Advances in Pediatric Research
Open Access

Abstract

Hospitalized Children with Critical SARS-CoV-2 Infection Cared in a Limited Resource Setting: Multicenter Cohort Study

Rafaella R. Gomes, Maria C.A. Justino, Kathia de O. Harada, Jessica L. Alves, Renata de B. Braga, Patricia B. Carvalho, Mary L.F. M.F. de Mello, Salma B. Saraty, Cristiane T.C. Silva, Railana D.F.P. Carvalho, Gabriela C.L. Pontes, Adriana MB de Sousa, Gabriella M. Galvão, Sara M.P. de Moraes, Emmerson C.F. de Farias*, Michaelle J.D. Serrão, Mayara M.M. Machado, Luana G. Dias, Carina C. Costa, Larisse F.Q. Aires, Kíssila M.M.M Ferraro, Marília C.B. Alves, Andreza H.O. Pinheiro, Valeria T.S. dos Santos, Dalila C.A. Pavão, Luciana M.P.P. do Nascimento, Susan C.D. de Sales and Manoel J.C. Pavão

Background: Some children can develop severe forms of SARS-CoV-2 infection either acutely or later, as represented by Multisystemic Inflammatory Syndrome in Children (MIS- C). To identify the risk factors for worse outcomes in hospitalized children and adolescents with severe acute SARS-CoV-2 infection and MIS-C.

Methods: This multicenter cohort study included all children and adolescents with confirmed or suspected critical SARS-CoV-2 infection admitted to the Pediatric Intensive Care Unit (PICU) between April 2020 and September 2021. The exclusion criteria were incomplete vaccinal status, immune-compromised status, and end-of-life decision. The main variables analyzed were epidemiological, clinical, and laboratory data, and ventilator settings at admission and after 72 h. The patients were divided into three groups (G): confirmed coronavirus disease (COVID-19) with MIS-C criteria (G1), confirmed COVID-19 without MIS-C criteria (G2), and MIS-C criteria without confirmed COVID-19.

Results: The median age of the patients was 28 months in G1, with comorbidities in 40 patients (72.7%) (p < 0.0001). The duration of exposure (median 23 days; p = 0.004) and fever were longer in G1 (12 days; p = 0.001). Moreover, Invasive Mechanical Ventilation (IMV) was required in 44 patients (80%, p < 0.0001), and cardiogenic shock occurred in 26 patients (54.2%, p < 0.0001) in G1. Sub-nutrition was most frequent in G1 in 55 cases (57.3%; p = 0.01). Under nutrition (< 2 SD for weight), longer exposure time (odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.37–3.25; p = 0.001), IMV time (OR: 2.6; 95% CI: 1.15–5.85; p = 0.03), and length of hospital stay (OR: 10.94; 95% CI: 1.93–63.1; p = 0.007) were associated with critical MIS-C in G1.

Conclusion: In the Brazilian Amazon area, specifically in the Pará state, we identified a cluster of more severe forms of pediatric acute or late SARS-CoV-2 infection.

Published Date: 2023-02-21; Received Date: 2023-01-17