Julia Orkin (Canada)
Hospital for Sick Children Division of Paediatric MedicineAuthor Of 1 Presentation
RISK FACTORS FOR SEVERE COVID-19 IN HOSPITALIZED CANADIAN CHILDREN: A NATIONAL PROSPECTIVE STUDY
Abstract
Backgrounds:
Comorbid conditions are a recognized risk factor for severe COVID-19 disease in children, though there is limited evidence regarding the risks associated with specific conditions. The objective of this study was to identify factors associated with severe COVID-19 among hospitalized children with SARS-CoV-2 infection in Canada.
Methods
We conducted a national prospective study on hospitalized children with microbiologically confirmed SARS-CoV-2 infection via the Canadian Paediatric Surveillance Program from March 2020-May 2021. Cases were reported voluntarily by a network of >2800 paediatricians and paediatric subspecialists. SARS-CoV-2 hospitalizations were classified as COVID-19-related, incidental infection, or infection control/social admissions. Severe disease was defined as intensive care, ventilatory, or hemodynamic requirements, select organ system complications, or death. Risk factors for severe disease were identified using multivariable Poisson regression, adjusting for child age and sex, coinfections, and timing of hospitalization.
Results:
We identified 541 children hospitalized with SARS-CoV-2 infection, including 329 (60.8%) with COVID-19-related disease. Median age at admission was 2.8 years (IQR 0.3-13.5) and 42.9% (n=232) had at least one comorbidity. Among COVID-19-related hospitalizations, severe disease occurred in 29.5% of children (n=97/329), including a higher proportion of children aged 1-4 years (42.6%) and 12-17 years (41.3%). Comorbidities associated with severe disease are described in Figure 1, and included technology dependence (adjusted risk ratio [aRR] 1.96, 95% confidence interval [CI] 1.31-2.95), neurologic conditions (aRR 1.87 95% CI 1.34-2.61), and pulmonary conditions (aRR 1.66, 95% CI 1.13-2.42).
Conclusions/Learning Points:
While severe outcomes were detected at all ages and among patients with and without comorbidities, neurologic and pulmonary conditions as well as technology dependence were associated with increased risk of severe COVID-19. These findings may help guide vaccination programs and prioritize targeted COVID-19 therapies for children.