Clinico-laboratory profile, outcome, and risk factors for pediatric intensive care admission among hospitalized COVID-19–infected children from Eastern India

Abstract

Background: Children had been affected less by COVID-19 than adults. But as the pandemic progressed more cases of severe pediatric COVID infection were reported. Aim of this study is to describe the clinical characteristics, laboratory parameters, treatments, and predictors of pediatric intensive care unit (PICU) admission among hospitalized children with SARS-CoV-2 infection.Subjects and Methods: This was a retrospective, observational study performed in a tertiary care COVID referral hospital among hospitalized children aged from 1 month to 12 years, from May 2020 to March 2021. Children treated in the pediatric ward were compared with those admitted in the PICU to assess predictors of intensive care admission.Results: Out of 447 hospitalized patients with confirmed COVID-19 infection, 92 (20.58%) required admission in the PICU. Mean age of the study population was 44.58 (16.77–72.39) months. Thirty-eight patients (8.50%) fulfilled multisystem inflammatory syndrome in children (MIS-C) diagnostic criteria. Invasive mechanical ventilation and inotropic support were needed for 28.26% and 36.96% of PICU-admitted patients, respectively. The mortality rate was 1.57%. Independent risk factors for PICU admission were infant age group, longer duration of fever (>5 days), shortness of breath, presence of shock, underlying comorbidities and higher pediatric early warning score (PEWS ≥5), poor Glasgow coma scale (GCS <7), MIS-C, elevated C-reactive protein (CRP >50 mg/L), neutrophil–lymphocyte ratio (NLR ≥4.5), and hypoalbuminemia (<2.5 g/dL).Conclusions: Clinical factors such as infancy, prolonged fever, respiratory distress at admission, shock, higher PEWS, poor GCS, and comorbidities indicate at risk for severe disease. Simple laboratory parameters such as CRP, NLR ≥4.5, and albumin may be considered as screening at admission to predict need of PICU care.