Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children

• Main Authors: Jesse Papenburg (Author), Dara Petel (Author), Joan L Robinson (Author), Shaun K Morris (Author), Manish Sadarangani (Author), Karina A Top (Author), Ann Bayliss (Author), Tammie Dewan (Author), Ali Manafi (Author), Ashley Roberts (Author), Ari Bitnun (Author), Rosie Scuccimarri (Author), Helena Brenes-Chacon (Author), Alejandra Soriano-Fallas (Author), Rolando Ulloa-Gutierrez (Author), Jacqueline Wong (Author), Peter Gill (Author), Michelle Barton (Author), Jared Bullard (Author), Adriana Yock-Corrales (Author), Fatima Kakkar (Author), Tilmann Schober (Author), Chelsea Caya (Author), Jennifer Bowes (Author), Suzette Cooke (Author), Rachel Dwilow (Author), Tala El Tal (Author), Cheryl Foo (Author), Behzad Haghighi Aski (Author), Janell Lautermilch (Author), Marie-Astrid Lefebvre (Author), Kirk Leifso (Author), Nicole Le Saux (Author), Alison Lopez (Author), Joanna Merckx (Author), Alireza Nateghian (Author), Luc Panetta (Author), Dominique Piché (Author), Rupeena Purewal (Author), Lea Restivo (Author), Sarah Tehseen (Author), Isabelle Viel-Theriault (Author), Carmen Yea (Author), Ann Yeh (Author)
• Format: Book
• Published: BMJ Publishing Group, 2022-08-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Objective To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection.Design Multicentre retrospective cohort study.Setting 18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021.Patients Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C).Main outcome measure Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses.Results We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53-10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45-9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease.Conclusion We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children.

Item Description

10.1136/bmjpo-2022-001440
2399-9772