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    Original Investigation
    Caring for the Critically Ill Patient
    May 11, 2020

    Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units

    Author Affiliations
    • 1Texas Children’s Hospital, Baylor College of Medicine, Houston
    • 2Children’s Healthcare of Atlanta, Atlanta, Georgia
    • 3Ann and Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
    • 4Johns Hopkins Children’s Center, Johns Hopkins School of Medicine, Baltimore, Maryland
    • 5Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
    • 6Baystate Children’s Hospital, UMass Medical School Baystate Campus, Springfield, Massachusetts
    • 7Children’s Hospital of Michigan, Wayne State University, Detroit
    • 8Bristol-Myers Squibb Hospital, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
    • 9NewYork-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Medical Center, New York
    • 10Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
    • 11Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia
    • 12Seattle Children’s Hospital, University of Washington, Seattle
    • 13Children’s Memorial Hermann Hospital, University of Texas, Houston
    • 14Children’s National Medical Center, George Washington School of Medicine, Washington, DC
    • 15Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
    JAMA Pediatr. Published online May 11, 2020. doi:10.1001/jamapediatrics.2020.1948
    Key Points

    Question  What has been the early experience of coronavirus disease 2019 (COVID-19) in pediatric intensive care units (PICUs)?

    Findings  In this cross-sectional study of 46 North American PICUs, between March 14 and April 3, 2020, 48 children were admitted to 14 PICUs in the US and none in Canada. A total of 40 children (83%) had preexisting underlying medical conditions, 35 (73%) presented with respiratory symptoms, and 18 (38%) required invasive ventilation, and the hospital mortality rate was 4.2%.

    Meaning  This early study shows that COVID-19 can result in a significant disease burden in children but confirms that severe illness is less frequent, and early hospital outcomes in children are better than in adults.


    Importance  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).

    Objective  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.

    Main Outcomes and Measures  Prehospital characteristics, clinical trajectory, and hospital outcomes of children admitted to PICUs with confirmed COVID-19 infection.

    Results  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.

    Conclusions and Relevance  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.