COVID-19 Outcomes Better in Critically Ill Children Than Adults

By Reuters Staff

May 13, 2020

NEW YORK (Reuters Health) - A North American case series of children with COVID-19 suggests the clinical course is typically less severe and the hospital outcomes better in critically ill children than in adults.

"We can be cautiously encouraged by the hospital outcomes for patients in this series, with an overall ICU mortality at the end of our follow-up period of less than 5% compared with published mortalities of 50% to 62% in adults admitted to the ICU," Dr. Lara Shekerdemian of Texas Children's Hospital, in Houston, and colleagues write in JAMA Pediatrics.

They describe the characteristics and clinical course of 48 children with COVID-19 admitted to pediatric intensive-care units (PICUs) in the United States between March 14 and April 3, with follow-up to April 10.

The children had a mean age of 13 years (range, 4 to 16 years) and 52% were boys. They spent a median of five days in the PICU (range, three to nine days) and seven days in the hospital (range, four to 13 days).

Most of the children (83%) had preexisting underlying medical conditions, as has been reported in adults; 73% presented with respiratory symptoms and 38% required invasive ventilation.

"An important subset of the patients in our series presented with only minimal or no respiratory symptoms but other important symptoms that warranted PICU admission. These included vaso-occlusive crises in the setting of sickle cell anemia, diabetic ketoacidosis, seizures, and circulatory collapse," the authors say.

None of the children experienced symptoms similar to a toxic shock-like syndrome, which have been observed in some children in New York and elsewhere.

Most of the children in the current series received at least one treatment aimed at modulating the course of the infection, most commonly hydroxychloroquine alone or in combination with one or more other agents, including azithromycin, the antiviral remdesivir, and the interleukin-6 blocker tocilizumab.

At the end of follow-up, 15 children (31%) remained hospitalized, three remained on ventilatory support, one was receiving extracorporeal membrane oxygenation and two children had died, for a mortality rate of 4%.

Dr. Shekerdemian and colleagues say it's worth noting that the overall burden of COVID-19 in children "remains relatively low" compared with seasonal influenza. According to the U.S. Centers for Disease Control and Prevention (CDC), as of May 8, nine children aged 14 or younger had died due to COVID-19 infection, whereas so far there have been 169 influenza-related deaths in this age group during the 2019-2020 season, with 81 of these occurring in 2020. (

"These preliminary observations provide an important platform for larger and more extensive studies of children with COVID-19 infection," they conclude.

Dr. Shekerdemian did not respond to a request for comment by press time.

SOURCE: JAMA Pediatrics, online May 11, 2020.