The differential impact of pediatric COVID-19 between high-income countries and low- and middle-income countries: A systematic review of fatality and ICU admission in children worldwide

Kitano, Taito; Kitano, Mao; Krueger, Carsten; Jamal, Hassan H.; Rawahi, Hatem Al; Lee-Krueger, Rachelle; Sun, Rose Doulin; Isabel, Sandra; García-Ascaso, Marta Taida; Hibino, Hiromi; Camara, B.; Isabel, Marc R.; Cho, Leanna; Groves, H M; Piché-Renaud, Pierre Philippe; Kossov, Michael; Kou, Ikuho; Jon, Ilsu; Blanchard, Ana C.; Matsuda, Nao; Mahood, Quenby; Wadhwa, Anu; Bitnun, Ari; Morris, Shaun K.

doi:10.1371/journal.pone.0246326

Cited by 116 publications

(147 citation statements)

References 19 publications

(26 reference statements)

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“…LMICs or the respiratory disease more commonly seen in young children. There has been more attention on MIS-C, a novel condition but one associated with very low mortality, rather than the COVID-19 related illnesses that we and others have found to have higher mortality 12 . This higher mortality warrants further investigation to determine whether care and outcomes can be improved, particularly in resource-limited settings.…”

Section: Current Literature Has Not Sufficiently Evaluated the Impact Of Critical Pediatric Covid-19 Inmentioning

confidence: 77%

“…While pediatric COVID-19 mortality rates are low in HICs, they are more concerning in LMICs. The review by Kitano and colleagues found that over 90% of pediatric COVID-19 deaths were from LMICs and that mortality risk was highest in children under 1 year old 12 . Mortality differences in LMICs can be partly explained by less-developed healthcare infrastructure and lack of resources, but the reasons for age-related differences are unclear.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric critical COVID-19 and mortality in a multinational cohort

González‐Dambrauskas¹,

Vásquez‐Hoyos

Camporesi

et al. 2021

Preprint

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Objectives: To understand the international epidemiology of critical pediatric COVID-19 and compare presentation, treatments, and outcomes of younger (<2 years) and older (>2 years) children. Design: Prospective, observational study from April 1 to December 31, 2020 Setting: International multicenter study from 55 sites from North America, Latin America, and Europe. Participants: Patients <19 years old hospitalized with critical COVID-19 Interventions: none Main outcomes measured: Clinical course, treatments, and outcomes were compared between younger and older children. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) for hospital mortality. Results: 557 subjects (median age, 8 years; 24% <2 years) were enrolled from 55 sites (63% Latin American). Half had comorbidities. Younger children had more respiratory findings (56% vs 44%), viral pneumonia (45% vs 29%), and treatment with invasive ventilation (50% vs 37). Gastrointestinal (28% vs 69%) or mucocutaneous (16% vs 44%) findings, vasopressor requirement (44% vs 60%), and MIS-C (15% vs 40%) were less common in younger children. Hospital mortality was 10% overall but 15% in younger children (odds ratio 1.89 [95%CI 1.05-3.39]). When adjusted for age, sex, region, and illness severity, mortality-associated factors included cardiac (aOR 2.6; 95%CI 1.07-6.31) or pulmonary comorbidities (aOR 4.4; 95%CI 1.68-11.5), admission hypoxemia (aOR 2.33; 95%CI 1.24-4.37), and lower respiratory symptoms (aOR 2.83; 95%CI 1.49-5.39). Gastrointestinal (aOR 0.49; 95%CI 0.26-0.92) or mucocutaneous symptoms (aOR 0.31; 95%CI 0.15-0.64), treatment with intravenous immune globulin (aOR 0.33; 95%CI 0.17-0.65), and MIS-C (aOR 0.26; 95%CI 0.11-0.64) were associated with lower mortality. Conclusions: We identified age-related differences in presentation and mortality for critical pediatric COVID-19 that should prompt more attention to improving management in younger children, especially in developing countries.

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Section: Current Literature Has Not Sufficiently Evaluated the Impact Of Critical Pediatric Covid-19 Inmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Pediatric critical COVID-19 and mortality in a multinational cohort

González‐Dambrauskas¹,

Vásquez‐Hoyos

Camporesi

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…The proportion of children who died without ICU support was about 36% in the poorest regions (Northeast and North), compared with about 23% in the richest regions (Southeast and South). Notably, in the systematic review reported by Kitano and colleagues, 8 among 138 countries, Brazil had the highest rate of deaths in the young population, reaching about 23•6 per 1 000 000 children. Consequently, the high mortality observed in our sample is likely to reflect both the inclusion of hospitalised individuals at the more severe end of the spectrum and an apparent inability to provide the highest level of care to the most critically ill patients, especially in less developed regions.…”

Section: Discussionmentioning

confidence: 98%

“…6,7 In addition, a systematic review has highlighted a greater impact of paediatric COVID-19 fatality in low-income and middle-income countries compared with high-income countries. 8 To date, however, few paediatric cohort studies have directly investigated the risk factors associated with severe COVID-19. 9 Further understanding these issues in children could provide important insights and guide the development of therapeutic and vaccination strategies for target groups.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and risk factors for death among hospitalised children and adolescents with COVID-19 in Brazil: an analysis of a nationwide database

Oliveira

Colosimo

Silva

et al. 2021

The Lancet Child & Adolescent Health

140

164

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Background COVID-19 is usually less severe and has lower case fatality in children than in adults. We aimed to characterise the clinical features of children and adolescents hospitalised with laboratory-confirmed SARS-CoV-2 infection and to evaluate the risk factors for COVID-19-related death in this population. MethodsWe did an analysis of all patients younger than 20 years who had quantitative RT-PCR-confirmed COVID-19 and were registered in the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe, a nationwide surveillance database of patients admitted to hospital with severe acute respiratory disease in Brazil), between Feb 16, 2020, and Jan 9, 2021. The primary outcome was time to recovery (discharge) or in-hospital death, evaluated by competing risks analysis using the cumulative incidence function. FindingsOf the 82 055 patients younger than 20 years reported to SIVEP-Gripe during the study period, 11 613 (14•2%) had available data showing laboratory-confirmed SARS-CoV-2 infection and were included in the sample. Among these patients, 886 (7•6%) died in hospital (at a median 6 days [IQR 3-15] after hospital admission), 10 041 (86•5%) patients were discharged from the hospital, 369 (3•2%) were in hospital at the time of analysis, and 317 (2•7%) were missing information on outcome. The estimated probability of death was 4•8% during the first 10 days after hospital admission, 6•7% during the first 20 days, and 8•1% at the end of follow-up. Probability of discharge was 54•1% during the first 10 days, 78•4% during the first 20 days, and 92•0% at the end of follow-up. Our competing risks multivariate survival analysis showed that risk of death was increased in infants younger than 2 years (hazard ratio 2•36 [95% CI 1•94-2•88]) or adolescents aged 12-19 years (2•23 [1•84-2•71]) relative to children aged 2-11 years; those of Indigenous ethnicity (3•36 [2•15-5•24]) relative to those of White ethnicity; those living in the Northeast region (2•06 [1•68-2•52]) or North region (1•55 [1•22-1•98]) relative to those in the Southeast region; and those with one (2•96 [2•52-3•47]), two (4•96 [3•80-6•48]), or three or more (7•28 [4•56-11•6]) pre-existing medical conditions relative to those with none.Interpretation Death from COVID-19 was associated with age, Indigenous ethnicity, poor geopolitical region, and pre-existing medical conditions. Disparities in health care, poverty, and comorbidities can contribute to magnifying the burden of COVID-19 in more vulnerable and socioeconomically disadvantaged children and adolescents in Brazil.

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“…A recent meta-analysis indicated that the outcome of children admitted to hospital with acute COVID-19 is worse in LMICs than in HICs (case fatality rates 0·29% [95% CI 0·28–0·31%] vs 0·03% [0·03–0·03%]). 14 Vaccinating CYP in LMICs may ultimately have more benefit to their health status compared with CYP in HICs.…”

mentioning

confidence: 99%