Paediatric critical COVID-19: clinical features and outcomes during five waves.

Abstract

Background: Data reported from several countries show that both children and adolescents accounted for less than 2% of symptomatic cases of Coronavirus disease 2019 (COVID-19). The study objective was to describe the clinical characteristics of children admitted to Tunisian paediatric intensive care units (PICU). Methods: This was a single centre observational retrospective study conducted in the PICU of the Farhat Hached tertiary teaching hospital in Sousse, Tunisia during the period from the March 1, 2020 to February 28, 2022. We included all children aged from one month to 15 years with recent severe or critical severe acute respiratory syndrome coronavirus 2. Infection was confirmed by the positivity of reverse transcriptase either for SARS-CoV2 or with presence of IgM antibodies. We included severe and critical forms of COVID-19 according to the World Health Organization (WHO) classification. Results: 26 patients were included. 16 (61%) were one year old or younger. 18 patients (69.2%) were male. The median age in our research series was six months [1-156 months]. 17 (65.3%) patients had morbidities including mainly cardiac and neurological diseases. Fever (88.4%) and tachypnea (80.8%) were the most common clinical signs. Leukocytosis, high level of C-reactive protein, D-dimer, troponin, and pro-B type natriuretic peptide levels were found in 17, 8, 10, 6, and 10 cases respectively. Seven patients were initially treated with high-flow nasal cannula and didn't need escalation. Three were intubated. Invasive mechanical ventilation was used in six cases. Antibiotics and corticosteroids were used in 84% and 42.3% of children. The median paediatric intensive care unit length-of-stay was 10.9 days. There were six deaths. Conclusion: Paediatricians should be vigilant to the different clinical manifestations of COVID-19 in children admitted in PICU. Special attention should be allocated to infants under one year of age, of the male gender, and for children with comorbidities.