Children with COVID-19 experience severe illness less frequently than adults, but the disease can still inflict a significant toll, especially in children with underlying medical conditions, according to a study published in JAMA Pediatrics.
These findings cut against the idea that children are safe from COVID-19, according to Katie Wolfe, MD, ’14 ’17 GME, instructor of Pediatrics in the Division of Critical Care, who was a co-author of the study.
“This study demonstrated that while the prevalence of illness and severe disease in pediatrics is lower than in adults, pediatric patients are absolutely not protected against this disease,” Wolfe said. “We found that children, especially those with comorbidities, were still at risk for severe disease and multi-organ system dysfunction.”
As COVID-19 spread across the globe, clinicians and scientists began to recognize patterns: high mortality for the elderly and those with significant co-morbidities, and low incidence of severe disease in children.
The latter was bolstered by observational studies from Wuhan province, China, and from the United States, both of which reported that less than two percent of COVID-19 patients were children, and an even smaller percentage were admitted to intensive care units (ICUs).
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To further explore this phenomenon, collaborators from several institutions conducted a retrospective review of pediatric patients admitted to 46 ICUs across North America — including at Ann and Robert H. Luirie Children’s Hospital — between mid-March and the beginning of April.
A total of 48 children were admitted to participating pediatric ICUs, 83 percent of whom had significant preexisting comorbidities, 38 percent required ventilation and 61 percent received targeted therapies including hydroxychloroquine.
Even with these complications, just two patients passed away and 15 remained hospitalized at the conclusion of the study, compared to studies that found the mortality rate for adults admitted to the ICU at more than 50 percent.
“I think this study confirmed what we were seeing in general and reinforced that excellent supportive clinical care remains important,” Wolfe said.
The demanding circumstances surrounding this study required a swift and careful approach to data collection and analysis, and this study is a model for rapid dissemination of COVID-19 findings, according to Wolfe.
“Everyone involved was willing and able to provide this information efficiently in order to help pediatric providers be on the same page when it comes to COVID-19 and caring for critically ill children,” Wolfe said. “I hope that we can learn from this process to continue to share information that can positively impact outcomes of children.”
Sharing new information is especially important, as since the conclusion of this study, the pediatric care community has described a post-infection inflammatory condition in children. This is a new wrinkle that may change how COVID-19 in children should be treated, and requires further study.
“We need to remain vigilant in caring for all critically ill children as we aim to better understand this virus,” Wolfe said.
