Global study notes risk factors for rare severe COVID-19 in children

A 10-country study of more than 3,000 children who tested positive for COVID-19 in emergency departments (EDs) finds that 3% developed serious illness within 2 weeks, risk factors being advanced age , chronic diseases and symptoms experience longer.

the to study was published yesterday in JAMA network open.

An international group of scientists reports that among 3,221 children aged 17 and under studied in Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain and the United States In the United States, 107 (3.3%) suffered serious complications within 2 weeks and 4 (0.12%) died. Among children sent home from ED, the risk was much lower.

The children had visited an emergency department from March 7, 2020 to June 15, 2021, a period that was mostly before the Delta variant (B1617.2) and long before the current Omicron variant (B.1.1.529) not be detected.

“Fortunately, the risk of developing serious illness in children with COVID-19 discharged from the emergency department is very low,” said study co-lead author Todd Florin, MD, associate professor of pediatrics at Northwestern University, in a university in Calgary. Press release. “Our findings may reassure parents and clinicians that children are well enough to be cared for in the community, while providing important information about children who may be at particular risk for serious outcomes.”

Asthma is not considered a risk factor

Of the 3,221 children treated in one of 41 emergency departments, 2007 (62.3%) were from the United States, 1,694 (52.6%) were male and 484 (15.0%) suffered from a self-reported chronic disease. They were quite young, with a median age of 3 years.

After 14 days of follow-up, 735 children (22.8%) were hospitalized, 107 (3.3%) had a serious evolution and 4 (0.12%) died. The researchers used a composite measure to define severe outcomes that included intensive interventions during hospitalization, such as positive pressure ventilation; diagnoses that indicated severe organic impairment; And the dead.

Characteristics associated with severe outcomes included being 5 to 9 years old (odds ratio [OR], 1.60 compared to children less than 1 year old), being between 10 and 17 years old (OR, 2.39), having a self-reported chronic disease (OR, 2.34), previous episode of pneumonia (OR, 3.15), symptoms starting 4-7 days before seeking emergency department care (vs. starting 0-3 days before seeking care: OR, 2.22), and country (e.g., Canada vs. USA: GOLD, 0.11; Costa Rica v USA: GOLD, 1.76; Spain v USA: GOLD, 0.51).

The study authors wrote, “Although asthma has been suggested as a risk factor for severe disease in young people with COVID-19, our study, along with a registry-based study in the United States , did not confirm this association.

Of the 2,510 children discharged from the emergency department after initial testing and who had full follow-up, 50 (2.0%) were eventually hospitalized and 12 (0.5%) had serious results.

Compared with hospitalized children who tested negative for COVID-19, the risk of serious outcomes was higher in hospitalized patients who tested positive for COVID-19, with a risk difference of 3.9% (95% confidence interval %, 1.1% to 6.9%).

The authors note, “Because the participating emergency departments were located in academic pediatric facilities, we cannot generalize our findings to all community emergency departments or generalize to countries other than those included in our analysis.”

“There are no specific evidence-based treatments and therapies for children at present, and detailed research data describing outcomes in young people with COVID-19 are lacking, so this study offers important information that we believe will be useful on the front line of care providers treating children with COVID-19,” said co-lead author Stephen Freedman, MD, a pediatrician at the University of Calgary, in the release. Press.

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