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. 2022 Sep 1;12(9):760-783.
doi: 10.1542/hpeds.2022-006613.

Factors Associated With Severe Illness in Patients Aged <21 Years Hospitalized for COVID-19

Rewa Choudhary #  1   2 , Bryant J Webber #  1   2   3 , Lindsay S Womack  1   4 , Hannah K Dupont  1   4 , Sophia K Chiu  1 , Valentine Wanga  1   2 , Megan E Gerdes  1 , Sophia Hsu  1   4 , Dallas S Shi  1   2 , Theresa M Dulski  1   2 , Osatohamwen I Idubor  1   4 , Arthur M Wendel  1   4 , Nickolas T Agathis  1   2 , Kristi Anderson  1 , Tricia Boyles  1 , Eleanor S Click  1 , Juliana Da Silva  1 , Mary E Evans  1 , Jeremy A W Gold  1 , Julia C Haston  1   2 , Pamela Logan  1 , Susan A Maloney  1 , Marisol Martinez  1 , Pavithra Natarajan  1 , Kevin B Spicer  1 , Mark Swancutt  1 , Valerie A Stevens  1 , Jessica Rogers-Brown  1 , Gyan Chandra  1 , Megan Light  1 , Frederick E Barr  5 , Jessica Snowden  5 , Larry K Kociolek  6 , Matthew McHugh  6 , David L Wessel  7 , Joelle N Simpson  7 , Kathleen C Gorman  7 , Kristen A Breslin  7 , Roberta L DeBiasi  7 , Aaron Thompson  8   9 , Mark W Kline  8   9 , Julie A Boom  10   11 , Ila R Singh  11   12 , Michael Dowlin  12 , Mark Wietecha  13 , Beth Schweitzer  1 , Sapna Bamrah Morris  1 , Emilia H Koumans  1 , Jean Y Ko  1   4 , David A Siegel  1   4 , Anne A Kimball  1
Affiliations

Factors Associated With Severe Illness in Patients Aged <21 Years Hospitalized for COVID-19

Rewa Choudhary et al. Hosp Pediatr. .

Abstract

Objectives: To describe coronavirus disease 2019 (COVID-19)-related pediatric hospitalizations during a period of B.1.617.2 (Δ) variant predominance and to determine age-specific factors associated with severe illness.

Methods: We abstracted data from medical charts to conduct a cross-sectional study of patients aged <21 years hospitalized at 6 United States children's hospitals from July to August 2021 for COVID-19 or with an incidental positive severe acute respiratory syndrome coronavirus 2 test. Among patients with COVID-19, we assessed factors associated with severe illness by calculating age-stratified prevalence ratios (PR). We defined severe illness as receiving high-flow nasal cannula, positive airway pressure, or invasive mechanical ventilation.

Results: Of 947 hospitalized patients, 759 (80.1%) had COVID-19, of whom 287 (37.8%) had severe illness. Factors associated with severe illness included coinfection with respiratory syncytial virus (RSV) (PR 3.64) and bacteria (PR 1.88) in infants; RSV coinfection in patients aged 1 to 4 years (PR 1.96); and obesity in patients aged 5 to 11 (PR 2.20) and 12 to 17 years (PR 2.48). Having ≥2 underlying medical conditions was associated with severe illness in patients aged <1 (PR 1.82), 5 to 11 (PR 3.72), and 12 to 17 years (PR 3.19).

Conclusions: Among patients hospitalized for COVID-19, factors associated with severe illness included RSV coinfection in those aged <5 years, obesity in those aged 5 to 17 years, and other underlying conditions for all age groups <18 years. These findings can inform pediatric practice, risk communication, and prevention strategies, including vaccination against COVID-19.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Dr Singh reports funding from the National Institutes of Health (NIH) as a coinvestigator for grant R61HD105593 to characterize pediatric coronavirus disease 2019 (COVID-19). Dr DeBiasi reports grant support and contracts for COVID-19 and multisystem inflammatory syndrome in children, unrelated to the current work; consulting fees from I-ACT for Children; honoraria from the Infectious Diseases in Children Conference (NYC) and Children’s Hospital Colorado Infectious Diseases Conference (Denver); and unpaid membership on the board of the Pediatric Infectious Diseases Society. Dr Kociolek reports a grant from the Walder Foundation Chicago Coronavirus Assessment Network Initiative, institutional support from Merck and NIH and National Institute of Allergy and Infectious Diseases; and honoraria for educational events at Northwest Community Hospital and Nemours and DuPont Children’s Hospital. Dr Snowden reports institutional support from NIH Office of the Director–Environmental influences on Child Health Outcomes program and NIH or National Heart, Lung, and Blood Institute RECOVER program, unrelated to the current work. Dr Barr reports application of patent 17364280 with Asklepion Pharmaceuticals for L-citrulline to prevent or treat endothelial dysfunction. Dr Morris reports membership on a data safety monitoring board in a study of ivermectin for treatment of severe COVID-19 in Ghana. Ms Hsu reports ownership of 5 shares of Moderna stock and 7 shares of Novavax stock, and ownership within the past 36 months (but no current ownership) of stock in BioNTech, Gilead Sciences, and Pfizer. Dr Dulski reports that her husband receives restricted stock units as part of his compensation from his employer, a cancer diagnostics company that also performs COVID-19 testing. No other potential conflicts of interest relevant to this article were disclosed.

Figures

FIGURE 1
FIGURE 1
Forest plots of prevalence ratios of factors associated with severe disease, defined as requiring ventilatory support. Unless otherwise specified, the referent group is absence of the characteristic of interest.
See this image and copyright information in PMC

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