Profile of Critical COVID-19 Illness in Children During the Second and Third Wave of the Pandemic: A Single Center Study from South India

Aims : To describe the clinical characteristics of children with critical COVID-19 illness from a single tertiary referral center during the second and third waves to understand the burden of critical COVID-19 illness in children which may guide preparedness in terms of resources, training, and services. Methods: A prospective observational study of critical COVID-19 children under the age of 18 years admitted to a ten-bedded PICU during the second wave (April-July 2021) and third wave (December-February 2022) of the COVID-19 pandemic. We categorized the children into 1) Acute COVID-19 infection and 2) Multi-inflammatory Syndrome in Children - MISC (post COVID-19/MISC secondary to acute COVID-19 infection). Demographic data, clinical data, investigations, treatment given, and outcome measures were studied. Results: Seventy-six critical COVID-19 illness admissions occurred with male preponderance. Sixty-two (81%) children presented with acute COVID-19 illness, 20 in the second wave and 42 in the third wave. Respiratory symptoms (85% vs 30%) predominated during the second wave and neurological symptoms (35% vs 20%) during the third wave. Critical care interventions were higher in the second wave. Neurological comorbidity led to mortality (5% vs 2%). MISC was seen in fourteen (19%) children. Intravenous immunoglobulin and methylprednisolone were given more during the third wave (80% vs 11%). One child in each wave died (11 % vs 20%). Conclusions: The clinical profile of children with critical COVID-19 illness has been changing and becoming progressively complex and atypical during each wave with significant morbidity but with good clinical outcomes/recovery rate.