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Factors Associated With Hospitalization or Intensive Care Admission in Children With COVID-19 in Latin America
Eduardo López-Medina1,2,3, German Camacho-Moreno4, Martin E Brizuela5
1Centro de Estudios en Infectología Pediátrica, Cali, Colombia.
Insights
Infants, comorbidities, and anemia increase hospitalization risk for children with COVID-19 in Latin America. Specific symptoms like pharyngitis or diarrhea were associated with lower admission rates.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Global Health
Background:
- Limited data exists on factors influencing COVID-19 hospitalization and pediatric intensive care unit (PICU) admission in low- and middle-income countries.
- Latin America, a region with diverse socioeconomic factors, requires specific data on pediatric COVID-19 outcomes.
Purpose of the Study:
- To identify and describe factors associated with hospitalization or PICU admission in children diagnosed with COVID-19 within Latin America.
Main Methods:
- A multicenter, retrospective analytical study was conducted across 10 Latin American countries.
- Data was collected from June 2020 to February 2021 through the SLIPE-COVID research network.
- Included were children under 18 with confirmed COVID-19, excluding those with multisystem inflammatory syndrome in children (MIS-C). Associations were analyzed using logistic regression.
Main Results:
- Of 1063 children with COVID-19, 47% were hospitalized, with 16% admitted to the ICU.
- Factors associated with hospitalization included age under 1 year, native race, and comorbidities.
- PICU admission was linked to metabolic/endocrine disorders, immune deficiency, preterm birth, anemia, peribronchial wall thickening, and severe clinical signs (hypoxia, altered mental status, seizures, shock).
- Pharyngitis, myalgia, and diarrhea were inversely associated with hospital admission.
Conclusions:
- Infants, social inequalities, comorbidities, anemia, bronchial wall thickening, and specific clinical presentations are associated with increased hospitalization or PICU admission rates in children with COVID-19 in Latin America.
- This evidence is crucial for developing targeted prevention and treatment strategies for pediatric COVID-19 cases in the region.
Background:
Limited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19.
Objective:
To describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America.
Method:
Multicenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children <18 years of age with COVID-19 confirmed by polymerase chain reaction or antigen detection from the nasopharynx were included. Children with multisystem inflammatory syndrome in children (MIS-C) were excluded. Associations were assessed using univariate and multivariable logistic regression models.
Results:
A total of 1063 children with COVID-19 were included; 500 (47%) hospitalized, with 419 (84%) to the pediatric wards and 81 (16%) to the ICU. In multivariable analyses, age <1 year (Odds Ratio [OR] 1.78; 95% CI 1.08-2.94), native race (OR 5.40; 95% CI 2.13-13.69) and having a co-morbid condition (OR 5.3; 95% CI 3.10-9.15), were associated with hospitalization. Children with metabolic or endocrine disorders (OR 4.22; 95% CI 1.76-10.11), immune deficiency (1.91; 95% CI 1.05-3.49), preterm birth (OR 2.52; 95% CI 1.41-4.49), anemia at presentation (OR 2.34; 95% CI 1.28-4.27), radiological peribronchial wall thickening (OR 2.59; 95% CI 1.15-5.84) and hypoxia, altered mental status, seizures, or shock were more likely to require PICU admission. The presence of pharyngitis (OR 0.34; 95% CI 0.25-0.48); myalgia (OR 0.47; 95% CI 0.28-0.79) or diarrhea (OR 0.38; 95% CI 0.21-0.67) were inversely associated with hospital admission.
Conclusions:
In this data analysis reported to the SLIPE research network in Latin America, infants, social inequalities, comorbidities, anemia, bronchial wall thickening and specific clinical findings on presentation were associated with higher rates of hospitalization or PICU admission. This evidence provides data for prioritization prevention and treatment strategies for children suffering from COVID-19.
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