Pediatric Hospitalizations and ICU Admissions Due to COVID-19 and Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 in England

Abstract

ImportanceInvestigating how the risk of serious illness after SARS-CoV-2 infection in children and adolescents has changed as new variants have emerged is essential to inform public health interventions and clinical guidance.ObjectiveTo examine risk factors associated with hospitalization for COVID-19 or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) among children and adolescents during the first 2 years of the COVID-19 pandemic and change in risk factors over time.Design, Setting, and ParticipantsThis population-level analysis of hospitalizations after SARS-CoV-2 infection in England among children and adolescents aged 0 to 17 years was conducted from February 1, 2020, to January 31, 2022. National data on hospital activity were linked with data on SARS-CoV-2 testing, SARS-CoV-2 vaccination, pediatric intensive care unit (PICU) admissions, and mortality. Children and adolescents hospitalized with COVID-19 or PIMS-TS during this time were included. Maternal, elective, and injury-related hospitalizations were excluded.ExposuresPrevious medical comorbidities, sociodemographic factors, and timing of hospitalization when different SARS-CoV-2 variants (ie, wild type, Alpha, Delta, and Omicron) were dominant in England.Main OutcomesPICU admission and death within 28 days of hospitalization with COVID-19 or PIMS-TS.ResultsA total of 10 540 hospitalizations due to COVID-19 and 997 due to PIMS-TS were identified within 1 125 010 emergency hospitalizations for other causes. The number of hospitalizations due to COVID-19 and PIMS-TS per new SARS-CoV-2 infections in England declined during the second year of the COVID-19 pandemic. Among 10 540 hospitalized children and adolescents, 448 (4.3%) required PICU admission due to COVID-19, declining from 162 of 1635 (9.9%) with wild type, 98 of 1616 (6.1%) with Alpha, and 129 of 3789 (3.4%) with Delta to 59 of 3500 (1.7%) with Omicron. Forty-eight children and adolescents died within 28 days of hospitalization due to COVID-19, and no children died of PIMS-TS (PIMS-S data were limited to November 2020 onward). Risk of severe COVID-19 in children and adolescents was associated with medical comorbidities and neurodisability regardless of SARS-CoV-2 variant. Results were similar when children and adolescents with prior SARS-CoV-2 exposure or vaccination were excluded.ConclusionsIn this study of data across the first 2 years of the COVID-19 pandemic, risk of severe disease from SARS-CoV-2 infection in children and adolescents in England remained low. Children and adolescents with multiple medical problems, particularly neurodisability, were at increased risk and should be central to public health measures as further variants emerge.

COVID‐19 clinical manifestations in children: What is the impact of the different SARS‐CoV‐2 variants and do we need to distinguish between different respiratory viruses?

“…6 Other published studies have shown lower intensive care needed in children infected during Omicron than with previous variant periods. 7,8 The main clinical finding in the study published by Wurm et al 1 was fever in 67% of the patients and this was maintained throughout the pandemic, with similar results as a multicentre network of paediatricians working at Primary Care and hospital level (https:// www. coped icat.…”

Characteristics and outcomes of neonates hospitalised with SARS-CoV-2 infection in the UK by variant: a prospective national cohort study

“…There have been very few population-based studies of neonates infected with SARS-CoV-2 infection, and data describing neonatal SARS-CoV-2 infection by variant are even more sparse. Population-level data from Germany describing paediatric SARS-CoV-2 infection show higher rates of COVID-19-related hospitalisation and intensive care unit admission for children under 5 years in the delta-predominant period compared with alpha-predominant, wildtype-predominant and omicron-predominant periods,19 although data from the UK did not report a higher rate of intensive care admissions for children under 5 with delta compared with earlier viral variants 20. Data covering approximately 10% of the US population found similar rates of intensive care admissions of infants <6 months of age with the delta and omicron variants 21.…”

COVID-19 in Children—Learning From the Past, Planning for the Future

“…In this issue of JAMA Pediatrics, Ward and colleagues 2 present a multiyear study characterizing the epidemiology of hospital and pediatric intensive care unit (PICU) admissions among children and young people with COVID-19 and pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (Paediatric Inflammatory Multisystem Syndrome [PIMS-TS], also referred to as multisystem inflammatory syndrome in children in England). Using national data reflecting 98% of hospitalizations and leveraging several linked data sources to systematically capture SARS-CoV-2 testing, PICU admissions, deaths, and prior COVID-19 vaccination or infection, the authors identified 10 540 hospitalizations between February 2020 and January 2022 in which COVID-19 was the primary reason for hospitalization.…”

“…While there is higher morbidity and mortality associated in infants born before 34 weeks' gestation, those born between 34 and 37 weeks' gestation (defined as late preterm) are at risk for greater adverse outcomes than term infants. 2 Mothers of preterm infants have increased levels of psychological distress compared with mothers of term infants. 3 Many pregnancies leading to preterm deliveries and subsequent neonatal intensive care unit (NICU) hospitaliza-tions are identified as high risk early in gestation.…”