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Background: To date, less is known about the clinical features of COVID-19 pediatric patients admitting to ICUs. Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes between COVID-19 pediatric patients admitting to ICU and non-ICU settings.Methods: This multicenter study involved 15 general and pediatrics hospitals on confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive real-time reverse transcription polymerase chain reaction (RT-PCR) between March 19 and May 31, 2020, during the initial peak of the COVID-19 pandemic in Iran.Results: Overall, 166 patients were included, of which 61 (36.7%) required ICU admission, especially in PConclusions: Underlying diseases were the major contributing factors in COVID-19 pediatric patients for the increased ICU admissions and mortality rates. There are few paraclinical parameters for differentiating pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with younger age and underlying medical conditions and define strategies to control and prevent COVID-19 transmission in this population.

Background: The objectives of this study were to analyze the clinical features and laboratory profiles and risk factors associated with critical illness of children with SARS-CoV-2.Methods: 325 COVID-19 pediatric patients were recruited through a collaborative research network between March and May 2020. Demographics, clinical, laboratory, and radiological results were obtained from patient files. Results: Of 325 patients, 189 (58%) and 136 (42%) were males and females, respectively. The mean age was 6.18 ± 4.99. 195 (60%) and 130 (40%), had moderate and severe conditions, respectively. 45 (13.9%) of patients died. The common symptoms were fever (72.6%), cough (59%) and shortness of breath (36%). 254 (78%) and 145 (44.6%( had gastrointestinal and neurological symptoms, respectively. Shortness of breath, rhinorrhea, nausea/vomiting, decrease in platelet counts; increase values in C-reactive protein, lactate dehydrogenase (LDH), and blood urea nitrogen, decrease in the blood PH and HCo3 were significantly associated with the disease severity. 58.2% and 65.4% of patients showed abnormal radiographic appearance in Chest X-ray and in chest CT scan, respectively, which were correlated with disease severity. 104 (32%) of patients referred to ICU. The coexistence of comorbidity was the main factor associated with ICU admission, shock, arrhythmia, acute kidney injury, acute respiratory distress syndrome (ARDS), acute cardiac injury, and death. Conclusions: We describe a higher than previously recognized rate of COVID-19 mortality in Iranian pediatric patients. Epidemiological factors, such as relatively high case fatality rate in the country and the presence of underlying diseases are the main factors for the high death rate.