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Risk Factors for Severe COVID-19 in Children: A Systematic Review and Meta-Analysis
Jae Hong Choi1, Soo-Han Choi2, Ki Wook Yun3
1Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea.
Insights
Children with certain comorbidities like obesity, diabetes, and heart disease face a higher risk of severe COVID-19. Neonates and premature infants are also at increased risk, necessitating targeted vaccination and hospitalization strategies.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Coronavirus disease 2019 (COVID-19) poses a global health challenge.
- While typically milder in children, increased hospitalizations are noted due to new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and adult vaccination.
- Urgent risk stratification is needed for pediatric COVID-19 hospitalization and vaccination priorities.
Purpose of the Study:
- To systematically review and meta-analyze risk factors for severe COVID-19 in children.
- To identify specific comorbidities and demographic factors associated with poor outcomes.
- To inform clinical decision-making for hospitalization and vaccination strategies.
Main Methods:
- Systematic review and meta-analysis of studies from PubMed, EMBASE, Scopus, and KoreaMed databases up to August 25, 2021.
- Inclusion criteria focused on severe COVID-19 outcomes (ICU admission, mechanical ventilation, death) and pre-existing comorbidities.
- Analysis of 17 articles for review and 10 for meta-analysis.
Main Results:
- Significant risk factors for severe COVID-19 in children included neonate status (RR 2.69), prematurity (RR 2.00), obesity (RR 1.43), diabetes (RR 2.26), chronic lung disease (RR 2.62), heart disease (RR 1.82), neurologic disease (RR 1.18), and immunocompromised status (RR 1.44).
- Conversely, age under 3 months (RR 0.26), asthma (RR 1.08), and neurodevelopmental disorders (RR 0.88) were not identified as risk factors.
- These findings highlight specific vulnerable pediatric populations.
Conclusions:
- Children with comorbidities such as obesity, diabetes, heart disease, chronic lung diseases (excluding asthma), seizure disorders, and immunocompromised status are at high risk for severe COVID-19.
- Neonate and premature infants face a significantly elevated risk of severe outcomes.
- Identifying these high-risk groups is crucial for guiding hospital admission decisions and prioritizing COVID-19 vaccination efforts.
Background:
Coronavirus disease 2019 (COVID-19) has been the most important global issue since December 2019. Although the clinical course of COVID-19 is known to be milder in children than in adults, associated hospitalizations among children have increased since the emergence of contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and the achievement of a high vaccination rate in adults. Considering these global and domestic situations, we believe that risk stratification in children with COVID-19 is urgently needed for decision making regarding hospitalization priority in children infected with SARS-CoV-2 and vaccination priority against COVID-19.
Methods:
This systematic review and meta-analysis was performed by comprehensively searching the PubMed, EMBASE, Scopus and KoreaMed databases through August 25, 2021. The criteria for enrollment were "severe COVID-19" as poor outcomes (intensive care unit admission, invasive mechanical ventilation, and/or death) and underlying comorbidities before SARS-CoV-2 infection.
Results:
Among 872 screened studies, 17 articles were included in the systematic review, and 10 articles were included in the meta-analysis. Neonate (risk ratio [RR], 2.69; 95% confidence interval [CI], 1.83-3.97), prematurity in young infants (RR, 2.00; 95% CI, 1.63-2.46), obesity (RR, 1.43; 95% CI, 1.24-1.64), diabetes (RR, 2.26; 95% CI, 1.95-2.62), chronic lung disease (RR, 2.62; 95% CI, 1.71-4.00), heart disease (RR, 1.82; 95% CI, 1.58-2.09), neurologic disease (RR, 1.18; 95% CI, 1.05-1.33), and immunocompromised status (RR, 1.44; 95% CI, 1.01-2.04) were significant risk factors for severe COVID-19 in children. In the subgroup analysis, age younger than 3 months (RR, 0.26; 95% CI, 0.11-0.66), asthma (RR, 1.08; 95% CI, 0.98-1.20), and neurodevelopmental disorders (RR, 0.88; 95% CI, 0.75-1.04) were not risk factors for severe COVID-19.
Conclusion:
Children with comorbidities such as obesity, diabetes, heart disease, chronic lung diseases other than asthma, seizure disorders, and an immunocompromised status had a high prevalence of severe COVID-19. Neonate and premature infants had a high risk of severe COVID-19. Defining the high-risk group for severe COVID-19 could help to guide hospital admission and priority for vaccination against SARS-CoV-2.
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