Abstract
Background: Knowledge of pediatric COVID-19 is important to determine those at risk for severe disease and mortality. There is limited data on risk factors for development of severe disease and predictors of mortality amongst children with COVID-19, especially from the developing nations. We aimed to study the profile, risk factors for severe COVID-19 and predictors of mortality in children with laboratory confirmed COVID-19. Methods: This prospective observational study was conducted from April to September 2020 in the Department of Pediatrics of a referral COVID-care hospital in Northern-India. All children 1 month to 18 years of age, hospitalized in the Pediatrics Department and having a positive Reverse Transcriptase-Polymerase chain reaction (RT-PCR) for SARS-CoV-2 infection on their combined oro-nasopharyngeal swab were enrolled. Results: A total of 335 SARS-CoV-2 positive children were enrolled with median age of 6 years, slight male predominance (54%) and 24.4% infants. Commonest presentations were respiratory (47.7%), gastrointestinal (33.3%) and neurological (14.9%) with moderate/severe disease in 24%, mortality in 4.8%, co-morbidities in 20.5% and co-infections in 17.9%. Risk factors for severe disease were underlying co-infection (p=0.017), associated tuberculosis (p=0.0015), associated culture positive bacterial sepsis (p=<0.001) and being underweight (p<0.001). Overweight/obese children had less severe COVID-19 (p=0.0016). Predictors of mortality were co-infections (p=0.0019), hypoxia (p<0.001), neurological manifestations (p=0.016), acute respiratory distress syndrome (p<0.001), acute kidney injury (p=0.05), shock (p<0.001), thrombocytopenia (p=0.021), leucopenia (p=0.028), lymphopenia (p=0.021), high Neutrophil:Lymphocyte ratio (p=0.02), coagulopathy (p=0.02), azotemia (p=0.038) and raised creatinine (p=0.05). Conclusions: Children with identified risk factors for severe disease and mortality should receive prioritized treatment.
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