Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis

Abstract

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Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

“…Shared pathophysiology underlying greater COVID-19 susceptibility in people with T2D or obesity may include heightened basal inflammatory tone, defective adaptive immune responses, endothelial dysfunction, and a greater propensity for development of coagulation-related complications ( Figure 1 ). Collectively, the available data suggest that the relationship between increasing BMI, severity of SARS-CoV-2 infection, and outcomes is not always linear; more relevant in younger people ( Burn et al., 2020 ), including children ( Duarte-Salles et al., 2020 ; Fernandes et al., 2020 ; Tsankov et al., 2020 ); and frequently complicated in adults by co-existing cardiometabolic risk factors. A diagnosis of T2D is also associated with adverse COVID-19 outcomes in younger adults, even those between 20 and 39 years of age ( Woolcott and Castilla-Bancayán, 2020 ).…”

Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children

“…Our understanding of COVID-19 illness in children is limited. 1 To date, most children with SARS-CoV-2 infection have been asymptomatic or had mild COVID-19 symptoms, but some children have had severe illness. 2 Prior literature identified risk factors for severe COVID-19 illness in children, including being younger than 1 year or having an underlying medical condition, such as congenital heart disease, asthma, obesity, diabetes, or neurologic conditions.…”

Multicenter cohort study of children hospitalized with SARS-CoV-2 infection

“…In the current study, neonatal age group, hospitalization outside of Canada, the presence of at least one comorbidity and chest imaging abnormalities compatible with COVID-19 were risk factors for severe or critical COVID-19. A systematic review of 285 014 children with SARS-CoV-2 infection reported that 5.1% with comorbidities and 0.2% without developed severe disease [5] but as with hospitalization, the risk with any given comorbidity is unknown. A study of 48 patients up to age 21 years admitted to ICUs in the United States reported that 40 (83%) had comorbidities (versus 56% in the current study) of which 19 were medically complex (defined as long-term dependence on technological support associated with developmental delay and/or genetic abnormalities) [6].…”

“…It is not clear whether this is because they have more severe disease or because the threshold for admission is lower for infants. Comorbidities increase the risk of pediatric hospitalization [5] and critical disease [6] but socio-demographic risk factors for hospitalization or critical disease in children are yet to be described.…”