Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 5 4 2021 07 04 e41 e41 Alireza Fahimzad Pediatric Infectious Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iraj Sedighi Department of Pediatric, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Neda Pak Children Medical Centre of Excellence, Tehran University of Medical Sciences, Tehran, Iran Mitra Khalili Radiology Department, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Farahmand Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza Shokrollahi Pediatric Medicine Research Center, Qom University of Medical Sciences, Qom, Iran Hosein Heydari Pediatric Medicine Research Center, Qom University of Medical Sciences, Qom, Iran Zahra Movahedi Pediatric Medicine Research Center, Qom University of Medical Sciences, Qom, Iran Anahita Sanaei Dashti Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Fatemeh Cheraghali Department of Pediatric, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran Ahmad Shamsizadeh Aboozar Children Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mohammadreza Mirkarimi Aboozar Children Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Mohsen Alisamir Aboozar Children Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Houman Hashemian Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran Jafar Soltani Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran Ali Hosseininasab Infectious and Tropical Research Center, Kerman University of Medical Sciences, Kerman, Iran Abdolkarim Hamedi Infection Control Hand & Hygiene Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Sadegh Rezai Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran Shirin Sayyahfar Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran Manijeh Kahbazi Infectious Diseases Research Center, Arak University of Medical Sciences, Arak, Iran Aliakbar Abedini Department of Pediatrics, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Afsaneh Akhondzadeh Infectious Disease Research Center (IDRC), Arak University of Medical Sciences, Arak, Iran Hamid Reza Sherkatolabbasieh Department of Pediatrics, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran Ali Akbar Razlansari Department of Pediatrics, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran Mina Alibeik Pediatric Infections Research Center, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Soheil Omid Malayeri Health Clinical Sciences Research Center, Zahedan Branch, Islamic Azad University, Zahedan, Iran Zohreh Shalchi Department of Pediatric, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Ali Shahabinezhad Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran Parinaz Khalkhali Asl Department of Microbiology, Faculty of Medicine, Golestsn University of Medical Sciences, Gorgan, Iran Yousef Erfani Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran Mehdi Norouzi Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Fatemeh Nafe Monfared Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Shiva Maleki Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Rezvan Kakavand Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Babak Shahbaz Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Vahdat Poortahmasebi Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran Sara Akhavan Rezayat Department of Health Care Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza Karimi Department of Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran Ali Jafarpour Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Saber Soltani Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Azam Ghaziasadi Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Razieh Dowran Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Shohreh Azimi Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran Shima Sadeghipour Marvi Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Foad Abazari Research Center for Clinical Virology, Tehran University of Medical Sciences, Tehran, Iran Milad Zandi Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Seyed Mohammad Jazayeri Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Ahmad Tavakoli Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran 2021 05 09 2021 06 22 Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions. https://fem.tums.ac.ir/index.php/fem/article/view/747 https://fem.tums.ac.ir/index.php/fem/article/download/747/362