| Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to
intensive care units (ICUs).
Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings,
clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in
non-ICU settings.
Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with
confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and
May 2020, during the initial peak of the COVID-19 pandemic in Iran.
Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest
number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were
the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There
were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine
phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU
patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common
features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially
higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001).
Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality
rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between
pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider
children as a high-risk group, especially those with underlying medical conditions. |