Study IDs risk factors for severe COVID-19 in kids

Results of the Global PERN–COVID-19 study have identified factors that increase the risk of severe outcomes* in children diagnosed with COVID-19.

“We found that older age, having a pre-existing chronic condition, and symptom duration were important risk factors for severe outcomes,” said senior co-author Professor Stephen Freedman from the Cumming School of Medicine, University of Calgary, Calgary, Canada.

The multinational**, prospective study involved 3,221 individuals aged <18 years (median age 3 years, 52.6 percent male) who tested positive for SARS-CoV-2 (as per PCR testing) at the participating emergency departments (ED) or during repeat testing over the next 2 weeks between March 2020 and June 2021. Fifteen percent of patients reported pre-existing underlying chronic comorbidities. About 5 percent of patients were asymptomatic at presentation.

At the initial ED presentation, 21.3 percent of patients were hospitalized, with 13.3 percent admitted to the intensive care unit (ICU).

At 14 days follow-up, 22.8 percent of the patients (n=735) had been hospitalized, 3.9 percent had been admitted to the ICU, and 3.3 percent had severe outcomes. Four patients (0.12 percent) had died. [JAMA Network Open 2022;5:e2142322]

The incidence of severe outcomes was greatest in patients aged 10 to <18 years and lowest in those aged <1 year (5.5 percent vs 1.7 percent). Fifty patients (1.6 percent) developed multisystem inflammatory syndrome in children or Kawasaki disease, 16 of whom had severe disease. These conditions were most common in patients aged 5 to <10 years.

Compared with patients aged <1 year, those aged 5 to <10 years were at an increased risk of severe outcomes (odds ratio [OR], 1.60, 95 percent confidence interval [CI], 1.09–2.34; p=0.02), with a greater risk observed in patients aged 10 to <18 years (OR, 2.39, 95 percent CI, 1.38–4.14; p=0.002).

The risk of severe disease was also increased in patients with self-reported chronic illness (OR, 2.34, 95 percent CI, 1.59–3.44; p<0.001), as well as in those with a previous pneumonia episode (OR, 3.15, 95 percent CI, 1.83–5.42; p<0.001). Patients who experienced symptoms for 4–7 days before ED presentation were also more likely to develop severe disease than those who presented within 0–3 days of symptom onset (OR, 2.22, 95 percent CI, 1.29–3.82; p=0.004).

Patients who were enrolled in Canada or Spain had a lower risk of developing severe disease compared with those enrolled in the US (ORs, 0.11 [p<0.001] and 0.51 [p=0.05] vs US), while those enrolled in Costa Rica had a higher risk (OR, 1.76; p=0.03).

A total of 2,510 patients were discharged from the ED after testing positive for SARS-CoV-2 at the initial presentation and had complete follow-up information. Within 14 days, 12.7 percent required medical care for new, worsening, or persistent symptoms. Fifty patients later required hospitalization and 12 patients (0.5 percent) developed severe outcomes, though there were no deaths. The risk of developing severe outcomes was higher among those with chronic underlying conditions (risk difference 1.7 percent).

Severe COVID-19 in kids: Rare, but not out of the question

“While those with chronic medical conditions are at the highest risk for complications from COVID-19, children who are otherwise healthy can still become seriously ill due to COVID,” said co-author Associate Professor Fahd Ahmad from the Washington University School of Medicine in St Louis, St Louis, Missouri, US, in a press release. [https://medicine.wustl.edu/news/study-examines-risk-factors-for-severe-health-problems-in-kids-with-covid-19/, accessed 21 January 2022]

“Overall, children do seem less likely to need ICU care due to COVID than adults. However, many children can become sick enough to need hospitalization. Those well enough to be at home are still contagious, and we don’t yet know the long-term effects of COVID-19 infections on kids,” he continued, thus stressing the importance of vaccination and boosters in eligible children.

The authors noted that the findings may not apply to community cases and screening criteria and testing capacity may have varied by enrolment site. Furthermore, the study was conducted prior to the circulation of the delta and omicron strains.

“We know that omicron is causing far more children to become ill with COVID-19 than at any other time in the pandemic and, because of this increase in infections, hospitalizations for kids who are sick from COVID-19 have spiked,” Ahmad said, though he noted that early evidence suggests that most children can receive care at home.