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

Rewa Choudhary1,2, Bryant J Webber1,2,3, Lindsay S Womack1,4

  • 1COVID-19 Emergency Response Team.

Hospital Pediatrics
|June 7, 2022
PubMed

Insights

Severe coronavirus disease 2019 (COVID-19) in hospitalized children was linked to RSV coinfection in young children and obesity in older children. Underlying conditions increased severe illness risk across multiple pediatric age groups.

Area of Science:

  • Pediatric Infectious Diseases
  • Epidemiology
  • Public Health

Background:

  • The B.1.617.2 (Delta) variant of SARS-CoV-2 led to increased pediatric hospitalizations for COVID-19.
  • Understanding risk factors for severe COVID-19 in children is crucial for public health interventions.

Purpose of the Study:

  • To describe COVID-19-related pediatric hospitalizations during the Delta variant surge.
  • To identify age-specific factors associated with severe illness in hospitalized children.

Main Methods:

  • A cross-sectional study analyzed medical charts of children (<21 years) hospitalized at 6 US children's hospitals (July-August 2021).
  • Severe illness was defined as requiring high-flow nasal cannula, positive airway pressure, or mechanical ventilation.
  • Age-stratified prevalence ratios (PR) were calculated to assess risk factors for severe COVID-19.

Main Results:

  • Of 759 COVID-19 patients, 37.8% experienced severe illness.
  • Infants with coinfections: RSV (PR 3.64), bacteria (PR 1.88).
  • Children aged 1-4 with RSV coinfection (PR 1.96).
  • Obesity associated with severe illness in ages 5-11 (PR 2.20) and 12-17 (PR 2.48).
  • Multiple underlying conditions (≥2) increased severe illness risk in infants (PR 1.82), ages 5-11 (PR 3.72), and 12-17 (PR 3.19).

Conclusions:

  • Severe COVID-19 in children is associated with RSV coinfection (under 5 years), obesity (5-17 years), and underlying conditions (<18 years).
  • Findings support targeted prevention strategies, including vaccination, and inform clinical practice.
  • Risk communication for pediatric COVID-19 should consider these age-specific factors.
Abstract

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