The impact of covid 19 on children from the Brazilian amazon region: clinical features, outcomes and associated factors

Objective: We aimed to describe the demographic, epidemiological, clinical, laboratory, imaging, and therapeutic characteristics of 90 pediatric coronavirus disease (COVID-19) patients, including severe cases and PMIS-TS. Methods: This prospective cohort study included all hospitalized children with confirmed COVID-19 admitted to four hospitals in the Brazilian Eastern Amazon. We excluded children with no molecular or serological positive test and no clinical-epidemiological presentation suggestive of SARS-CoV-2 infection. Results: The 90 participants were divided into three groups: ward group [18 (20%)], PMIS-TS group [30 (33.3%)] and pediatric intensive care unit (PICU) group [42 (46.7%)]. Among the PMIS-TS group, the median age was 59 months, and the most frequent age group was 2 to 5 years old [14(46.7%)]. Comorbidity had a high frequency ratio in all groups: ward [8 (44%), PMIS-TS: 22(73.3%)and PICU: 22(52%)]. Twenty-six (62%) patients had severe COVID-19. The median duration of invasive ventilation was 13 days in the PMIS-TS group. The overall mortality was 17deaths (18.9%). In the PMIS-TS group, pneumonia was diagnosed in 25 (83.3%) patients; 13 (43.3%) of them progressedtoacute respiratory distress syndrome. Additionally, male children, cutaneous rashes and longer duration of fever represented risk factors for PMIS-TS. Lymphopenia, hyperlactemia, hyperfibrinogenemia, hyperferritinemia, increased serum C-reactive protein, D-dimer and troponin levels were the main biological features in the patients with multiple organ dysfunctions. Conclusions: Comorbidities, cutaneous rashes and increased inflammatory markers in PMIS-TS patients indicate the subgroups that require great concern for development of severe COVID-19 in the Amazon region.