Abstract
AIM: To describe the characteristics of severe and critically ill children with first-wave SARS-CoV-2 Omicron infection admitted to the pediatric intensive care unit (PICU) at the National Children's Regional Medical Center in Northeast China and to explore factors associated with poor outcomes. METHODS: This observational cohort study was conducted in a PICU in northeastern China and included children under 18 years of age who were severely and critically ill due to SARS-CoV-2 Omicron infection between December 2022 and February 2023. Patients were categorized into two groups: the invasive mechanical ventilation (IMV) group and the non-IMV group. The primary outcome measured was the need for IMV, while secondary outcomes included death or prolonged PICU stay. Univariate and multivariate logistic regression analyses were performed to identify risk factors for poor outcomes. RESULTS: A total of 38 severe and critically ill children were included in the study. Of these, 25 (66%) were diagnosed with respiratory failure, and four (16%) developed acute respiratory distress syndrome. Additionally, 21 (55%) were diagnosed with COVID-19-associated neurological disorders, and 18 (47%) received IMV. Multivariate logistic regression analysis identified the chest computed tomography (CT) score, based on the COVID-19 Risk Assessment and Diagnosis System (CO-RADS), was statistically significant as an independent predictor for IMV in severe and critically ill children (odds ratio [OR]: 2.781 [95% confidence interval (CI): 1.021-7.571]). Furthermore, the Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score and serum aspartate aminotransferase (AST) levels at admission were found to be independent predictors of death or prolonged PICU stay. CONCLUSIONS: Respiratory failure and COVID-19-associated neurological disorders were the most common complications among severe and critically ill children with first-wave SARS-CoV-2 Omicron infection. Chest CT score, PELOD-2 score, and serum AST levels may serve as important indicators of poor outcomes in this patient population.