Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 1;149(1):e2021053418.
doi: 10.1542/peds.2021-053418. Epub 2021 Dec 22.

Risk Factors for Severe COVID-19 in Children

Rebecca C Woodruff  1   2 , Angela P Campbell  1 , Christopher A Taylor  1 , Shua J Chai  2   3   4 , Breanna Kawasaki  5 , James Meek  6 , Evan J Anderson  7   8   9 , Andy Weigel  10 , Maya L Monroe  11 , Libby Reeg  12 , Erica Bye  13 , Daniel M Sosin  14   15 , Alison Muse  16 , Nancy M Bennett  17 , Laurie M Billing  18 , Melissa Sutton  19 , H Keipp Talbot  20 , Keegan McCaffrey  21 , Huong Pham  1 , Kadam Patel  1   22 , Michael Whitaker  1 , Meredith L McMorrow  1   2 , Fiona P Havers  1   2
Affiliations

Risk Factors for Severe COVID-19 in Children

Rebecca C Woodruff et al. Pediatrics. .

Abstract

Objectives: Describe population-based rates and risk factors for severe coronavirus disease 2019 (COVID-19) (ie, ICU admission, invasive mechanical ventilation, or death) among hospitalized children.

Methods: During March 2020 to May 2021, the COVID-19-Associated Hospitalization Surveillance Network identified 3106 children hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection in 14 states. Among 2293 children primarily admitted for COVID-19, multivariable generalized estimating equations generated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) of the associations between demographic and medical characteristics abstracted from medical records and severe COVID-19. We calculated age-adjusted cumulative population-based rates of severe COVID-19 among all children.

Results: Approximately 30% of hospitalized children had severe COVID-19; 0.5% died during hospitalization. Among hospitalized children aged <2 years, chronic lung disease (aRR: 2.2; 95% CI: 1.1-4.3), neurologic disorders (aRR: 2.0; 95% CI: 1.5‒2.6), cardiovascular disease (aRR: 1.7; 95% CI: 1.2‒2.3), prematurity (aRR: 1.6; 95% CI: 1.1‒2.2), and airway abnormality (aRR: 1.6; 95% CI: 1.1‒2.2) were associated with severe COVID-19. Among hospitalized children aged 2 to 17 years, feeding tube dependence (aRR: 2.0; 95% CI: 1.5‒2.5), diabetes mellitus (aRR: 1.9; 95% CI: 1.6‒2.3) and obesity (aRR: 1.2; 95% CI: 1.0‒1.4) were associated with severe COVID-19. Severe COVID-19 occurred among 12.0 per 100 000 children overall and was highest among infants, Hispanic children, and non-Hispanic Black children.

Conclusions: Results identify children at potentially higher risk of severe COVID-19 who may benefit from prevention efforts, including vaccination. Rates establish a baseline for monitoring changes in pediatric illness severity after increased availability of COVID-19 vaccines and the emergence of new variants.

PubMed Disclaimer

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Mr Meek and Dr Sutton report receiving funding from the Centers for Disease Control and Prevention (CDC) Emerging Infections Program cooperative agreement. Ms Reeg and Ms Billing report receiving a CDC federal grant from the Council of State and Territorial Epidemiologists. Ms Billing reports receiving Epidemiology and Laboratory Capacity grant funding from CDC to support vaccine preventable disease epidemiology staffing and additionally report receiving Immunizations and Vaccines for Children grant funding from CDC. Dr Anderson has consulted for Pfizer, Sanofi Pasteur, Janssen, and Medscape, and his institution receives funds to conduct clinical research unrelated to this article from MedImmune, Regeneron, PaxVax, Pfizer, GSK, Merck, Sanofi Pasteur, Janssen, and Micron. He also serves on a safety monitoring board for Kentucky BioProcessing, Inc. and Sanofi Pasteur. His institution has also received funding from National Institutes of Health to conduct clinical trials of Moderna and Janssen COVID-19 vaccines.

Figures

FIGURE 1
FIGURE 1
Demographic characteristics associated with severe COVID-19. Demographic characteristics and ≥1 underlying conditions associated with ICU admission, invasive mechanical ventilation, or death among children <18 years hospitalized with COVID-19: 14 states, March 2020 to May 2021. a Includes non-Hispanic American Indian or Alaskan Native, non-Hispanic multiple races, or unknown. b Private residence includes home with services. Congregate setting includes hospitalized since birth, group home/retirement, homeless shelter, psychiatric facility, facility, long-term acute care hospital, corrections facility, other, and unknown. c Includes obesity (among those aged 2‒17 years); prematurity (among those aged <2 years); chronic lung disease; airway abnormality; neurologic disorders; immunocompromised conditions; feeding tube dependence; cardiovascular disease; chronic metabolic disease; blood disorders; gastrointestinal or liver disease; renal disease; rheumatologic, autoimmune, or inflammatory conditions; or other conditions.
FIGURE 2
FIGURE 2
Underlying conditions associated with severe COVID-19 by age group. Underlying conditions associated with ICU admission, invasive mechanical ventilation, or death among children (A) aged <2 years and (B) aged 2‒17 years hospitalized with COVID-19: 14 states, March 2020 to May 2021. a Multivariable models are adjusted for age group, sex, race and ethnicity group, and housing type. b Born <37 weeks’ gestational age. c Includes immunocompromised conditions, liver disease, chronic metabolic disease, blood disorders, renal disease, and other disease specified on the case report form. d Children aged 2 to 17 years were classified as having obesity if they had body mass index (kg/m2) ≥95th percentile for age and sex based on CDC growth charts, ICD-10 codes for obesity in the electronic medical record, or obesity selected on the COVID-NET case report form. e Chronic lung disease excludes asthma, chronic metabolic disease excludes type 1 or 2 diabetes mellitus, and neurologic disorder excludes developmental delay. fIncludes liver disease; renal disease; rheumatologic, autoimmune, and inflammatory conditions; and other conditions specified on the case report form.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention . COVID data tracker. Available at: https://covid.cdc.gov/covid-data-tracker/#datatracker-home. Accessed February 1, 2021
    1. Garg S, Kim L, Whitaker M, et al. . Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 - COVID-NET, 14 states, March 1-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):458–464 - PMC - PubMed
    1. Kim L, Whitaker M, O’Halloran A, et al. ; COVID-NET Surveillance Team . Hospitalization rates and characteristics of children aged< 18 years hospitalized with laboratory-confirmed COVID-19 - COVID-NET, 14 states, March 1-July 25, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1081–1088 - PMC - PubMed
    1. Fernandes DM, Oliveira CR, Guerguis S, et al. ; Tri-State Pediatric COVID-19 Research Consortium . Severe acute respiratory syndrome coronavirus 2 clinical syndromes and predictors of disease severity in hospitalized children and youth. J Pediatr. 2021;230:23–31.e10 - PMC - PubMed
    1. Shekerdemian LS, Mahmood NR, Wolfe KK, et al. ; International COVID-19 PICU Collaborative . Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174(9):868–873 - PMC - PubMed

Publication types

Substances