New Research Identifies Which Children Are Most Likely to Need Intensive Care

NEW YORK (November 18, 2020) – Research led by investigators at the Children’s Hospital at Montefiore, Albert Einstein College of Medicine and Yale School of Medicine, identifies symptoms that can predict how severely children will be affected by COVID-19. The research, published in the Journal of Pediatrics, shows that children with respiratory disease and those with Multi-System Inflammatory Syndrome (MIS-C), a rare but serious condition associated with COVID-19, experienced the most severe illness.

“Much of the discussion to date around COVID-19 suggests that children don’t typically suffer serious illness,” said lead author, Danielle Fernandes, M.D., attending physician, Division of Hospital Medicine, CHAM, and assistant professor of pediatrics at Einstein. “Our study shows that children with COVID-19, like adults, can experience symptoms ranging from mild to severe, and tragically, children can die from the disease.”

The investigators assessed 281 children hospitalized with COVID-19 disease at eight medical centers in New York, New Jersey and Connecticut between March and May of this year. Half the children had respiratory disease with symptoms including cough, wheezing, sore throat, and difficulty breathing. The remaining 50% of patients were equally divided between children who experienced MIS-C and children who exhibited a range of symptoms, including gastrointestinal issues and fever. Of the three groups, children with MIS-C were most likely to require intensive care, but only children with respiratory illness passed away from COVID-19.

The eight participating hospitals in the tri-state area serve diverse patient populations, however the majority of hospitalized patients in this study were Hispanic or Black. In contrast to studies involving adults with COVID-19, the researchers found that race or ethnicity did not influence how children with COVID-19 fared following hospitalization. Additionally, the study showed:

• Children with obesity and those with low oxygen levels at the time of admission were more likely to have severe respiratory disease and require prolonged intensive care;
• One in five children with severe respiratory disease required intubation and mechanical ventilation;
• Children with lower lymphocytes, a subset of white blood cells, and those with higher levels of C-reactive protein, a test commonly used to evaluate inflammation, were more likely to have severe MIS-C;
• Children with MIS-C were more likely to be non-Hispanic Black
• Race/ethnicity and socioeconomic status was not associated with more severe disease

“We hope that pediatric providers will use these warning signs to predict which children may need enhanced monitoring and treatment that could prevent them from becoming severely ill or dying,” said Dr. Fernandes.

The paper is titled “SARS-CoV-2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth.” Co-authors include members of The Tri-State Pediatric COVID-19 Research Consortium from Albert Einstein College of Medicine, the Children’s Hospital at Montefiore, Yale School of Medicine, Kings County Hospital Center, Maimonides Children’s Hospital, Joseph M. Sanzari Children’s Hospital, K. Hovnanian Children’s Hospital, Neptune City, SUNY Downstate Medical Center University Hospital and Stony Brook University Renaissance Hospital.