Severe community-acquired pneumonia in children: what happened before and during the COVID-19 pandemic?

Introduction: Hospitalizations for severe pneumonia in children were less frequent during the COVID-19 pandemic than years before. On the other hand, worse outcomes were observed in the pandemic. Objective: to describe the clinical-epidemiological profile, complications, and outcomes of children hospitalized with CAP in a Pediatric Intensive Care Unit (PICU) in Niteroi, state of Rio de Janeiro, Brazil, before and during the COVID-19 pandemic. Methodology: descriptive, cross-sectional and retrospective study, carried out with children, aged 1 month to 11 years, between January 2017 and October 2022, through data collection in electronic medical records. Results: Of the 286 cases, 152 (53%) were male, 239 (83%) were under five years, and 73 (25.5%) were hospitalized during the pandemic. The average length of stay was 7.7 days for CAP and 15.4 days for complicated CAP. Comorbidities were found in 148 (51%) cases. Complications occurred in 101 (35%) cases, with a higher prevalence ratio during the pandemic (p-value < 0.05). All seven deaths were associated with severe sepsis and invasive mechanical ventilation, and six (83%) of them had comorbidities. During the pandemic, there were more cases of respiratory failure requiring invasive mechanical ventilation (p-value < 0.05). Only one case of CCAP due to SARS-CoV-2 (COVID-19) was found. Conclusions: Although the number of hospitalizations due to CAP was lower during the pandemic, there was a higher prevalence of both complications and severity. Sepsis, invasive mechanical ventilation necessity, and comorbidities were associated with death. Comorbidity was the main risk factor associated with severity and complications.