High incidence of stroke and mortality in pediatric critical care patients with COVID-19 in Peru.
Journal
Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
received:
10
09
2020
accepted:
05
04
2021
revised:
05
03
2021
pubmed:
5
5
2021
medline:
14
7
2022
entrez:
4
5
2021
Statut:
ppublish
Résumé
Pediatric critical care patients with COVID-19 treated in Peru have higher mortality than those previously reported from other countries. Pediatric providers have reported a high number of patients without comorbidities presenting with hemorrhagic strokes associated with COVID-19. We present a study analyzing the factors associated with mortality in this setting. Prospective case-control study that included patients <17 years old admitted to a pediatric critical care unit with a positive test confirming COVID-19. The primary outcome was mortality. Fisher's exact test and the Mann-Whitney U test were used for the analysis. Forty-seven patients were admitted to critical care. The mortality of our study is 21.3%. The mortality of patients with neurological presentation was 45.5%, which was significantly higher than the mortality of acute COVID-19 (26.7%) and MIS-C (4.8%), p 0.18. Other risk factors for mortality in our cohort were strokes and comorbidities. Only one patient presenting with hemorrhagic stroke had an undiagnosed comorbidity. Cerebrovascular events associated with COVID-19 in pediatric patients, including infants, must be recognized as one of the more severe presentations of this infection in pediatric patients. Pediatric patients with COVID-19 can present with hemorrhagic and ischemic strokes on presentation. Neurological presentation in pediatric patients with COVID-19 has high mortality. Mortality of pediatric patients with COVID-19 is associated with comorbidities. Pediatric presentation and outcomes of COVID-19 in different regions can be novel to previously described.
Identifiants
pubmed: 33941862
doi: 10.1038/s41390-021-01547-x
pii: 10.1038/s41390-021-01547-x
pmc: PMC8090521
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1730-1734Informations de copyright
© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.
Références
Dong, Y. et al. Epidemiology of COVID-19 Among Children in China. Pediatrics 145, e20200702 (2020).
doi: 10.1542/peds.2020-0702
Parri, N., Lenge, M. & Buonsenso, D. Children with Covid-19 in pediatric emergency departments in Italy. N. Engl. J. Med. 383, 187–190 (2020).
doi: 10.1056/NEJMc2007617
Swann, O. V. et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study. Bmj 370, m3249 (2020).
doi: 10.1136/bmj.m3249
Belhadjer, Z. et al. Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 Pandemic. Circulation 142, 429–436 (2020).
doi: 10.1161/CIRCULATIONAHA.120.048360
C. D. C. Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Coronavirus Disease 2019 (COVID-19), case definition for MIS-C. In HAN (ed), https://emergency.cdc.gov/han/2020/han00432.asp (2020).
Feldstein, L. R. et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N. Engl. J. Med. 383, 334–346 (2020).
doi: 10.1056/NEJMoa2021680
Panupattanapong, S. & Brooks, E. B. New spectrum of COVID-19 manifestations in children: Kawasaki-like syndrome and hyperinflammatory response. Cleve Clin. J. Med. Epub ahead of print (2020).
Riphagen, S., Gomez, X., Gonzalez-Martinez, C., Wilkinson, N. & Theocharis, P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 395, 1607–1608 (2020).
doi: 10.1016/S0140-6736(20)31094-1
Toubiana, J. et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ 369, m2094 (2020).
doi: 10.1136/bmj.m2094
Grimaud, M. et al. Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children. Ann. Intensive Care 10, 69 (2020).
doi: 10.1186/s13613-020-00690-8
Kaushik, S. et al. Multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 infection (MIS-C): a multi-institutional study from New York city. J. Pediatr. 224, 24–29 (2020).
doi: 10.1016/j.jpeds.2020.06.045
Shekerdemian, L. S. et al. Characteristics and outcomes of children with Coronavirus Disease 2019 (COVID-19) infection admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. Sep 1 174, 868–873 (2020).
doi: 10.1001/jamapediatrics.2020.1948
Garcia-Salido, A. et al. Children in critical care due to severe acute respiratory syndrome coronavirus 2 infection: experience in a Spanish hospital. Pediatr. Crit. Care Med. 24, 666 (2020).
González-Dambrauskas, S. et al. Pediatric critical care and COVID19. Pediatrics. 146, e20201766 (2020).
doi: 10.1542/peds.2020-1766
Sachdeva, R. et al. The impact of coronavirus disease 2019 pandemic on U.S. and Canadian PICUs. Pediatr. Crit. Care Med. 21, e643–e650 (2020).
doi: 10.1097/PCC.0000000000002510
Force, A. D. T. et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 307, 2526–2533 (2012).
Parsons, T. et al. COVID-19-associated acute disseminated encephalomyelitis (ADEM). J. Neurol. 267, 2799–2802 (2020).
doi: 10.1007/s00415-020-09951-9
Mirzaee, S. M. M., Gonçalves, F. G., Mohammadifard, M., Tavakoli, S. M. & Vossough, A. Focal cerebral arteriopathy in a COVID-19 pediatric patient. Radiology. 297, E274–E275 (2020).
doi: 10.1148/radiol.2020202197
Ellul, M. A. et al. Neurological associations of COVID-19. Lancet Neurol. Sep 19, 767–783 (2020).
doi: 10.1016/S1474-4422(20)30221-0
de Havenon, A., Ney, J. P., Callaghan, B., Yaghi, S. & Majersik, J. J. Excess neurological death in New York City after the emergence of COVID-19. J. Neurol. Epub ahead of print (2020).
Li, Y. et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc. Neurol. 5, 279–284 (2020).
doi: 10.1136/svn-2020-000431
Spence, J. D. et al. Mechanisms of stroke in COVID-19. Cerebrovasc. Dis. 9, 451–458 (2020).
doi: 10.1159/000509581
Merkler, A. E. et al. Risk of ischemic stroke in patients with coronavirus disease 2019 (COVID-19) vs patients with influenza. JAMA Neurol. 77, 1–7 (2020).
doi: 10.1001/jamaneurol.2020.2730
Nordvig, A. S. et al. Potential neurological manifestations of COVID-19. Neurol. Clin. Pract. 11, e135–e146 (2020).
doi: 10.1212/CPJ.0000000000000897