Related Experiment Video
Updated: Jul 4, 2025
Author Spotlight: Evaluating the Adjuvant Efficacy and Safety of Angong Niuhuang Pill in Viral Encephalitis Treatment
Published on: April 19, 2024
Risk Factors for Pediatric Critical COVID-19: A Systematic Review and Meta-Analysis
Camila Aparicio1, Zachary I Willis2, Mari M Nakamura3
1Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
Insights
The absolute risk of critical COVID-19 in healthy children is low, but comorbidities significantly increase this risk. This highlights the need for risk stratification in pediatric COVID-19 management.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Critical Care Medicine
Background:
- Risk stratification is crucial for managing COVID-19 in children.
- This systematic review and meta-analysis defines clinical characteristics and comorbidities linked to critical COVID-19 in pediatric populations.
Approach:
- Literature search of Medline and EMBASE for studies up to August 2023.
- Included patients aged ≤21 years with COVID-19, defining critical disease as ICU admission, mechanical ventilation, or death.
- Employed random effects models to estimate pooled odds ratios (OR) and 95% confidence intervals (CI).
Key Points:
- Analyzed data from 70 studies encompassing 172,165 children and adolescents.
- Absolute risk of critical COVID-19 in healthy children was 4%.
- Comorbidities markedly increased critical disease risk: OR 3.95 for one comorbidity, 9.51 for ≥2. Key risk factors included cardiovascular, neurological, chronic pulmonary, diabetes, obesity, and immunocompromise.
Conclusions:
- The absolute risk of critical COVID-19 in children without underlying conditions is low.
- One or more comorbidities significantly elevate the risk of critical COVID-19 in pediatric patients.
- Findings underscore the importance of risk stratification for tailored pediatric COVID-19 treatment.
Background:
Risk stratification is a cornerstone of the Pediatric Infectious Diseases Society COVID-19 treatment guidance. This systematic review and meta-analysis aimed to define the clinical characteristics and comorbidities associated with critical COVID-19 in children and adolescents.
Methods:
Two independent reviewers screened the literature (Medline and EMBASE) for studies published through August 2023 that reported outcome data on patients aged ≤21 years with COVID-19. Critical disease was defined as an invasive mechanical ventilation requirement, intensive care unit admission, or death. Random effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was explored through subgroup analyses.
Results:
Among 10,178 articles, 136 studies met the inclusion criteria for review. Data from 70 studies, which collectively examined 172,165 children and adolescents with COVID-19, were pooled for meta-analysis. In previously healthy children, the absolute risk of critical disease from COVID-19 was 4% (95% CI, 1%-10%). Compared with no comorbidities, the pooled OR for critical disease was 3.95 (95% CI, 2.78-5.63) for presence of one comorbidity and 9.51 (95% CI, 5.62-16.06) for ≥2 comorbidities. Key risk factors included cardiovascular and neurological disorders, chronic pulmonary conditions (excluding asthma), diabetes, obesity, and immunocompromise, all with statistically significant ORs >2.00.
Conclusions:
While the absolute risk for critical COVID-19 in children and adolescents without underlying health conditions is relatively low, the presence of one or more comorbidities was associated with markedly increased risk. These findings support the importance of risk stratification in tailoring pediatric COVID-19 management.
More Related Videos
Related Concept Videos
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:30Pneumonia III: Complications and Assessment