What contributes to severe COVID-19 in kids

Much of the focus on 2019 coronavirus disease (COVID-19) has focused on adult cases, but there were in fact over 2,000,000 pediatric cases in 2020. And while many of the cases were mild, some cases were mechanical artificial respiration or admission to the intensive care unit. A study letter in JAMA Network Open looked at the associations between patient characteristics and severe COVID-19 in hospitalized pediatric patients.1

The researchers used discharge data from the Premier Healthcare Database Special COVID-19 Release, which was used to find clinical or emergency cases with a primary or secondary COVID-19 discharge diagnosis from March 1 to October 31, 2020. In the report severe COVID -19 was defined as treatment in an intensive care unit or step-down unit, the use of invasive mechanical ventilation, or death.

The cohort included 20,714 patients with COVID-19. Slightly more than half of the cohort consisted of girls aged 12 to 18 years. There were 8,148 Hispanic or Latino patients and 5,054 who were non-Hispanic black. About 29% of the patients had 1 or more chronic conditions. A sub-cohort of 2,430 patients had to be hospitalized for COVID-19 and 756 patients had severe COVID-19. The researchers noted an increased association with COVID-19 in patients who had 1 or more chronic conditions compared to those who had none (adjusted odd ratio [aOR], 3.27; 95% CI, 2.44-4.37); children 2 to 11 years versus children 12 to 18 years (aORs, 1.53; 95% CI, 1.11-2.13 and 1.53; 95% CI, 1.04-2.23, respectively); and in male versus female patients (aOR, 1.52; 95% CI, 1.26-1.83). No statistically significant association was noted between insurance type or race / ethnicity and severe COVID-19.

The researchers concluded that younger children seemed to have an increased association with severe COVID-19, although they did note that younger children may be admitted to intensive care because of more caution than actual disease severity. They also found independent links of severe COVID-19 with male and pre-existing chronic conditions.


1. Preston L, Chevinsky J, Kompaniyets L, et al .; Disease Characteristics and Severity of American Children and Adolescents Diagnosed with COVID-19. JAMA Netw Open. 2021; 4 (4): e215298. doi: 10.1001 / jamanetworkopen.2021.5298

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