Clinical Characteristics of SARS-CoV2 Infected and Exposed Patients at a Tertiary Care Allergy/Immunology Program in Florida

Abstract

RATIONALE: Children born in urban minority populations are at higher risk of respiratory morbidity, including lower respiratory tract infections (LRTI) and the ongoing COVID-19 pandemic. There is a critical need to identify risk and protective factors for LRTI in this vulnerable population. METHODS: We examined 3,131 mother-child dyads from the Boston Birth Cohort (BBC), a predominantly urban, low-income, minority birth cohort, aiming to identify prenatal and perinatal predictors of LRTI during infancy (0-12 months). LRTI were defined as the presence of bronchiolitis, bronchitis, or pneumonia, as documented by ICD9/10 diagnosis codes from electronic medical records. LRTI predictors were selected using Akaike's Information Criteria (AIC) and stepwise logistic regression. RESULTS: The strongest predictors of LRTI during infancy in this population were preterm birth (adjOR51.64, 95%CI 1.31-2.05), multiparity (adjOR51.53, 95%CI 1.20-1.96), male sex (adjOR 1.43, 95%CI 1.15-1.77) and maternal overweight and obesity (adjOR51.37, 95% CI1.09-1.71). Breastfeeding (adjOR 0.73 95%CI 0.57-0.93), vaginal delivery (adjOR 0.75, 95%CI 0.60-0.94) and maternal age 24-35 years (adjOR 0.65 95%CI 0.50-0.85) were negatively associated with LRTI. Interestingly, race and maternal education were comparable between infants with and without LRTI. CONCLUSIONS: In this sample of high-risk U.S. minority children, we replicated some known clinical predictors of early life LRTI. Our findings also raise important questions as to why prenatal factors such as maternal obesity increase LRTI risk. Such information, along with underlying mechanisms, if further confirmed, would inform primary prevention efforts starting in-utero in vulnerable populations. Finally, this study motivates further investigation into whether these susceptibility factors apply to COVID-19 among minority children.