Characteristics of critical Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) infection in children is not well understood. This study described the clinical characteristics of children admitted to intensive care units (ICU) and explored factors associated with the need for invasive ventilation or mortality. A multicenter, retrospective, cohort study was conducted over eight medical centers, including all patients younger than 18 years of age and admitted to the ICU due to a direct consequence of coronavirus disease 2019 (COVID-19). Patients who were admitted to the ICU for any alternate reason and tested positive for SARS-CoV-2 by screening test, and patients who were admitted due to multi-inflammatory syndrome in children, were excluded. Demographic, laboratory, imaging, and clinical data were collected. Descriptive statistics were used to compare survivors and non-survivors. Fine and Gray’s hazard model was used to estimate the association between clinical variables and ICU death. During the study period, 25 pediatric COVID-19 patients received care in the ICUs. The median age was 2.78 years (IQR 0.21–8.51), and 60% were male. Only three patients were reported to be previously healthy at admission. Nine (36%) patients required invasive mechanical ventilation, including two were on extracorporeal membrane oxygenation. Four (16%) patients died during ICU care. In univariate analysis, the presence of comorbidity (HR 0.0001; 95%CI 0.00001–0.00016), platelets count (HR 0.99; 95% CI 0.98–0.99), elevated procalcitonin (HR 1.05; 95%CI 1.016–1.09), and circulatory compromise (HR 16.34; 95%CI 1.99–134.35), all at the time of ICU admission, were associated with in-ICU mortality. Our findings suggest that children admitted to the ICU with SARS-CoV-2 infection, generally, have a favorable outcome. Low platelets count, elevated procalcitonin, presence of comorbidity, and shock at the time of ICU admission were associated with death. This study may shed more light on the disease dynamics of critical pediatric COVID-19.

Objective Subsequent protection from SARS-CoV-2 infection in paediatrics is not well reported in the literature. We aimed to describe the clinical characteristics and dynamics of SARS-CoV-2 PCR repositivity in children. Design This is a population-level retrospective cohort study. Setting Patients were identified through multiple national-level electronic COVID-19 databases that cover all primary, secondary and tertiary centres in Kuwait. Participants The study included children 12 years and younger between 28 February 2020 and 6 March 2021. SARS-CoV-2 reinfection was defined as having two or more positive SARS-CoV-2 PCR tests done on a respiratory sample, at least 45 days apart. Clinical data were obtained from the Pediatric COVID-19 Registry in Kuwait. Primary and secondary outcome measures The primary measure is to estimate SARS-CoV-2 PCR repositivity rate. The secondary objective was to establish average duration between first and subsequent SARS-CoV-2 infection. Descriptive statistics were used to present clinical data for each infection episode. Also, incidence-sensitivity analysis was performed to evaluate 60-day and 90-day PCR repositivity intervals. Results Thirty paediatric patients with COVID-19 had SARS-CoV-2 reinfection at an incidence of 1.02 (95% CI 0.71 to 1.45) infection per 100 000 person-days and a median time to reinfection of 83 (IQR 62–128.75) days. The incidence of reinfection decreased to 0.78 (95% CI 0.52 to 1.17) and 0.47 (95% CI 0.28 to 0.79) per person-day when the minimum interval between PCR repositivity was increased to 60 and 90 days, respectively. The mean age of reinfected subjects was 8.5 (IQR 3.7–10.3) years and the majority (70%) were girls. Most children (55.2%) had asymptomatic reinfection. Fever was the most common presentation in symptomatic patients. One immunocompromised experienced two reinfection episodes. Conclusion SARS-CoV-2 reinfection is uncommon in children. Previous confirmed COVID-19 in children seems to result in a milder reinfection.

Background: The Outpatient Parenteral Antimicrobial Therapy (OPAT) Clinic at the Alberta Children’s Hospital (ACH) offers a vital service, enabling stable pediatric patients to receive intravenous (IV) antimicrobial therapy on an outpatient basis. Established in 1997, the program aims to reduce hospital admissions and enhance patient experience. Eligible patients with various infectious conditions receive initial treatment in the emergency department before transitioning to outpatient care. The program not only improves patient satisfaction but also minimizes the risks associated with hospital stays, such as hospital‐acquired infections, while addressing the challenges of antibiotic stewardship and monitoring for potential complications. This study seeks to characterize OPAT outcomes in pediatric patients, filling a gap in existing literature. Methods: We conducted a retrospective descriptive study reviewing records of patients under 18 years of age treated with IV antimicrobials as outpatients within the OPAT program. Data were collected from electronic hospital records from May 1, 2023, to May 31, 2024. All data entries were recorded in REDCap as our data management platform. Result: The study included 902 pediatric participants, with 455 males (50.4%); 32.9% were 1–5 years of age, followed by 26.9% of 6–10 years of age. The most common diagnoses were cellulitis (15.7%), genitourinary (GU) infections (15.5%), dental infections (9.8%), and pneumonia (8.2%). Ceftriaxone was the primary IV antibiotic for GU infections, while cefazolin was commonly used for cellulitis and dental infections. Of the total participants, 8% required hospitalization due to worsening infection or to increase the frequency of antibiotics. Additionally, a higher rate of admission was noted in males ( p = 0.03). Most patients (97%) received peripheral IV access with minimal complications. Overall, OPAT demonstrated high efficacy and safety in managing pediatric infections. Conclusion: This study underscores the safety of OPAT. Supported by a multidisciplinary team, the program effectively treated common infections primarily using ceftriaxone. Most patients maintained peripheral IV access without significant complications. While hospitalization rates were low, notable differences between male and female patients warrant further investigation into contributing factors to these disparities.