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Comparing COVID-19 Variants in Children Hospitalized for Concern of Tracheostomy-associated Infection: A Multicenter
Ilana Moffet1, Naoko Kono2, Margaret Rush3,4
1From the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
The Pediatric Infectious Disease Journal
|December 10, 2025
Summary
COVID-19 variants like alpha, delta, and omicron presented similarly in children with tracheostomies. Dexamethasone use was higher with the delta variant, and all variants required significant respiratory support, with a 3-6% mortality rate.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 infections pose risks to children, particularly those with tracheostomies.
- Different SARS-CoV-2 variants (Alpha, Delta, Omicron) may influence disease presentation and outcomes.
- Bacterial tracheostomy-associated infections can complicate COVID-19 in this vulnerable population.
Purpose of the Study:
- To compare the clinical presentation and outcomes of COVID-19 in pediatric patients with tracheostomies across different SARS-CoV-2 variants.
- To identify potential differences in treatment, such as dexamethasone use, based on the infecting variant.
- To assess the need for respiratory support and mortality rates associated with COVID-19 variants in this cohort.
Main Methods:
- Ancillary study of a prospective cohort including 103 children with tracheostomies (108 admissions).
- Comparison of COVID-19 presentation and outcomes stratified by variant (Alpha, Delta, Omicron).
- Analysis focused on respiratory support requirements, medication use (dexamethasone), and mortality.
Main Results:
- No significant differences in presentation or outcomes were observed across Alpha, Delta, and Omicron variants in children with tracheostomies.
- Dexamethasone use was significantly higher in Delta variant cases compared to Alpha (78% vs. 40%; OR, 5.5; P = 0.04).
- Increased oxygen support (76%-89%) and ventilatory support (35-67%) were common across all variants, with a 3%-6% mortality rate.
Conclusions:
- COVID-19 variants did not significantly alter the clinical presentation or outcomes in hospitalized children with tracheostomies.
- While dexamethasone use varied by variant, respiratory support needs and mortality remained consistent across Alpha, Delta, and Omicron.
- This highlights the persistent risk of severe respiratory illness and mortality in tracheostomized children with COVID-19, irrespective of the dominant variant.
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