Why Some Children Develop Severe COVID-19 Disease
Researchers have identified risk factors associated with more severe outcomes in children with COVID-19. To cull this information, researchers followed more than 10,300 children who presented to 41 EDs in 10 countries. Among the more than 3,222 children who tested positive for COVID-19, 107 developed severe outcomes within two weeks of their ED visit. A total of 735 patients were hospitalized.
Severe outcomes included cardiovascular complications (e.g., myocarditis), neurologic complications, respiratory problems, and infectious-related issues. Four patients died.
Most COVID-positive children who were discharged from the ED were low risk for developing severe disease. However, those with pre-existing chronic disease, older age, and longer symptom duration put them at serious risk for severe outcomes. Reassuringly, most children who were considered healthy at their ED visit rarely declined significantly following this encounter.
Further, while asthma has been discussed as a potential risk factor for severe disease in COVID-19 patients, these researchers did not find such an association. Similarly, the authors reported young infants were not found to be at higher risk for severe outcomes. (Editor’s Note: For more data and information about methodology, please visit this link.)
Clinicians should consider the fact these data were collected and analyzed before the omicron variant swept the United States, according to co-author Stephen Freedman, MDCM, MSc, a professor of pediatrics and emergency medicine in at Alberta Children’s Hospital Research Institute in Canada.
“When faced with a child who might have one of the higher-risk features, if they are deemed well enough to be discharged, close follow-up is likely all that is required. We found that such children have a very low likelihood of deterioration and severe outcomes,” Freedman says. “On the other hand, if a child with a high-risk feature for a severe outcome requires hospitalization, then consideration should be given to ensuring that the admitting facility has the resources and skill set necessary to provide care to a child with COVID-19 who develops severe disease.”
Freedman adds that as therapeutic options become available for children older than age 12 years, frontline providers should consider treating such children if they meet eligibility criteria.
More broadly, Freedman advises clinicians to integrate these new findings into their overall assessments of children who present with COVID-19, and to stay attuned to the evolving evidence base. “We plan to explore whether similar risk factors occur in children infected by the omicron variant, and to look more specifically at the risks associated with individual underlying medical conditions,” he says.
Severe outcomes included cardiovascular complications, neurologic complications, respiratory problems, and infectious-related issues. Those with pre-existing chronic disease, older age, and longer symptom duration put them at serious risk for severe outcomes.
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