HomeThe PCMC Journalvol. 18 no. 1 (2022)

Clinical presentation and outcome of pediatric COVID-19 patients admitted in Philippine Children's Medical Center (PCMC): The first 100 cases. chronic kidney disease pediatric patients: a randomized controlled study

Jenneelyn A Gonzales-Ritona | Caridad M Santos | Mary Ann C. Bunyi

Discipline: medicine by specialism

 

Abstract:

BACKGROUND: There are numerous studies on adult patients admitted for COVID-19 but there is paucity of local data in children. OBJECTIVE: This study aims to determine the clinical presentation and outcome of children admitted for COVID-19. METHODOLOGY: This is a retrospective review of medical records of patients 0 to 18 years old with COVID-19 admitted in Philippine Children’s Medical Center (PCMC). Descriptive statistics summarized the clinical profile of the patients. Pearson’s Chi Square and Fischer’s Exact Test were used for data analysis. RESULTS: There were 100 confirmed COVID-19 pediatric patients admitted at PCMC from March 2020 to March 2021. Most were within the 0-4 years of age (52%). Fever (63%), respiratory symptoms (31%) and shock (28%) were the predominant clinical manifestations. Most (78%) had no exposure to symptomatic household contacts but all came from communities with known local transmission. Fourteen cases of hospital acquired COVID-19 were also identified. Out of the 100 cases, 53 had critical COVID-19 on admission and 82 had co-morbidities, mostly neurologic, hematologic and infectious diseases. Seventy four patients recovered and 26 patients died. Fever (p-value=0.014) and shock (p-value=0.000), thrombocytopenia or thrombocytosis (p=0.030) and electrolyte imbalances (p=0.045) were significantly associated with critical COVID-19. There was no significant association between the presence of co-morbid conditions on admission and clinical outcome. O2 support by facemask (p=0.001) or by mechanical ventilator (p=0.001), and inotropic support (p=0.000) were significantly associated with mortality. CONCLUSION: Children admitted for COVID-19 infection generally recover but those with critical COVID-19 is highly associated with mortality.



References:

  1. World Health Organization. WHO COVID-19 Dashboard. 2021 Apr 30.Available from: https://covid19.who.int/
  2. World Health Organization. COVID-19 in the Philippines. 2021 Feb 21. Available from: https://www.who.int/philippines/emergencies/covid-19-in-the-philippines
  3. Department of Health (PH). COVID-19 Tracker. 2021 Apr 30. Available from:https://doh.gov.ph/covid19tracker
  4. Hoang A, Chorath K, Moreira A et al. COVID-19 in 7780 pediatric patients: A Systematic review. EClinicalMedicine Internet. 2020 June 26 cited 2020 Jul 01;24:100433. Available from: https://doi.org/10.1016/j.eclinm.2020.100433
  5. Centers for Disease Control and Prevention Health Alert Network (US). Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19) Internet. 2020 May 14. Available from: https://emergency.cdc.gov/han/2020/han00432.asp
  6. World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19: Scientific Brief Internet. 2020 May 15. Available from:
  7. Chao J, Derespina K, Herold B, et al. Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 at a Tertiary Care Medical Center in New York City. J Peds Internet. 2020 May 11 cited 2020 Aug 01;223:14-19. Available from: https://dx.doi.org/10.1016%2Fj.jpeds.2020.05.006
  8. Coates T. Approach to the child with lymphocytosis or lymphocytopenia. UptoDate. 2020 Apr 14. 9. Cai Q, Huang D, Yu H, et al. COVID-19: Abnormal liver function tests. J Hep Internet. 2020 April 13 cited 2020 Sep 01;73(3);566-574. Available from: https://doi.org/10.1016/j.jhep.2020.04.006
  9. Cai Q, Huang D, Yu H, et al. COVID-19: Abnormal liver function tests. J Hep Internet. 2020 April 13 cited 2020 Sep 01;73(3);566-574. Available from: https://doi.org/10.1016/j.jhep.2020.04.006
  10. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract Internet. 2012 August 07;120:c179–c184. Available from: https://doi.org/10.1159/000339789
  11. Jayaprasad N. Heart Failure in Children. Heart Views Internet. 2016 Oct 19;17(3):92-99. Available from:https://dx.doi.org/10.4103%2F1995-705X.192556
  12. Philippine Pediatric Society; Pediatric Infectious Disease Society of the Philippines (PH). Interim Guidelines on the Screening, Assessment and Clinical Management of Pediatric Patients with Suspected or Confirmed Coronavirus Disease (COVID-19) Version 4 Internet. 2021 Feb 06.
  13. Centers for Disease Control and Prevention (US). Pandemic Planning and Scenarios Internet. 2021 Mar 19. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html
  14. Yuanyuan D, Mo X, Hu Y, et al. Epidemiology of COVID-19 among Children in China. Peds Internet. 2021 Jun 01;145(6):e20200702. Available from: https://doi.org/10.1542/peds.2020-0702
  15. World Health Organization. Diarrheal Diseases Internet. 2017 May 02. Available from: https://www.who.int/news-room/fact- sheets/detail/diarrhoeal-disease
  16. World Health Organization.Pneumonia Internet.2020 November 11. Available from: https://www.who.int/news-room/fact-sheets/detail/pneumonia
  17. Götzinger F, Santiago-García B, Noguera-Julián A, et al. COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study. Lancet Child Adolesc Heal Internet. 2020 Jun 05 cited 2020 Sep 01;4(9):653–661. Available from: https://doi.org/10.1016/S2352-4642(20)30177-2
  18. Johansson MA, et al. SARS-CoV-2 Transmission From People Without COVID-19 Symptoms. JAMA Network Open Internet. 2021 Jan 07;4(1):e2035057. Available from: https://doi.org/10.1001/jamanetworkopen.2020.35057
  19. Abbas M, Nunes T, Martischang R, et al. Nosocomial Transmission and Outbreaks of Coronavirus Disease 2019: the need to protect both patients and healthcare workers. Antimicrob Resist Infect Control Internet. 2021 Jan 06;10:7. Available from: https://doi.org/10.1186/s13756-020- 00875-7
  20. Jing Y, Run-Qian L, Hao-Ran W, et al.Potential influence of COVID-19/ACE2 on the female reproductive system. Mol Hum Reprod Internet.2020 May 04;26:367–73. Available from: https://dx.doi.org/10.1093%2Fmolehr%2Fgaaa030
  21. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet Internet. 2020 Jan 24 cited by 2020 Feb 15;395(10223):497-506. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext
  22. Faes C, Abrams S, Van Beckhoven D, et al. Time between Symptom Onset, Hospitalisation and Recovery or Death: Statistical Analysis of Belgian COVID-19 Patients. Int J Environ Res Public Health Internet. 2020 Oct 17;17(20):7560. Available from: https://doi.org/10.3390/ijerph1720756
  23. Harman K, Verma A, Cook J, et al. Ethnicity and COVID-19 in children with  comorbidities. Lancet Internet. 2020 May 28 cited by 2020 Jul 01;4(7):E24-E25. Available from: https://doi.org/10.1016/S2352-4642(20)30167-X
  24. Tsankov B, Allaire M, Irvine M, et al. Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis. Int J Infect Dis Internet. 2020 Nov 20 cited by 2021 Feb 01.103:246-256. Available from: https://dx.doi.org/10.1016%2Fj.ijid.2020.11.163
  25. Liguoro I, Pilotto C, Bonanni M, et al. SARS-CoV-2 infection in children and newborns: a systematic review. Eur J Pediatr Internet.2020 May 18;179(7):1029. Available from: https://dx.doi.org/10.1007%2Fs00431-020-03684-7
  26. Fox S, Vashisht R, Siuba M, et al. Evaluation and management of shock in patients with COVID-19. CCJM Internet. 2020 Jul. Available from: https://www.ccjm.org/content/early/2020/07/10/ccjm.87a.ccc052
  27. Neumann B, Schmidbauer M, Dimitriadis K, et al. Cerebrospinal fluid findings in COVID-19 patients with neurological symptoms. J Neurol Sci Internet. 10 Aug 2020 cited by 2020 Nov 15.2020;418:117090. Available from: https://dx.doi.org/10.1016%2Fj.jns.2020.117090
  28. Asadi-Pooya A. Seizures associated with coronavirus infection. European Journal of Epilepsy Internet. 2020 May 11 cited by 2020 Jul 01.79: 49-52. Available from: https://dx.doi.org/10.1016%2Fj.seizure.2020.05.005
  29. Mak P, Chung K, Wong J, et al. Anosmia and Ageusia: Not an Uncommon Presentation of COVID-19 Infection in Children and Adolescents. J Pediatr Infect Dis Internet. 2020 Aug 08;39(8):e199-e200. Available from: doi:10.1097/INF.0000000000002718
  30. Dagli H, Ackan O, Peckan S, et al. Uncommon Presentation of COVID-19 in Pediatric Patients: Anosmia. J Pediatr Infect Dis Internet. 2021 Feb 18;16(2):80-84. Available from: https://dx.doi.org/10.1055/s-0041-1723974
  31. Tian Y, Rong L, Nian W, et al. Review article: gastrointestinal features in COVID-19 and the possibility of fecal transmission. Aliment Pharmacol Ther Internet. 2020 Mar 29;51:843–851. Available from: https://doi.org/10.1111/apt.15731
  32. Luglio M, Tannuri U, de Carvalho W, et al. COVID-19 and Liver Damage:Narrative Review and Proposed Clinical Protocol for Critically Ill Pediatric Patients. Clinics Internet. 2020 Nov 02;75:e2250. Available from: https://doi.org/10.6061/clinics/2020/e2250
  33. Verduyn M, Allou N, Gazaille V, et al. Co-infection of dengue and COVID-19: A case report. PLoS Negl Trop Dis Internet. 2020 Aug 3;314(8):e0008476. Available from: https://doi.org/10.1371/journal.pntd.0008476
  34. Centers for Disease Control and Prevention (US). Is it Dengue or is it COVID-19? 2020 June 24. Available from: https://www.cdc.gov/dengue/healthcare-providers/dengue-or-covid.html
  35. Figueredo M, Amancio T, Salvatierra J, et al. COVID-19 and dengue coinfection in Brazil. World J Clin Infect Dis Internet. 2020 Oct 28;10(4):51-54. Available from: https://dx.doi.org/10.5495/wjcid.v10.i4.51
  36. 36. Bicudo N, Bicudo E, Costa J, et al. Co-infection of SARS-CoV-2 and dengue virus: a clinical challenge. Braz J Infect Dis Internet.2020 Aug 26;24(5):452-4. Available from: https://doi.org/10.1016/j.bjid.2020.07.008
  37. Yan G, Lee C, Lam L, et al. Covert COVID-19 and false-positive dengue serology in Singapore. Lancet Infect DisInternet. 2020 March 04 cited by 01 May 2020;20(5):536. Available from: https://doi.org/10.1016/S1473-3099(20)30158-4
  38. Centers for Disease Control and Prevention (US). Multisystem Inflammatory Syndrome in Children Internet. Available from:https://www.cdc.gov/mis-c/cases/index.html
  39. Henderson L, Canna S, Friedman K, et al., American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated with SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19 (Version 2). Arthritis and RheumatologyInternet. 2020 Dec 05;73(4):e13-e-29. Available from: https://doi.org/10.1002/art.41616
  40. Biswas M, Rahaman S, Biswas T, et al. Association of Sex, Age, and Comorbidities with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis. Intervirology Internet. 2020 Dec 09;64:36-47. Available from: https://doi.org/10.1159/000512592
  41. Harman K, Verma A, Cook J, et al. Ethnicity and COVID-19 in children with comorbidities. Lancet Internet. 2020 May 28 cited by 2020 Jul 01;4(7):E24-E25. Available from: https://doi.org/10.1016/S2352-4642(20)30167-X
  42. Tsankov B, Allaire J, Irvine M, et al. Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis. Int J Infect Dis Internet. 2020 Nov 20 cited by 2021 Feb;103:246-256. Available from: https://doi.org/10.1016/j.ijid.2020.11.163
  43. Shekerdemian L, Mahmood N, Wolfe K, et al. Characteristics and Outcomes of Children with Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr Internet. 2020 May 11;174(9):868–873. Available from: https://doi.org/10.1001/jamapediatrics.2020.1948
  44. Simonnet A, Chetboun M, Poissy J, et al. High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Requiring Invasive Mechanical Ventilation. Obesity Internet. 2020 Apr 09;28(7):1195-9. Available from: https://doi.org/10.1002/oby.22831
  45. CDC COVID-19 Response Team (US). Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. MMWR Internet. 2020 Apr 10. 69(14). Available from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6914e4.htm
  46. Centers for Disease Control and Prevention (US). Clinical Care Guidance Internet. 2021 Feb 16. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html
  47. Liang Su, Xiang M, Yu H, et al. The different clinical characteristics of Coronavirus disease cases between children and their families in China –the character of children with COVID-19. Emerging Microbes & Infections Internet. 2020 Mar 25;9(1):707-713. Available from: https://dx.doi.org/10.1080%2F22221751.2020.1744483
  48. Wu C, Chen X, Cai Y, et al. Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med Internet. 2020 Mar 13; 180(7):934. Available from: https://doi.org/10.1001/jamainternmed.2020.0994
  49. Shi S, Qin M, Shen B, et al. Association of Cardiac Injury with Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol Internet. 2020 Mar 25;5(7):802. Available from: https://doi.org/10.1001/jamacardio.2020.0950
  50. Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol Internet. 2020 Jul 10;7(9):e671. Available from: https://doi.org/10.1016/S2352-3026(20)30217-9
  51. Zachariah P, Johnson C, Halabi K, et al. Epidemiology, Clinical Features, and Disease Severity in Patients with Coronavirus Disease 2019 (COVID-19) in a Children's Hospital in New York City, New York. JAMA Pediatr Internet. 2020 Jul 10 cited by 2020 Sep 01;174(10): e202430. Available from:https://doi.org/10.1001/jamapediatrics.2020.2430
  52. Kainth M, Goenka P, Williamson K, et al. Early Experience of COVID-19 in a US  Children's Hospital. Pediatrics Internet.2020 Jul 13 cited by 20 Oct 01;146(4):e2020003186. Available from: https://doi.org/10.1542/peds.2020-003186
  53. Del Valle D, Kim-Schulze S, Huang H, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nat Med Internet. 2020 Aug 24.;26(10):1636. Available from: https://doi.org/10.1038/s41591-020-1051-9
  54. Aljondi R, Alghamdi S. Diagnostic Value of Imaging Modalities for COVID-19: Scoping Review. J Med Internet Res Internet. 2020 April 28;22(8):e19673.  Available from: https://doi.org/10.2196/1967355.
  55. Foust A, Philipps G, Chu W, et al.International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management: Imaging Findings, Imaging Study Reporting and Imaging Study Recommendations. Radiology:Cardiothoracic Imaging Internet. 2020 Apr 23;2(2):e200214. Available from: https://doi.org/10.1148/ryct.2020200214
  56. Kumar A, Kubota Y, Chernov M, et al. Potential role of zinc supplementation in prophylaxis and treatment of COVID-19. Med Hypotheses Internet. 2020 May 25;144:109848. Available from:https://doi.org/10.1016/j.mehy.2020.109848
  57. Murdaca G, Pioggia G. Negrini S. Vitamin D and Covid-19: an update on evidence and potential therapeutic implications. Clin Mol Allergy Internet.19 Nov 2020;18:23  Available from: https://doi.org/10.1186/s12948-020-00139-0
  58.  Recto M, Tan F, Cuajunco E, et al. A Review of Immunomodulators as Therapeutic Interventions for Moderate to Severe COVID-19 Infection version 3. Philippine Society of Allergy, Asthma and Immunology. 2020 Sep 20.
  59. Gautret P, Lagier J, Parola P, et al. Hydroxychloroquine and Azithromycin as a treatment of COVID-19: Results of an Open-Label Non-Randomized Trial. Int Journal Antimicrob Agents Internet. 2020 Jul;56(1):1-6 Available from: https://doi.org/10.1016/j.ijantimicag.2020.105949
  60. Infectious Disease Society of America (US). Treatment and Management of Patients with COVID-19 Internet. 2020 Apr 11. Last updated March 18, 2021. Available from: https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/
  61. RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with COVID-19. NEJM Internet . 2021 Feb 21;384:693-704. Available from:  https://doi.org/10.1056/NEJMoa2021436