95 COVID and PIMS-TS: the paediatric experience (the barts health edition). (17th August 2022)

• Record Type: Journal Article
• Authors: Kanani, Shivan; Yoong, Michael
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A358
• Page End: A359
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.579
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : NHS Aims: An observational cohort study to examine associations between COVID-19 and paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) directed therapies and patient characteristics and outcomes among children with confirmed or presumed COVID-19. Methods: Data was collected from 19 th January 2020 to 3 rd March 2021. Inclusion criteria was all infants, children and young adults <16 years of age with confirmed or suspected COVID-19 or PIMS-TS. Exclusions included children with positive screening swabs for elective surgery or chemotherapy and positive swabs in the emergency department in patients who were either not admitted or transferred to another hospital due to capacity issues. For suspected PIMS-TS, the RCPCH consensus guidelines were used. Data was collected from all hospitals within Barts NHS Trust. Baseline patient characteristics were recorded and included patient gender, age, ethnicity and presence of co-morbidities. Clinical data during time in critical care (PICU) included presence and time from initial illness to onset of complications, COVID-19 diagnosis method, physiological parameters, blood markers and further imaging results. Clinical treatment interventions included duration and type of organ support and treatment options for COVID-19 and PIMS-TS. Clinical outcome data included in-hospital mortality, discharge destination, hospital and PICU lengths of stay. Results: Over the 15 month period, 235 patients had either a positive of suspected COVID-19 diagnosis, with 35 of them being treated for PIMS-TS. 55% were male and the mean age was 6.17. There was an over-representation of BAME, with 70% of patients falling in this category ( figure 1 ). 35% of patients had multiple co-morbidities. Fever was found to be the most common symptom ( figure 2 ). From a critical care aspect, we found that 26 patients required PICU admission, with 10 of them requiring invasive ventilation and 6 patients requiring non-invasive ventilation. The majority had multiple co-morbidities. They were treated with a combination of various forms of steroids, IV immunoglobulin (all 26 cases) and high dose aspirin (24 cases). We are pleased to report, during this period of data collection, there were no fatalities. In regards to PIMS-TS, 35 patients fulfilled the criteria, with a mean age of 7.14. 9 were admitted to PICU, with 2 requiring invasive ventilation. Average admission length in PICU was only 2.44 days with a total hospital admission of 5.63 days. Most surprisingly, only 1 patient had a cardiac past medical history, the rest had no comorbidities. Secondly, it took on average 15.3 days between presumed diagnosis of COVID-19 and admission to hospital, with the majority having a negative PCR. Conclusion: A large cohort of children were admitted with COVID-19, with a significant over-representation of BAME, neonates and children with multiple co-morbidities. Fever was the most common symptom. In regards to critical care requirements, over 11% of admissions required PICU input. Interestingly, in regards to PIMS-TS, those requiring intervention often had no co-morbidities and were likely to be normal at baseline. Long term follow up will be required for these patients to truly understand the effects both COVID-19 and PIMS-TS have had on the paediatric population.