 7.571]）。此外，入院时的小儿逻辑器官功能障碍-2（PELOD-2）评分和血清天冬氨酸氨基转移酶（AST）水平是死亡或PICU住院时间延长的独立预测因素。
呼吸衰竭和新型冠状病毒肺炎相关神经系统疾病是首波新型冠状病毒奥密克戎感染重症及危重症儿童中最常见的并发症。胸部CT评分、PELOD-2评分和血清AST水平可能是该患者群体不良预后的重要指标。
