Pre-existing Immunocompromising Conditions and Outcomes of Acute COVID-19 Patients Admitted for Pediatric Intensive Care


Courtney M. Rowan, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
Brenna LaBere, Harvard Medical School, Boston, MA
Cameron C. Young, Boston Children's Hospital, Boston, MA
Laura D. Zambrano, Centers for Disease Control and Prevention, Atlanta, GA
Margaret M. Newhams, Boston Children's Hospital, Boston, MA
Suden Kucukak, Boston Children's Hospital, Boston, MA
Elizabeth R. McNamara, Boston Children's Hospital, Boston, MA
Elizabeth H. Mack, Medical University of South Carolina, Charleston, SC
Julie C. Fitzgerald, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Katherine Irby, Arkansas Children's Hospital, Little Rock, AR
Aline B. Maddux, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
Jennifer E. Schuster, Children's Mercy Kansas City, Kansas City, MO
Michele Kong, University of Alabama at Birmingham, Birmingham, AL
Heda Dapul, Hassenfeld Children's Hospital at NYU Langone, New York, NY
Stephanie P. Schwartz, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill, NC
Melania M. Bembea, Johns Hopkins University School of Medicine, Baltimore, MD
Laura L. Loftis, Baylor College of Medicine, Houston, TX
Amanda R. Kolmar, Washington University in St. Louis, St. Louis, MO
Christopher J. Babbitt, Miller Children's and Women's Hospital of Long Beach, Long Beach, CA
Ryan A. Nofziger, Akron Children's Hospital, Akron, OH
Mark W. Hall, Nationwide Children's Hospital, Columbus, OH
Shira J. Gertz, Cooperman Barnabas Medical Center, Livingston, NJ
Natalie Z. Cvijanovich, UCSF Benioff Children's Hospital Oakland, Oakland, CA
Matt S. Zinter, University of California San Francisco, San Francisco, CA
Natasha B. Halasa, Vanderbilt University Medical Center, Nashville, TN.
Tamara T. Bradford, LSU Health Sciences Center - New OrleansFollow
Gwenn E. McLaughlin, University of Miami Miller School of Medicine, Miami, FL
Aalok R. Singh, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, NY
Charlotte V. Hobbs, University of Mississippi Medical Center, Jackson, MS
et al

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Clinical Infectious Diseases


BACKGROUND: We aimed to determine if pre-existing immunocompromising conditions (ICCs) were associated with the presentation or outcome of patients with acute coronavirus disease 2019 (COVID-19) admitted for pediatric intensive care. METHODS: 55 hospitals in 30 U.S. states reported cases through the Overcoming COVID-19 public health surveillance registry. Patients < 21 years admitted March 12, 2020-December 30, 2021 to the pediatric intensive care unit (PICU) or high acuity unit for acute COVID-19 were included. RESULTS: Of 1,274 patients, 105 (8.2%) had an ICC including 33 (31.4%) hematologic malignancies, 24 (22.9%) primary immunodeficiencies and disorders of hematopoietic cells, 19 (18.1%) nonmalignant organ failure with solid organ transplantation, 16 (15.2%) solid tumors and 13 (12.4%) autoimmune disorders. Patients with ICCs were older, had more underlying renal conditions, and had lower white blood cell and platelet counts than those without ICCs, but had similar clinical disease severity upon admission. In-hospital mortality from COVID-19 was higher (11.4% vs. 4.6%, p = 0.005) and hospitalization was longer (p = 0.01) in patients with ICCs. New major morbidities upon discharge were not different between those with and without ICC (10.5% vs 13.9%, p = 0.40). In patients with ICC, bacterial co-infection was more common in those with life-threatening COVID-19. CONCLUSIONS: In this national case series of patients < 21 years of age with acute COVID-19 admitted for intensive care, existence of a prior ICCs were associated with worse clinical outcomes. Reassuringly, most patients with ICCs hospitalized in the PICU for severe acute COVID-19 survived and were discharged home without new severe morbidities.

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