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Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C
Aline B Maddux1, Cameron C Young2, Suden Kucukak2
1Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States.
Insights
Nearly one-third of children hospitalized with COVID-19 and one-fourth with MIS-C experienced persistent impairments for over two months. Obesity and severe illness were key risk factors, highlighting the need for targeted follow-up care for vulnerable pediatric populations.
Area of Science:
- Pediatric Health
- Infectious Diseases
- Public Health
Background:
- The SARS-CoV-2 pandemic led to widespread pediatric hospitalizations for acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C).
- Understanding long-term health consequences in children post-hospitalization is crucial for effective management and recovery strategies.
Purpose of the Study:
- To identify risk factors associated with persistent impairments following pediatric hospitalization for acute COVID-19 or MIS-C.
- To inform targeted follow-up care for children experiencing prolonged symptoms after severe SARS-CoV-2 infection.
Main Methods:
- A prospective cohort study involving 25 U.S. hospitals.
- Inclusion of patients under 21 years old hospitalized for acute COVID-19 or MIS-C between May 2020 and March 2022.
- Surveying patients 2-4 months post-admission and utilizing multivariable regression to determine risk ratios.
Main Results:
- Among acute COVID-19 patients, 30.6% had persistent symptoms and 21.6% activity impairments; for MIS-C, 23.2% had persistent symptoms and 24.1% activity impairments.
- Mechanical ventilation (aRR 1.83) was linked to persistent symptoms in acute COVID-19. Obesity (aRR 2.18) and greater organ involvement (aRR 1.35) were associated with activity impairments.
- For MIS-C, pre-existing respiratory conditions (aRR 3.04) correlated with persistent symptoms, while obesity (aRR 1.86) and organ involvement (aRR 1.26) were linked to activity impairments.
Conclusions:
- A significant proportion of children experience persistent health impairments for at least two months after hospitalization for acute COVID-19 or MIS-C.
- Severe illness indicators like mechanical ventilation and multi-organ involvement, alongside conditions such as obesity and pre-existing respiratory issues, are critical risk factors for long-term impairments.
Objective:
To identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.
Methods:
Across 25 U.S. Overcoming COVID-19 Network hospitals, we conducted a prospective cohort study of patients <21-years-old hospitalized for acute COVID-19 or MIS-C (May 2020 to March 2022) surveyed 2- to 4-months post-admission. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI).
Results:
Of 232 children with acute COVID-19, 71 (30.6%) had persistent symptoms and 50 (21.6%) had activity impairments at follow-up; for MIS-C (n = 241), 56 (23.2%) had persistent symptoms and 58 (24.1%) had activity impairments. In adjusted analyses of patients with acute COVID-19, receipt of mechanical ventilation was associated with persistent symptoms [aRR 1.83 (95% CI: 1.07, 3.13)] whereas obesity [aRR 2.18 (95% CI: 1.05, 4.51)] and greater organ system involvement [aRR 1.35 (95% CI: 1.13, 1.61)] were associated with activity impairment. For patients with MIS-C, having a pre-existing respiratory condition was associated with persistent symptoms [aRR 3.04 (95% CI: 1.70, 5.41)] whereas obesity [aRR 1.86 (95% CI: 1.09, 3.15)] and greater organ system involvement [aRR 1.26 (1.00, 1.58)] were associated with activity impairments.
Discussion:
Among patients hospitalized, nearly one in three hospitalized with acute COVID-19 and one in four hospitalized with MIS-C had persistent impairments for ≥2 months post-hospitalization. Persistent impairments were associated with more severe illness and underlying health conditions, identifying populations to target for follow-up.
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