1. In a large French national surveillance study of hospitalized children with COVID-19, age ≥ 10 years, hypoxemia, and extremely elevated C-reactive protein (CRP) were associated with severe disease.
2. In contrast to previous studies, children < 90 days old were at lowest risk of severe disease.
Evidence Rating Level: 2 (Good)
Study Rundown: Numerous studies have shown that children are at low risk for severe COVID-19. However, severe disease, including death, has occurred in pediatric patients. Information regarding risk factors for severe illness in children has been limited. Reports published earlier in the pandemic suggested that children < 1 year of age are at increased risk for severe disease. For this study, researchers in France performed a national prospective surveillance of hospitalized children with COVID-19 across 60 hospitals. Out of 397 children included in the study, 6 (1.5%) died. Severe disease occurred in 11% of cases. Risk factors independently associated with severe illness (in children without MIS-C) included age ≥ 10 years, hypoxemia, and CRP ≥ 80 mg/L. Comorbidities were not independently associated with severe illness. Children < 90 days of age represented the largest group of hospitalized children, but only 3% had severe disease. The study captured 38.5% of all pediatric COVID-19 cases in France during the study period, providing useful information for clinicians taking care of children with COVID-19.
Relevant Reading: Epidemiology of COVID-19 among children in China
In-Depth [prospective cohort]: All children hospitalized with COVID-19 at 60 hospitals in France from February 12 to June 1, 2020 were included in the study (n=397, 57% male, median age 16 months). Cases of COVID-19 were defined by positive PCR testing for SARS-CoV-2 (n=385) or chest CT scan findings compatible with COVID-19 (n=12). Severe disease was defined as the need for hemodynamic support, non-invasive ventilation (including high-flow nasal cannula), or death. 29% of children had comorbidities, but none were associated with severe illness. Children < 90 days of age made up 37% of all patients, and 92% of these children had fever. Only 3% in this group had severe disease. 29 patients were diagnosed with MIS-C, however those with positive SARS-CoV-2 serology and negative PCR tests were excluded from the study, so it is likely that many children with MIS-C were not included. Risk factors for severe disease were analyzed excluding children with MIS-C. Age ≥ 10 years (OR 3.4, p=0.034), hypoxemia (defined as SpO2 < 95%, OR 8.9, p=0.0004), and CRP ≥80 mg/L (OR 6.6, p=0.012) were independently associated with severe illness.
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