COVID-19 in Pediatric Patients with and Without Immunocompromised

The effect of Coronavirus Disease 2019 (COVID-19) on pediatric patients with immunodeficiency is a major research priority. .. The objective of this investigation was to perform a comparative assessment of the symptomatology, clinical course, and endpoints of COVID-19 infection in children patients with and without immunocompromised conditions.

This retrospective cohort study included children aged ≤18 years with confirmed COVID-19 infection, diagnosed via RT-PCR (Reverse Transcription Polymerase Chain Reaction) testing, who were admitted to Ali Asghar Children's Hospital in Tehran, Iran, from February 20, 2020, to February 20, 2023. A total of 200 patients were included, comprising 100 immunocompromised and 100 non-immunocompromised children, selected from hospital records. Categorical variables were compared using the chi-square or Fisher's exact test, and continuous variables were compared using the independent t-test or Mann-Whitney U test, based on their normality as determined by the Kolmogorov-Smirnov test. A P-value < 0.05 was considered statistically significant.

The average age of patients with immunocompromised conditions was 76.48 ± 58.33 months, while those without such conditions had a mean age of 38.02 ± 44.47 months. Children with immunocompromised conditions had lower exposure to positive contacts (P = 0.010) and exhibited higher rates of cough (P < 0.001), respiratory distress (P = 0.001), vomiting (P = 0.024), diarrhea (P < 0.001), and lower oxygen saturation (P = 0.001). Additionally, they demonstrated significantly higher rates of mortality (P = 0.018), intubation (P = 0.018), and longer hospital stays (P < 0.001). An age-stratified analysis revealed that patients (<1 year) with immunocompromise were at the highest risk, with mortality and intubation rates of 50% and 66.7%, respectively, compared to 0% and 10% in immunocompetent infants.

Pediatric patients with immunocompromised conditions who contracted COVID-19 experienced more severe symptoms than their non-immunocompromised counterparts. These patients had higher mortality and intubation rates, as well as longer hospital stays. This increased risk underscores the necessity for specialized management strategies tailored to this vulnerable population.