Underlying illness, respiratory infection increases risk of severe COVID in children
Of two new studies on severe COVID-19 in children, the first shows that more than one in four had an underlying medical condition, and the second shows that children diagnosed as having an acute lower respiratory infection ( ALRI) were more than twice as likely to require invasive mechanical ventilation.
Type 1 diabetes, obesity, heart problems
First study, published today in JAMA network open, researchers from the U.S. Centers for Disease Control and Prevention used the special COVID-19 version of the Premier healthcare database, which contains data from 872 hospitals, to study 43,465 patients aged 18 and over fewer who visited an emergency department or were hospitalized for severe COVID-19 from March 2020 to January 2021.
They found that 28.7% of all patients with COVID-19 had at least one chronic disease, the most common of which were asthma (10.2%), neurodevelopmental disorders (3.9%) , anxiety and fear disorders (3.2%), depression (2.8%), and obesity (2.5%). An underlying disease has been identified in 62.9% of hospitalized COVID-19 patients.
The most important risk factors for hospitalization included type 1 diabetes (adjusted risk ratio [aRR], 4.60) and obesity (aRR, 3.07), while type 1 diabetes (aRR, 2.38) and congenital heart and circulatory disorders (aRR, 1.72) were the highest risks. high from serious illness.
Prioritize public health, vaccination efforts
In children under 2 years of age, prematurity was a risk factor for severe COVID-19 disease (aRR, 1.83). Chronic and complex chronic diseases were risk factors for hospitalization (RRa, 2.91 and 7.86, respectively) and for severe disease (RRa, 1.95 and 2.86).
Chronic conditions linked to a higher risk of hospitalization for COVID-19 in children of all ages were epilepsy and / or seizures (aRR, 1.97); dependence on medical support, such as a feeding tube (aRR, 1.96); trauma and stress-related disorders (aRR, 1.82); neurodevelopmental disorders (aRR, 1.64); type 2 diabetes (aRR: 1.59); depression (RRa: 1.58); essential hypertension (aRR, 1.51); anxiety and fear disorders (aRR, 1.47); and asthma (aRR: 1.23).
Among the 4,302 children admitted to a hospital with COVID-19, at-risk intensive care unit (ICU) admission, mechanical ventilation, or death were highest among people with type 1 diabetes (aRR, 2.38), congenital heart and circulatory disorders (aRR, 1.72), and epilepsy and / or convulsions (RRa, 1.71).
Other conditions linked to a higher risk of poor outcome included obesity (aRR, 1.42); essential arterial hypertension (aRR: 1.39); sleep disorders such as sleep apnea (aRR, 1.26); and dependence on medical support (aRR, 1.25).
Of all COVID-19 patients, 29.6% were admitted to intensive care, 9.9% were hospitalized, 6.4% required invasive mechanical ventilation, and 0.9% died. The median age of the patients was 12 years (range: 4 to 16), 52.8% were female, 33.0% were Hispanic or Latino, and 24.1% were black.
The researchers said public health mitigation efforts and vaccine prioritization should be considered for children with underlying chronic conditions. “Health care practitioners may consider the potential need for prudent clinical management of children with these conditions and COVID-19,” they concluded. “Further epidemiological investigation could provide insight into the causal pathways underlying our findings and identify other factors that put children at increased risk for serious illness from COVID-19. “
Death, need for mechanical ventilation
In one letter to the editor at the end of last week in the Journal of infections, Vivian Botelho Lorenzo, MD, and Cristiana Nascimento-Carvalho, MD, PhD, both from the Federal University of Bahia School of Medicine in Salvador, Brazil, described a retrospective study of 210 children under 17 years old admitted to an ALRI pediatric intensive care unit from April 2020 to April 2021. The median age was 2.8 years.
Of 210 ALRI patients, 29.5% tested positive for COVID-19, 15.7% required mechanical ventilation and 3.8% died. COVID-19 patients were more likely than their peers to need mechanical ventilation (25.8% vs. 11.5%) and to die (8.1% vs. 2.0%). Boys and patients with sickle cell disease were more likely than others to test positive for COVID-19 (67.7% vs. 52.7%; 6.5% vs. 0%).
Among all patients, the most common symptoms of ARII were shortness of breath (98.1%), cough (68.6%), and fever (57.6%), while the most common signs were an oxygen concentration of less than 92% (73.3%), requiring respiratory assistance. (62.4%) and dehydration (39.5%). The researchers note that wheezing on admission was more likely to be a symptom in those who were not admitted (21.0% vs. 38.5%, respectively).
More than one in three patients also had an underlying medical condition (34.3%), the most common of which were chronic lung disease (18.6%), neurological diseases other than epilepsy (7.1 %) and epilepsy (5.2%). In addition, three of the five COVID-19 patients who died had an underlying disease, two diagnosed as having cerebral palsy and one having floppy infant syndrome.
Researchers noted that amid the coronavirus pandemic, about two-thirds of patients were hospitalized with severe ARIs without COVID-19. “In 2016, 3 years before the onset of the current COVID-19 pandemic, ALRI was estimated at 652,572 deaths in children under 5 worldwide,” they wrote. “Therefore, besides SARS-CoV-2, other causative agents continue to cause severe ALRI.”
The authors said clinicians should be aware that children with severe ALRI and COVID-19 need mechanical ventilation more often than other patients and that children with sickle cell disease should be given priority for COVID vaccination. -19.