Hospitalization for COVID-19 and Risk Factors for Severe Disease Among Children: 2022-2024

Abstract

Objectives: We assessed characteristics associated with pediatric COVID-19 hospitalizations and risk factors for severe disease among hospitalized children aged 6 months and older.

Methods: Using data from COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) during October 1, 2022, to April 30, 2024, we described demographic characteristics, underlying medical conditions, COVID-19 vaccination status, and clinical outcomes, including severe disease (intensive care unit admission, mechanical ventilation, extracorporeal membrane oxygenation, in-hospital death), of hospitalized children aged 6 months to 17 years residing in the COVID-NET catchment area with laboratory-confirmed SARS-CoV-2 infection. Multivariable log-linked Poisson generalized estimating equations were conducted to assess risk factors for severe disease among children aged 6 to 23 months and 2 to 17 years.

Results: Of 2490 children hospitalized for COVID-19, 1114 (44.7%) were aged 6 to 23 months; 1358 (54.1%) were male. Overall, 1464 (58.9%) had at least 1 underlying condition: 471 (41.8%) of children aged 6 to 23 months, 290 (61.6%) aged 2 to 4 years, 383 (79.2%) aged 5 to 11 years, and 320 (77.0%) aged 12 to 17 years. One hundred (3.8%) were up to date with recommended COVID-19 vaccination. Among children aged 6 to 23 months, severe disease was associated with underlying chronic lung (adjusted risk ratio [aRR], 1.5; 95% CI, 1.2-1.8) and cardiovascular disease (aRR, 1.4; 95% CI, 1.1-1.7). Among children aged 2 years and older, severity was associated with chronic lung disease (aRR, 1.9; 95% CI, 1.5-2.3), diabetes (aRR, 1.5; 95% CI, 1.2-1.8), and neurologic disorders (aRR, 1.4; 95% CI, 1.2-1.6).

Conclusion: Most hospitalized children aged 6 months and older had at least 1 underlying condition, and less than 5% were up to date with COVID-19 vaccination. Specific conditions were associated with increased risk of severe illness. Increasing COVID-19 vaccination, particularly among children with high-risk conditions, may reduce pediatric COVID-19 hospitalizations and severe outcomes.