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s_cid=mm7045e1_w † † COVID-19 was confirmed with laboratory detection of SARS-CoV-2 by reverse transcription-polymerase chain reaction or antigen test. § § Patients with MIS-C as the reason for hospitalization included patients who met the clinical case definition for MIS-C (clinically severe illness requiring hospitalization in a person aged <21 years with fever, laboratory evidence of inflammation, multisystem [≥2] organ involvement and no alternative plausible diagnosis, and evidence of current or recent SARS-CoV-2 infection by reverse transcription polymerase chain reaction, serology or antigen test, or COVID-19 exposure within the 4 weeks preceding symptom onset [https:// emergency.cdc.gov/han/2020/han00432.asp]) and were hospitalized for diagnosis and management of MIS-C, based on chart review.

Objectives: To describe COVID-19-related pediatric hospitalizations during a period of B.1.617.2 (Delta) variant predominance and to determine age-specific factors associated with severe illness. Patients and Methods: We abstracted data from medical charts to conduct a cross-sectional study of patients aged &lt;21 years hospitalized at 6 US children's hospitals during July–August 2021 for COVID-19 or with an incidental positive SARS-CoV-2 test. Among patients with COVID-19, we assessed factors associated with severe illness by calculating age-stratified prevalence ratios (PR). We defined severe illness as receiving high-flow nasal cannula, positive airway pressure, or invasive mechanical ventilation. Results: Of 947 hospitalized patients, 759 (80.1%) had COVID-19, of whom 287 (37.8%) had severe illness. Factors associated with severe illness included coinfection with RSV (PR 3.64) and bacteria (PR 1.88) in infants; RSV coinfection in patients aged 1–4 years (PR 1.96); and obesity in patients aged 5–11 (PR 2.20) and 12–17 years (PR 2.48). Having ≥2 underlying medical conditions was associated with severe illness in patients aged &lt;1 (PR 1.82), 5–11 (PR 3.72), and 12–17 years (PR 3.19) Conclusions: Among patients hospitalized for COVID-19, factors associated with severe illness included RSV coinfection in those aged &lt;5 years, obesity in those aged 5–17 years, and other underlying conditions for all age groups &lt;18 years. These findings can inform pediatric practice, risk communication, and prevention strategies, including vaccination against COVID-19

ObjectivesTo characterise heat-related acute kidney injury (HR-AKI) among US workers in a range of industries.MethodsTwo data sources were analysed: archived case files of the Occupational Safety and Health Administration’s (OSHA) Office of Occupational Medicine and Nursing from 2010 through 2020; and a Severe Injury Reports (SIR) database of work-related hospitalisations that employers reported to federal OSHA from 2015 to 2020. Confirmed, probable and possible cases of HR-AKI were ascertained by serum creatinine measurements and narrative incident descriptions. Industry-specific incidence rates of HR-AKI were computed. A capture–recapture analysis assessed under-reporting in SIR.ResultsThere were 608 HR-AKI cases, including 22 confirmed cases and 586 probable or possible cases. HR-AKI occurred in indoor and outdoor industries including manufacturing, construction, mail and package delivery, and solid waste collection. Among confirmed cases, 95.2% were male, 50.0% had hypertension and 40.9% were newly hired workers. Incidence rates of AKI hospitalisations from 1.0 to 2.5 hours per 100 000 workers per year were observed in high-risk industries. Analysis of overlap between the data sources found that employers reported only 70.6% of eligible HR-AKI hospitalisations to OSHA, and only 41.2% of reports contained a consistent diagnosis.ConclusionsWorkers were hospitalised with HR-AKI in diverse industries, including indoor facilities. Because of under-reporting and underascertainment, national surveillance databases underestimate the true burden of occupational HR-AKI. Clinicians should consider kidney risk from recurrent heat stress. Employers should provide interventions, such as comprehensive heat stress prevention programmes, that include acclimatisation protocols for new workers, to prevent HR-AKI.

Introduction More information is needed to understand the clinical epidemiology of youth hospitalized with diabetes and COVID‐19. We describe the demographic and clinical characteristics of patients <21 years old hospitalized with COVID‐19 and either Type 1 or Type 2 Diabetes Mellitus (T1DM or T2DM) during peak incidence of SARS‐CoV‐2 infection with the B.1.617.2 (Delta) variant. Methods This is a descriptive sub‐analysis of a retrospective chart review of patients aged <21 years hospitalized with COVID‐19 in six US children's hospitals during July‐August 2021. Patients with COVID‐19 and either newly diagnosed or known T1DM or T2DM were described using originally collected data and diabetes‐related data specifically collected on these patients. Results Of the 58 patients hospitalized with COVID‐19 and diabetes, 34 had T1DM and 24 had T2DM. Of those with T1DM and T2DM, 26% (9/34) and 33% (8/24), respectively, were newly diagnosed. Among those >12 years old and eligible for COVID‐19 vaccination, 93% were unvaccinated (42/45). Among patients with T1DM, 88% had diabetic ketoacidosis (DKA) and 6% had COVID‐19 pneumonia; of those with T2DM, 46% had DKA and 58% had COVID‐19 pneumonia. Of those with T1DM or T2DM, 59% and 46%, respectively, required ICU admission. Conclusion Our findings highlight the importance of considering diabetes in the evaluation of youth presenting with COVID‐19; the challenges of managing young patients who present with both COVID‐19 and diabetes, particularly T2DM; and the importance of preventive actions like COVID‐19 vaccination to prevent severe illness among those eligible with both COVID‐19 and diabetes. This article is protected by copyright. All rights reserved.

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