• Kim R Derespina, Shubhi Kaushik, Anna Plichta, Edward E Conway, Asher Bercow, Jaeun Choi, Ruth Eisenberg, Jennifer Gillen, Anita I Sen, Claire M Hennigan, Lillian M Zerihun, Sule Doymaz, Michael A Keenaghan, Stephanie Jarrin, Franscene Oulds, Manoj Gupta, Louisdon Pierre, Melissa Grageda, H Michael Ushay, Vinay M Nadkarni, AgusMichael S DMSDDivision of Medical Critical Care, Boston Children's Hospital, Boston, MA., and Shivanand S Medar.
• Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.
• J. Pediatr. 2020 Nov 1; 226: 55-63.e2.

ObjectivesTo describe the clinical manifestations and outcomes of critically ill children with coronavirus disease-19 (COVID-19) in New York City.Study DesignRetrospective observational study of children 1 month to 21 years admitted March 14 to May 2, 2020, to 9 New York City pediatric intensive care units (PICUs) with severe acute respiratory syndrome coronavirus 2 infection.ResultsOf 70 children admitted to PICUs, median age was 15 (IQR 9, 19) years; 61.4% male; 38.6% Hispanic; 32.9% black; and 74.3% with comorbidities. Fever (72.9%) and cough (71.4%) were the common presenting symptoms. Twelve patients (17%) met severe sepsis criteria; 14 (20%) required vasopressor support; 21 (30%) developed acute respiratory distress syndrome (ARDS); 9 (12.9%) met acute kidney injury criteria; 1 (1.4%) required renal-replacement therapy, and 2 (2.8%) had cardiac arrest. For treatment, 27 (38.6%) patients received hydroxychloroquine; 13 (18.6%) remdesivir; 23 (32.9%) corticosteroids; 3 (4.3%) tocilizumab; and 1 (1.4%) anakinra; no patient was given immunoglobulin or convalescent plasma. Forty-nine (70%) patients required respiratory support: 14 (20.0%) noninvasive mechanical ventilation, 20 (28.6%) invasive mechanical ventilation (IMV), 7 (10%) prone position, 2 (2.8%) inhaled nitric oxide, and 1 (1.4%) extracorporeal membrane oxygenation. Nine (45%) of the 20 patients requiring IMV were extubated by day 14 with median IMV duration of 218 (IQR 79, 310.4) hours. Presence of ARDS was significantly associated with duration of PICU and hospital stay, and lower probability of PICU and hospital discharge at hospital day 14 (P < .05 for all).ConclusionsCritically ill children with COVID-19 predominantly are adolescents, have comorbidities, and require some form of respiratory support. The presence of ARDS is significantly associated with prolonged PICU and hospital stay.Copyright © 2020 Elsevier Inc. All rights reserved.

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