While severe cases of COVID-19 are uncommon in children, children with pre-existing medical conditions, including type 1 diabetes and congenital heart defects, or who meet the criteria for “medical complexity,” are at increased risk for serious illness and hospitalization, according to a new study by researchers at the US Centers for Disease Control and Prevention (CDC).
Lyudmyla Kompaniyets, PhD, COVID-19 Response, CDC, Atlanta, Georgia, and colleagues found that previous studies of risk factors in children were limited by small sample sizes, and so conducted the current study with a large database of all payers covering both. emergency and clinical departments of more than 900 geographically dispersed US hospitals.
“Using a large electronic healthcare administrative dataset, we sought to describe common underlying medical conditions and medical complexities, as well as their associations with the risk of hospitalization or serious illness in children seeking hospital care,” Kompaniyets explained. and colleagues out.
Their patient sample included more than 43,000 children in emergency medicine or clinical encounters with primary or secondary discharge diagnosis of COVID-19 from March 1, 2020 through January 31, 2021. The median age was 12 years; 52.8% were female; 33% were Hispanic or Latino; 24.1% were non-Hispanic black individuals. Hospitalization was required for 9.9% (4,302), of whom 29.6% received an intensive care unit (ICU), 6.4% received invasive mechanical ventilation (IMV) and 0.9% died.
Kompaniyets and colleagues found that children at the highest risk of severe COVID-19 disease, characterized by IC admission, IMV, or death, were those with type 1 diabetes (adjusted risk ratio [aRR] 2.38; 95% confidence interval [CI], 2.06-2.76); congenital anomalies of the heart and circulation (aRR 1.72; 95% CI 1.48-199); and epilepsy and/or convulsions (aRR, 1.71; 95% CI 1.41-2.08).
The researchers also assessed the relationship between severe COVID-19 disease and the presence of medical complexity, defined using the validated pediatric medical complexity algorithm (PMCA) for the presence or absence of complex and non-complex chronic diseases. Medical complexity was associated with the risk of hospitalization and serious illness upon hospitalization. Compared to children without chronic disease, children with non-complex chronic disease and complex chronic disease had 2.91 times (95% CI, 2.63-3.23) and 7.86 times (95% CI, 6.91- 8.95 more likely to be hospitalized).
“Our finding that levels of medical complexity are a risk factor for severe COVID-19 disease identifies a previously unidentified population at higher risk, not clearly described in previous literature,” Kompaniyets and colleagues claim.
In accompanying, invited commentary, Jennifer Schuster, MD, MSc, Division of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, and Annabelle de St Maurice, MD, MPH, Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, welcomed the addition to previously limited data on pediatric risk factors for hospitalization from COVID-19.
They agree that a large database can be used to provide information on uncommon illnesses, including severe pediatric COVID-19, but also point out some limitations. For example, they note that attributing associations can be difficult. In this study, they point out that most of the children were adolescents and risk factors differed when the data was stratified by age, suggesting that recommendations for COVID-19 treatment and prevention should also vary by age.
“This study identifies factors associated with severe pediatric COVID-19 and highlights the need for multi-center collaboration and dedicated funding to study pediatric COVID-19,” Schuster and the St Maurice state. “To provide the best care for children, we have pediatric-specific data.”