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

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

doi:10.3389/fmed.2023.987194

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

Front Med (Lausanne). 2023 Feb 17:10:987194. doi: 10.3389/fmed.2023.987194. eCollection 2023.

Authors

Olufunke Y Martin¹, Deepika S Darbari^{1

2}, Stefanie Margulies¹, Robert S Nickel^{1

2}, Alexis Leonard^{1

2}, Barbara Speller-Brown^{1

2}, Brenda Martin¹, John R Barber³, Jennifer Webb^{1

2}, Suvankar Majumdar^{1

2}, Matthew P Sharron^{2

4}, Andrew D Campbell^{1

2}

Affiliations

¹ Center for Cancer and Blood Disorders, Division of Hematology, Children's National Hospital, Washington, DC, United States.
² George Washington University School of Medicine and Health Sciences, Children's National Hospital, Washington, DC, United States.
³ Department of Biostatistics and Study Methodology, Children's National Hospital, Washington, DC, United States.
⁴ Department of Pediatrics, The George Washington University School of Medicine, Washington, DC, United States.

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, there are a limited number of primarily multi-center studies reporting 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. 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).

Conclusion: 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. We observed no mortality despite variable morbidity.

Keywords: COVID-19; SARS-CoV-2; morbidity; mortality; pediatrics–children; sickle cell disease (SCD).

Grants and funding

This study was supported by Children’s National Sickle Cell Research Fund; Dr. Beth Tarini Children’s National Internal Research Funding.