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Original research
COVID-19 international experience in paediatric patients with congenital heart disease
  1. Mary J Yeh1,
  2. Lisa Bergersen1,
  3. Kimberlee Gauvreau1,
  4. Oliver M Barry2,
  5. Sarosh P Batlivala3,
  6. Elsa Bjornlund1,
  7. Brian Boe4,
  8. Luiz Fernando Caneo5,
  9. Ulisses A Croti6,
  10. Thomas Doyle7,
  11. Shumaila Furnaz8,
  12. Rodrigo Cesar Moraes9,
  13. Michael L O'Byrne10,11,
  14. Erica de Oliveira Paes12,
  15. Alexis Palacios-Macedo13,
  16. Dimitar Pechilkov14,
  17. Nestor Fernando Sandoval15,
  18. Supratim Sen16,
  19. Mila Stajevic17,
  20. Marco Antonio Ferreira Travessa18,
  21. Kathy J Jenkins1
  1. 1 Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
  2. 2 The Congenital Heart Center, New York Presbyterian/Morgan Stanley Children’s Hospital, New York, New York, USA
  3. 3 Department of Pediatrics, Cincinnati Children's Hospital Medical Center Heart Institute, Cincinnati, Ohio, USA
  4. 4 The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA
  5. 5 Department of Cardiovascular Surgery, Instituto do Coracao do Hospital das Clinicas de Universidade de São Paulo, São Paulo, Brazil
  6. 6 Department of Pediatrics and Pediatric Surgery, CardioPedBrasil Children’s Heart Center, Hospital da Criança e Maternidade FUNFARME/FAMERP São José do Rio Preto, São Paulo, Brazil
  7. 7 Division of Pediatric Cardiology, Monroe Carell Junior Children's Hospital at Vanderbilt University Medical Center, Nashville, Tennessee, USA
  8. 8 Research Department, National Institute of Cardiovascular Disease, Karachi, Pakistan
  9. 9 Dr. Carlos Alberto Studart Gomes Hospital, Hospital de Messejana, Fortaleza, Brazil
  10. 10 Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  11. 11 Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  12. 12 UTI Cardiopediátrica and Neonatal, Hospital do Coração (HCor), São Paulo, Brazil
  13. 13 Department of Pediatric Cardiac Surgery, American British Cowdray Medical Center IAP, Mexico City, Mexico
  14. 14 Department of Pediatric Cardiology, Multiprofile Hospital for Active Treatment National Cardiology Hospital, Sofiâ, Bulgaria
  15. 15 Department of Cardiac Surgery, Fundación Cardioinfantil de Bogotá, Bogotá, Cundinamarca, Colombia
  16. 16 Department of Pediatric Cardiology, Narayana Health SRCC Children's Hospital, Mumbai, Maharashtra, India
  17. 17 Department for Pediatric Cardiothoracic Surgery, Mother and Children Health Institute, Belgrade, Serbia
  18. 18 Department of Cardiovascular Surgery, Hospital Gaspar Vianna, Belem, Brazil
  1. Correspondence to Dr Lisa Bergersen, Department of Cardiology, Boston Children's Hospital, Boston BCH 3215, Massachusetts, USA; lisa.bergersen{at}


Objective As COVID-19 continues to affect the global population, it is crucial to study the impact of the disease in vulnerable populations. This study of a diverse, international cohort aims to provide timely, experiential data on the course of disease in paediatric patients with congenital heart disease (CHD).

Methods Data were collected by capitalising on two pre-existing CHD registries, the International Quality Improvement Collaborative for Congenital Heart Disease: Improving Care in Low- and Middle-Income Countries and the Congenital Cardiac Catheterization Project on Outcomes. 35 participating sites reported data for all patients under 18 years of age with diagnosed CHD and known COVID-19 illness during 2020 identified at their institution. Patients were classified as low, moderate or high risk for moderate or severe COVID-19 illness based on patient anatomy, physiology and genetic syndrome using current published guidelines. Association of risk factors with hospitalisation and intensive care unit (ICU) level care were assessed.

Results The study included 339 COVID-19 cases in paediatric patients with CHD from 35 sites worldwide. Of these cases, 84 patients (25%) required hospitalisation, and 40 (12%) required ICU care. Age <1 year, recent cardiac intervention, anatomical complexity, clinical cardiac status and overall risk were all significantly associated with need for hospitalisation and ICU admission. A multivariable model for ICU admission including clinical cardiac status and recent cardiac intervention produced a c-statistic of 0.86.

Conclusions These observational data suggest risk factors for hospitalisation related to COVID-19 in paediatric CHD include age, lower functional cardiac status and recent cardiac interventions. There is a need for further data to identify factors relevant to the care of patients with CHD who contract COVID-19 illness.

  • COVID-19
  • Heart Defects, Congenital
  • Risk Factors
  • Global Health

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, LB, upon reasonable request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, LB, upon reasonable request.

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  • Correction notice This article has been corrected since it was first published to correct affiliation 17.

  • Contributors MJY drafted the initial manuscript, assisted in study design and collected data. LB assisted in study design, developing data collection tools and provided guidance in drafting the manuscript. KG guided and conducted all statistical analyses. OMB, SPB, BB, LFC, UAC, TD, SF, RCM, MLO’B, EdOP, AP-M, DP, NFS, SS, MS and MAFT all assisted in local data collection and provided critical reviews of the manuscript in the drafting and revision stages. EB assisted in data collection and revision of the manuscript, and site coordination. KJJ guided study design, development of the data collection tool, and provided expert oversight in drafting, revising and finalising the study and manuscript, and serves as the guarantor for this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.