Risk factors for PICU admission and death among children and young people hospitalized with COVID-19 and PIMS-TS in England during the first pandemic year

Background: Children living with chronic comorbid conditions are at increased risk for severe COVID-19, though there is limited evidence regarding the risks associated with specific conditions and which children may benefit from targeted COVID-19 therapies. The objective of this study was to identify factors associated with severe disease among hospitalized children with COVID-19 in Canada. Methods: We conducted a national prospective study on hospitalized children with microbiologically confirmed SARS-CoV-2 infection via the Canadian Paediatric Surveillance Program from April 2020—May 2021. Cases were reported voluntarily by a network of >2800 paediatricians. Hospitalizations were classified as COVID-19-related, incidental infection, or infection control/social admissions. Severe disease (among COVID-19-related hospitalizations only) was defined as disease requiring intensive care, ventilatory or hemodynamic support, select organ system complications, or death. Risk factors for severe disease were identified using multivariable Poisson regression, adjusting for age, sex, concomitant infections, and timing of hospitalization. Findings: We identified 544 children hospitalized with SARS-CoV-2 infection, including 60·7% with COVID-19-related disease and 39·3% with incidental infection or infection control/social admissions. Among COVID-19-related hospitalizations (n=330), the median age was 1·9 years (IQR 0·1—13·3) and 43·0% had chronic comorbid conditions. Severe disease occurred in 29·7% of COVID-19-related hospitalizations (n=98/330), most frequently among children aged 2-4 years (48·7%) and 12-17 years (41·3%). Comorbid conditions associated with severe disease included technology dependence (adjusted risk ratio [aRR] 2·01, 95% confidence interval [CI] 1·37-2·95), neurologic conditions (e.g. epilepsy and select chromosomal/genetic conditions) (aRR 1·84, 95% CI 1·32-2·57), and pulmonary conditions (e.g. bronchopulmonary dysplasia and uncontrolled asthma) (aRR 1·63, 95% CI 1·12-2·39). Interpretation: While severe outcomes were detected at all ages and among patients with and without comorbidities, neurologic and pulmonary conditions as well as technology dependence were associated with increased risk of severe COVID-19. These findings may help guide vaccination programs and prioritize targeted COVID-19 therapies for children. Funding: Financial support for the CPSP was received from the Public Health Agency of Canada.

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“…4•1-15•4%). [24][25][26] These differences may also be attributable to heterogeneous definitions of COVID-19 severity.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021

Farrar

Drouin

Hepburn

et al. 2022

Preprint

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“…A publication by Ward and colleagues found that in the first year of the pandemic (2020), 51 children and adolescents in the UK were admitted to a paediatric ICU with COVID-19, and 91% of these children or adolescents had a pre-existing health condition. 7 However, an important key finding of Mensah and colleagues' study is that reinfection with SARS-CoV-2 was not associated with fatal paediatric cases. 1 …”

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confidence: 91%

Importance of understanding the reinfection risk of COVID-19 in children

Crawford

2022

The Lancet Child & Adolescent Health

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“…Between February 2019 and January 2021, 6300 hospitalizations of children with COVID‐19 were counted in England, of which 259 were admitted to intensive care and eight children died. Hospitalization was more common among males, older children from deprived neighbourhoods and non‐White ethnicities (Ward et al ., 2021 ). Paediatricians were concerned that children suffering from chronic respiratory infection showed increased susceptibility to COVID‐19 disease.…”

Section: Introductionmentioning

confidence: 99%

“…Many developed shock and 14% had coronary artery aneurysm (Whittaker et al ., 2020 ). British epidemiologists identified 712 hospitalizations with MIS‐C, of which 312 were admitted to intensive care and five died (Ward et al ., 2021 ).…”

Section: Introductionmentioning

confidence: 99%

COVID‐19 and children: medical impact and collateral damage

Brüssow

2022

Microbial Biotechnology

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Summary Children mostly experience mild SARS‐CoV‐2 infections, but the extent of paediatric COVID‐19 disease differs between geographical regions and the distinct pandemic waves. Not all infections in children are mild, some children even show a strong inflammatory reaction resulting in a multisystem inflammatory syndrome. The assessments of paediatric vaccination depend on the efficacy of protection conferred by vaccination, the risk of adverse reactions and whether children contribute to herd immunity against COVID‐19. Children were also the target of consequential public health actions such as school closure which caused substantial harm to children (educational deficits, sociopsychological problems) and working parents. It is, therefore, important to understand the transmission dynamics of SARS‐CoV‐2 infections by children to assess the efficacy of school closures and paediatric vaccination. The societal restrictions to contain the COVID‐19 pandemic had additional negative effects on children’s health, such as missed routine vaccinations, nutritional deprivation and lesser mother–child medical care in developing countries causing increased child mortality as a collateral damage. In this complex epidemiological context, it is important to have an evidence‐based approach to public health approaches. The present review summaries pertinent published data on the role of children in the pandemic, whether they are drivers or followers of the infection chains and whether they are (after elderlies) major sufferers or mere bystanders of the COVID‐19 pandemic.

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Risk factors for PICU admission and death among children and young people hospitalized with COVID-19 and PIMS-TS in England during the first pandemic year

Cited by 82 publications

References 23 publications

Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021

Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021

Importance of understanding the reinfection risk of COVID-19 in children

COVID‐19 and children: medical impact and collateral damage

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