Comparison of Clinical Findings in SARS-CoV-2 with Other Respiratory Viruses in Critically Ill Children during the COVID-19 Pandemic

• Published in: Journal of tropical pediatrics (1980) Vol. 67; no. 6
• Main Authors: Perk, Oktay, Ozcan, Serhan, Emeksiz, Serhat, Uyar, Emel, Gulhan, Belgin
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 08-12-2021
• Subjects: Child; Child, Preschool; COVID-19 - diagnosis; Critical Illness; Female; Humans; Infant; Intensive Care Units, Pediatric; Male; Original Paper; Oxygen Saturation; Pandemics; Respiratory Tract Diseases - diagnosis; Respiratory Tract Diseases - virology; Retrospective Studies; SARS-CoV-2; Turkey; Viruses - classification; Turkey; COVID-19; SARS-CoV-2; children; respiratory airway viruses; pediatric intensive care
• DOI: 10.1093/tropej/fmab102
• EISSN: 1465-3664
• ISSN: 0142-6338

Abstract
Objectives
The aim of this study was to compare the clinical and laboratory findings in SARS-CoV-2 (COVID-19) with those of other respiratory viruses in critically ill children.
Methods
It is a single center retrospective descriptive study conducted in a 32-bed pediatric intensive care unit (PICU). Our study was performed in Ankara City Hospital, Ankara, Turkey, between 1 March 2020, and 1 March 2021. Demographic and clinical characteristics of the patients were collected and we recorded the antibiotic use, antiviral treatments, respiratory and extracorporeal supports, PICU stay and survival rates.
Results
A total of 202 pediatric patients who tested positive for either COVID-19 or for another respiratory virus panel (RVP) were included in the study. Seventy-two patients were COVID-19 positive. The median age of COVID-19 positive patients and RVP positive patients was 97 and 17 months, respectively. Hypoxia was much more common in patients with RVP than in COVID-19 patients. Low oxygen saturation in arterial blood (SaO2), increased oxygen saturation index (OSI) and fraction of inspired oxygen (FiO2) needs were more significant in RVP patients than in COVID-19 patients. Respiratory support therapies, such as high-flow nasal cannula and non-invasive ventilation (NIV), were used more frequently in RVP patients than in COVID-19 patients.
Conclusion
It is important to distinguish between COVID-19 and RVP cases in order to prioritize intensive care needs in these patients. In addition, non-Covid diseases should not be left aside in the pandemic and appropriate care should be provided to them.
Lay Summary
COVID-19 originated in Wuhan, China, at the end of 2019 and has since spread around the world. During the key period of the pandemic from 1 March 2020, to 1 March 2021, the pediatric intensive care unit registered a total of 72 patients testing positive for SARS-CoV-2 and 130 patients positive for RVP on the respiratory virus panel. In this single-center study, we compared the clinical differences and course of the disease in pediatric intensive care patients infected with SARS-CoV-2 with patients diagnosed with respiratory tract viruses during the COVID-19 outbreak. Unlike previous studies, this is the first to compare the clinical manifestations of COVID-19 with other respiratory pathogens requiring intensive care. Respiratory support therapy, such as high-flow nasal cannula (HFNC) and NIV, was prescribed more frequently in RVP patients than in COVID-19 patients. In our study, low oxygen saturation in the arterial blood (SaO2), increased OSI and increased fraction of inspired oxygen (FiO2) requirements were more significant in RVP patients than in COVID-19 patients. In parallel, the need for mechanical ventilation was higher in RVP patients than in COVID-19 patients. Therefore, we believe that RVP patients should be followed more carefully during this pandemic period.