Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children

Abstract

Key Points Question Among children with a COVID-19 diagnosis, what conditions are common, and which are associated with severe COVID-19 illness? Findings In this cross-sectional study of 43 465 patients aged 18 years or younger with COVID-19, more than one-quarter had 1 or more underlying condition; asthma, obesity, neurodevelopmental disorders, and certain mental health conditions were most common. Certain conditions as well as medical complexity were associated with a higher risk of severe COVID-19 illness. Meaning These findings expand the knowledge available regarding children with COVID-19 and could inform pediatric clinical practice and public health priorities, such as prevention and mitigation of COVID-19.

Trends in COVID-19 Cases, Emergency Department Visits, and Hospital Admissions Among Children and Adolescents Aged 0–17 Years — United States, August 2020–August 2021

“…Children and adolescents can experience severe acute COVID-19, which might require mechanical ventilation, or result in other complications, such as multisystem inflammatory syndrome in children (MIS-C) ( 2 ) ¶¶¶ and persistent symptoms from COVID-19 ( 4 ). Pediatric patients who have underlying medical conditions might be at risk for more severe disease ( 3 ). The increases in COVID-19 hospital admissions found in this study occurred for all assessed pediatric age groups during July–August 2021, with most admissions among patients aged ≤4 or 12–17 years.…”

“…Although COVID-19 generally results in milder disease in children and adolescents than in adults, severe illness from COVID-19 can occur in children and adolescents and might require hospitalization and intensive care unit (ICU) support (1)(2)(3). It is not known whether the B.1.617.2 (Delta) variant,* which has been the predominant variant of SARS-CoV-2 (the virus that causes COVID-19) in the United States since late June 2021, † causes different clinical outcomes in children and adolescents compared with variants that circulated earlier.…”

Results of COVID-19 Surveillance in a Large United States Pediatric Healthcare System over One Year

“…We excluded children who died from this analysis. A more recent analysis through Wave 2 and partially into Wave 3 (March 2020 through January 2021) using the COVID-NET data found a higher risk of severe COVID-19 illness among children with medical complexity and certain underlying conditions, such as type 1 diabetes, cardiac and circulatory congenital anomalies, and obesity [ 21 ]. These results are similar to those found here in that children with either type 1 or type 2 diabetes were at increased risk for both hospitalization and ICU admissions [ 21 ].…”

“…This finding may be due to children with obesity presenting with more severe illness requiring immediate ICU admission. Obesity is a known risk factor for severe COVID-19 illness in adults [ 21 ] and especially severe obesity [ 22 ] but not necessarily a COVID-19 diagnosis. Our results are also consistent with other studies that show that children with asthma, diabetes, and mental health disorders including depression are at increased risk for hospitalization [ 21 , 23 ].…”

School Operation for the 2021-2022 Academic Year in the Context of the COVID-19 Pandemic

“…The majority of children and youth who become infected with SARS-CoV-2 are either asymptomatic or have mild, self-limited symptoms such as cough, nasal congestion, runny nose, sore throat, fever, or gastrointestinal symptoms such as abdominal pain or diarrhea. [24][25][26][27][28] Severe acute disease requiring intensive care has been described in a small minority of pediatric cases (0.06% of confirmed COVID-19 cases in children under 19 years of age in Canada), 29 particularly among those with certain underlying medical conditions, 30 but even in these patients the clinical course is usually much less severe than in adults, and deaths are extremely rare. [31][32][33][34][35] In Canada, as of July 2, 2021, there have been 14 reported pediatric deaths out of 272,257 reported pediatric COVID-19 cases.…”