526. Clinical Presenting Characteristics of Pediatric COVID-19 Infection in a Tertiary Care Children’s Hospital in Detroit

Background: There is limited data regarding the presenting clinical characteristics of COVID-19 in children Our objective is to describe the clinical presentations and outcomes of COVID-19 infection early in the pandemic at our institution Methods: We performed a retrospective chart review of children up to 18 years who underwent testing for SARS CoV-2 from March 1st to May 10th 2020 at our pediatric emergency department We abstracted patient's demographics, clinical presentation, diagnostic studies and patient disposition We classified the severity of clinical illness based on published criteria We excluded patients diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 Results: SARS CoV-2 testing was performed on 481 patients of whom 43 (8 9%) tested positive Of these, 4 were diagnosed with MIS-C Data of 39 patients were analyzed Patients' demographics, co-morbidities, presenting signs and symptoms and disposition are shown in Table 1 Age range was 47 days - 18 years Infants representing one third (14/39;35 9%) of our study cohort There was equal sex distribution Asthma or obesity was present in 17 (44%) The most common presenting symptoms included fever, cough, shortness of breath and diarrhea Chest radiograph showed pneumonia in 12 (30 8%) patients Two thirds (27/39;69 2%) were asymptomatic or had mild disease;six patients (15 4%) had severe or critical illness (Figure 1) Nineteen (48%) patients were admitted to the general pediatric service Eleven (28%) were admitted to the Intensive Care Units (ICU) The characteristics, presenting symptoms and interventions performed in the PICU cohort are shown in Table 2 Half of these patients required mechanical ventilation There was one death in a 3 month old infant unrelated to SARS CoV-2 Majority of the infants required hospitalization (12/14;85 7%), including 4 to the PICU (one each for non accidental trauma, ingestion, seizure and pneumonia) Conclusion: Majority (17;43%) of our children with COVID-19 had a mild disease Eleven (28%) including 4 infants required critical care;5 required mechanical ventilation There was no COVID-19 related mortality Larger studies are needed to further define the spectrum of COVID- 19 and risk factors associated with severe disease in children (Table Presented)