COVID-19 in pediatric patients: a case series from the Bronx, NY
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ORIGINAL ARTICLE
COVID-19 in pediatric patients: a case series from the Bronx, NY Einat Blumfield 1
&
Terry L. Levin 1
Received: 10 May 2020 / Revised: 22 June 2020 / Accepted: 9 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Coronavirus disease 2019 (COVID-19) primarily affects adults, with a lower incidence in children. Objective To report our experience with critically ill children with COVID-19. Materials and methods We reviewed the medical records of children with COVID-19 who were admitted Feb. 25 to May 1, 2020. We reviewed patient demographics, symptoms, comorbidities, requirement for respiratory support, evidence of acute myocardial injury, and chest radiographs. Results The study included 19 children and adolescents (ages 2 months to 18 years, median 8 years; 10 males, 9 females; 18 COVID-19-positive, 1 COVID-19-negative with positive exposure). Presenting symptoms included fever (89%), cough (68%), respiratory distress (68%) and vomiting/diarrhea (47%). Comorbidities were present in 12 (63%). Fourteen required intensive care; eight required intubation. Two children died. Five patients developed acute myocarditis (median age 7 years); in all five, chest radiographs were notable for cardiomegaly and pulmonary congestion or interstitial edema. Of these five, one (age 18 years), who had underlying hypertension and obesity, developed multifocal pneumonia and renal failure. The other four were previously healthy; three (ages 5 years, 7 years, 8 years) were subsequently diagnosed with multisystemic inflammatory syndrome in children (MIS-C); one developed pulmonary opacities consistent with adult respiratory distress syndrome, three (60%) had no parenchymal pulmonary opacities. Fourteen patients (median 13 years), most with comorbidities, had no acute myocardial injury. Chest radiographs in 13 (93%) demonstrated parenchymal lung disease with a predominant perihilar and basilar distribution. Conclusion Myocarditis without pulmonary disease occurred in children in their first decade as a component of MIS-C, a newly described syndrome of multisystemic inflammation requiring further investigation. Pulmonary disease dominated the radiographic features of COVID-19-positive adolescents in their second decade in whom radiographs demonstrated predominantly perihilar and basilar distribution of lung opacities. Keywords Adolescents . Children . Coronavirus . COVID-19 . Heart . Multisystem inflammatory syndrome . Myocarditis . Pneumonia . Radiography
Introduction Coronavirus disease 2019 (COVID-19), a disease caused by the severe acute respiratory syndrome coronavirus-2 (SARSCoV-2), was declared a pandemic by the World Health Organization on March 11, 2020 [1]. The infection has rapidly spread over the last months and led to more than 510,000 deaths around the world as of June 30 [2]. The highest
* Einat Blumfield [email protected] 1
Department of Radiology, Division of Pediatric Radiology, Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467, USA
morbidity
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