Characteristics and outcomes of children with SARS-CoV-2 respiratory failure: a matched cohort study

Abstract

Abstract Background There are limited data on the clinical characteristics and outcomes of critically ill children requiring mechanical ventilation for SARS-CoV-2 acute respiratory failure. Methods We performed a multicentre prospective matched cohort study of mechanically ventilated paediatric patients aged 2 weeks to 18 years with confirmed SARS-CoV-2 acute respiratory failure, excluding Multisystem Inflammatory Syndrome. Cases were matched at 1:4 ratio to a pre COVID-19 pandemic paediatric cohort. Age, paediatric acute respiratory distress (PARDS) category, and organ dysfunction on days 0–1 of mechanical ventilation were used to match patients. Results Of 53 COVID-19 subjects, 60% were male, median age was 11.1 years (interquartile range 1.6–15.7), and 89% had moderate to severe PARDS on days 0–1. Compared to 195 matched controls, more children with COVID-19 were obese, cognitively or functionally impaired at baseline, Hispanic/Latino, and had pre-existing respiratory and neurologic conditions. Observed 28-day mortality was not different, but the COVID-19 cohort experienced fewer ventilator-free days and, among survivors, longer PICU stays. More COVID-19 patients were transitioned to extracorporeal membrane oxygenation. Conclusions Children with COVID-19 related acute respiratory failure suffered disproportionately from chronic conditions and required more critical care support than children with acute respiratory failure without SARS-CoV-2 related infection.