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Similar to adults, most children hospitalized for COVID-19 had pre-existing conditions, with nearly 40% who required invasive mechanical ventilation, a small study of U.S. and Canadian pediatric intensive care units (PICUs) found.

Among 48 children admitted, , while 11 had failure of two or more organ systems, reported Lara Shekerdemian, MD, of Baylor College of Medicine in Houston, and colleagues in the International COVID-19 PICU Collaborative.

At the end of the follow-up period, two patients had died and 15 were still hospitalized, with three still requiring ventilatory support and one who was receiving extracorporeal membrane oxygenation, the authors wrote online in JAMA Pediatrics.

Children have comprised a minority of hospitalizations for COVID-19 in the U.S., with the authors citing CDC data from April that found only 1.7% of 150,000 known cases of COVID-19 infection were children, 15 of whom were admitted to an intensive care unit and three of whom died.

The authors explained that more than 300 pediatric ICU and infectious diseases specialists from more than 100 of the largest pediatric hospitals across six continents formed the International COVID-19 PICU Collaborative, "to share best practices and real-time information from across the world on critical illness caused by COVID-19 in children."

The researchers collected data from a retrospective medical record review of pediatric patients in 40 U.S. and six Canadian PICUs from March 14 to April 3, with outcome follow-up through April 10.

Of the 48 children under age 21 admitted, half were boys and the median age was 13, though children ranged from age 4 to about 17. Thirty-five patients presented with respiratory symptoms, although three had diabetic ketoacidosis and a young infant had sickle cell disease and a vaso-occlusive crisis that presented with bone pain.

Notably, the researchers said, 24 patients in the cohort had one comorbidity. Nineteen were classified as "medically complex" (defined as long-term dependence on technological support associated with developmental delay or genetic anomalies), 11 had immunosuppression, seven had obesity, and four had diabetes.

There were 33 of 48 patients severely or critically ill on admission and 12 who required vasoactive drugs. In addition, 39 patients required respiratory support, and 21 of those were managed non-invasively, with the remaining 18 requiring endotracheal or tracheostomy ventilation. Six children required adjunctive ventilatory interventions or extracorporeal therapies.

While 28 patients received a variety of specific therapies, hydroxychloroquine was the most common, used in 11 patients, and in combination in 11 patients, the team reported. Remdesivir was used in eight patients -- by itself in two patients and in combination in the other six patients.

The two patients who died were ages 12 and 17, both with pre-existing comorbidities and both who developed multi-system organ failure, the authors said. They noted a 4.2% case fatality rate up to the time of the report.

Median PICU stay was 5 days, with a median hospital length of stay of 7 days for those who had been discharged.

The authors said they were "cautiously encouraged" by the hospital outcomes, given that the patients in this series have an overall ICU mortality rate of less than 5% compared with much higher mortality rates of 50% to 62% for adults admitted to the ICU.

Finally, Shekerdemian and co-authors emphasized that the burden of COVID-19 infection in children was much lower compared with seasonal influenza, with CDC reporting eight deaths in children ages 14 and younger related to COVID-19 compared with 169 influenza-related deaths in the same age group during the 2019-2020 flu season, as of April 28.

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