Profile, risk factors for severe disease and predictors of mortality in children with COVID-19: experience from a tertiary COVID-care center in India

Background: Knowledge of pediatric COVID-19 is important to determine those at risk for severe disease and mortality. There is limited data on risk factors for development of severe disease and predictors of mortality amongst children with COVID-19, especially from the developing nations. We aimed to study the profile, risk factors for severe COVID-19 and predictors of mortality in children with laboratory confirmed COVID-19.Methods: This prospective observational study was conducted from April to September 2020 in the Department of Pediatrics of a referral COVID-care hospital in Northern-India. All children 1 month to 18 years of age, hospitalized in the Pediatrics Department and having a positive Reverse Transcriptase-Polymerase chain reaction (RT-PCR) for SARS-CoV-2 infection on their combined oro-nasopharyngeal swab were enrolled.Results: A total of 335 SARS-CoV-2 positive children were enrolled with median age of 6 years, slight male predominance (54%) and 24.4% infants. Commonest presentations were respiratory (47.7%), gastrointestinal (33.3%) and neurological (14.9%) with moderate/severe disease in 24%, mortality in 4.8%, co-morbidities in 20.5% and co-infections in 17.9%. Risk factors for severe disease were underlying co-infection (p=0.017), associated tuberculosis (p=0.0015), associated culture positive bacterial sepsis (p=<0.001) and being underweight (p<0.001). Overweight/obese children had less severe COVID-19 (p=0.0016). Predictors of mortality were co-infections (p=0.0019), hypoxia (p<0.001), neurological manifestations (p=0.016), acute respiratory distress syndrome (p<0.001), acute kidney injury (p=0.05), shock (p<0.001), thrombocytopenia (p=0.021), leucopenia (p=0.028), lymphopenia (p=0.021), high Neutrophil:Lymphocyte ratio (p=0.02), coagulopathy (p=0.02), azotemia (p=0.038) and raised creatinine (p=0.05).Conclusions: Children with identified risk factors for severe disease and mortality should receive prioritized treatment.

Clinical profile of Group A meningococcal outbreak in Delhi.

We present a retrospective analysis of clinical profile of 100 children admitted to a Government hospital at Delhi between April 2005 and December 2006 with group A meningococcal infection. Maximum children presented in late winter and spring.Younger children were less affected (5% children < 1 year). Fever (86%), vomiting (64%) and rash (63%) were the most common presenting symptoms. All children presented within 5 days of onset of symptoms and 52% within 24 hours. 67 % children had meningococcal meningitis; 20% had meningococcemia; and 13% had both. Overall mortality was 17%. Altered sensorium and shock at presentation significantly increased the mortality. All culture positive cases had group A Neisseria meningitides. All meningococcal isolates were sensitive to penicillin/ampicillin, ciprofloxacin, ceftriaxone, chloramphenicol and erythromycin except, one each resistant to ampicillin and erythromycin.

Diagnosing Cholera in The Young: A Review of W.H.O. Criteria.

This study was undertaken to study the occurrence of cholera in young children with a view to define the clinical criteria of diagnosis and endemicity of cholera in Delhi and to compare its clinical profile with rotavirus diarrhea. Hundred children below 3 years of age admitted with acute watery diarrhea were recruited. The severity of diarrhea and degree of dehydration were noted. Stool specimens collected from all cases were subjected to bacterial culture for identification of Vibrio cholerae and rotavirus detection by ELISA and PAGE techniques. Both Vibrio cholerae and rotavirus were detected in 5, Vibrio cholerae alone in 13 and rotavirus alone in 18 cases. Sixty-one percent cases of cholera occurred in children below two years. Rice watery stools were seen only in 28% (5/18) cases of cholera. Three (3/13) cases with cholera alone and 6/18 with rotavirus alone had mild diarrhea. Moderate diarrhea occurred in 3/5 cases with both pathogens, 6/13 with cholera alone and 7/18 with rotavirus alone. Severe diarrhea occurred in 3/5 cases with both pathogens, 4/13 with cholera alone, and 5/18 cases with rotavirus alone. Mild dehydration occurred in 3/5 and severe dehydration in 2/5 children with both pathogens. Only 3/13 children with cholera alone and one child with rotavirus alone were severely dehydrated. It is concluded that considering the diagnosis of cholera solely on clinical grounds and overlap between the clinical spectrum of cholera and rotavirus diarrhea would result in missing many cholera cases in a non-endemic area like Delhi.

Malignant hypertension in a child with solitary functioning hydronephrotic kidney.

A child with solitary functioning hydronephrotic kidney and hypertensive encephalopathy is described. Removal of the contralateral dysplastic kidney failed to normalize his blood pressure.