AUTHOR=Martin Olufunke Y. , Darbari Deepika S. , Margulies Stefanie , Nickel Robert S. , Leonard Alexis , Speller-Brown Barbara , Martin Brenda , Barber John R. , Webb Jennifer , Majumdar Suvankar , Sharron Matthew P. , Campbell Andrew D. 

TITLE=Clinical outcomes of children and adolescents with sickle cell disease and COVID-19 infection: A year in review at a metropolitan tertiary pediatric hospital

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.987194

DOI=10.3389/fmed.2023.987194

ISSN=2296-858X

ABSTRACT=Background: COVID-19 was declared a global pandemic in March 2020. Early reports were primarily in adults, and sickle cell disease (SCD) was classified as a risk factor for severe COVID-19 disease.  However, a limited number of small, primarily multi-center studies report on the clinical course of pediatric patients with SCD and COVID-19.

Methods: We conducted an observational study of all patients with SCD diagnosed with COVID-19 at our institution between March 31, 2020, and February 12, 2021.  Demographic and clinical characteristics of this group were collected by retrospective chart review.  

Results: A total of 55 patients were studied, including 38 children and 17 adolescents.  Demographics, acute COVID-19 clinical presentation, respiratory support, laboratory findings, healthcare utilization, and SCD modifying therapies were comparable between the children and adolescents s.  Seventy-three percent (N=40) of all patients required emergency department care or hospitalization. While 47% (N=26) were hospitalized, only 5% (N=3) of all patients required intensive care unit admission.  Patients frequently had concurrent vaso-occlusive pain crisis (VOC) (N=17, 43%) and acute chest syndrome (ACS) (N=14, 35%).  Those with ACS or an oxygen requirement had significantly higher white blood cell count, lower nadir hemoglobin, and higher D-dimers, supporting a pro-inflammatory and coagulopathic picture.  Non-hospitalized patients were more likely to be on hydroxyurea than hospitalized patients (79% vs. 50%, p=0.023). 

Conclusions: Children and adolescent patients with SCD and acute COVID-19 often present with ACS and VOC pain requiring hospital-level care. Hydroxyurea treatment appears to be protective. While the morbidity was variable, there was no mortality.