Risk factors for admission to the pediatric critical care unit among children hospitalized with COVID-19 in France

Abstract

BackgroundCOVID-19 infection is less severe among children than among adults; however, some patients require hospitalization and even critical care. Using data from the French national medico-administrative database, we estimated the risk factors for critical care unit (CCU) admissions among pediatric COVID-19 hospitalizations, the number and characteristics of the cases during the successive waves from January 2020 to August 2021 and described death cases.MethodsWe included all children (age < 18) hospitalized with COVID-19 between January 1st, 2020, and August 31st, 2021. Follow-up was until September 30th, 2021 (discharge or death). Contiguous hospital stays were gathered in “care sequences.” Four epidemic waves were considered (cut off dates: August 11th 2020, January 1st 2021, and July 4th 2021). We excluded asymptomatic COVID-19 cases, post-COVID-19 diseases, and 1-day-long sequences (except death cases). Risk factors for CCU admission were assessed with a univariable and a multivariable logistic regression model in the entire sample and stratified by age, whether younger than 2.ResultsWe included 7,485 patients, of whom 1988 (26.6%) were admitted to the CCU. Risk factors for admission to the CCU were being younger than 7 days [OR: 3.71 95% CI (2.56–5.39)], being between 2 and 9 years old [1.19 (1.00–1.41)], pediatric multisystem inflammatory syndrome (PIMS) [7.17 (5.97–8.6)] and respiratory forms [1.26 (1.12–1.41)], and having at least one underlying condition [2.66 (2.36–3.01)]. Among hospitalized children younger than 2 years old, prematurity was a risk factor for CCU admission [1.89 (1.47–2.43)]. The CCU admission rate gradually decreased over the waves (from 31.0 to 17.8%). There were 32 (0.4%) deaths, of which the median age was 6 years (IQR: 177 days–15.5 years).ConclusionSome children need to be more particularly protected from a severe evolution: newborns younger than 7 days old, children aged from 2 to 13 years who are more at risk of PIMS forms and patients with at least one underlying medical condition.

Study Limitations and Harmonious Discord of Results Reveal Melody to Public Health Measures*

“…With a cohort of almost two hundred omicron patients compared with twenty-eight children with the original strain, the authors’ main findings are that younger children are more afflicted in the omicron cohort and that there is a seven-fold increase in PICU admissions. This finding contrasts to other studies that have compared the original to D614G to delta to omicron variant outcomes and subsequently shown that the PICU admission rate gradually decreased over these waves (from 31.0% to 17.8%) (13, 14). However, the authors in the present study failed to identify “any” association between epoch period and baseline comorbidity profile.…”

COVID‐19 and pediatric pulmonology: Feedback from an expert center after the first year of the pandemic

“… 20 Among hospitalized adolescents, children with underlying conditions, such as asthma, obesity, or sickle cell disease are overrepresented. 3 , 12 , 21 , 22 , 23 , 24 Rare cases of pulmonary embolism associated with COVID‐19 have also been reported in pediatric patients. 25 , 26 …”

“…A systematic review of COVID‐19 in 63 infants under 3 months of age reported moderate severity and nonspecific clinical signs; however, one‐fifth of children required ICU care 20 . Among hospitalized adolescents, children with underlying conditions, such as asthma, obesity, or sickle cell disease are overrepresented 3,12,21–24 . Rare cases of pulmonary embolism associated with COVID‐19 have also been reported in pediatric patients 25,26 …”

“…20 Among hospitalized adolescents, children with underlying conditions, such as asthma, obesity, or sickle cell disease are overrepresented. 3,12,[21][22][23][24] Rare cases of pulmonary embolism associated with COVID-19 have also been reported in pediatric patients. 25,26 In children, a specific hyperinflammatory syndrome with multiorgan involvement associated with COVID-19 has been described and named as a multisystemic inflammatory syndrome in children (C-MIS) or pediatric multisystemic inflammatory syndrome (PIMS).…”