Factors associated with hospital and intensive care admission in paediatric SARS-CoV-2 infection: a prospective nationwide observational cohort study

Media type: E-Article
Title: Factors associated with hospital and intensive care admission in paediatric SARS-CoV-2 infection: a prospective nationwide observational cohort study
Contributor: Uka, Anita; Buettcher, Michael; Bernhard-Stirnemann, Sara; Fougère, Yves; Moussaoui, Dehlia; Kottanattu, Lisa; Wagner, Noémie; Zimmermann, Petra; Ritz, Nicole; Albisetti, M.; Bernet, V.; Betti, C.; Cachat, F.; Caplazi, P.; Decker, M-L.; Durrer, E.; Fluri, S.; Gebauer, M.; Gehri, M.; Giannoni, E.; Grupe, S.; Horn, M.; L’Huiller, A.; Karen, T.; [...]
imprint: Springer Science and Business Media LLC, 2022
Published in: European Journal of Pediatrics
Language: English
DOI: 10.1007/s00431-021-04276-9
ISSN: 0340-6199; 1432-1076
Origination:
Footnote:
Description: <jats:title>Abstract</jats:title><jats:p>Coronavirus disease 2019 (COVID-19) is usually less severe in children compared to adults. This study describes detailed clinical characteristics, treatment and outcomes of children with COVID-19 in a non-hospitalised and hospitalised setting and quantifies factors associated with admission to hospital and intensive care unit in children with SARS-CoV-2 infection on a nationwide level. Data were collected through the Swiss Paediatric Surveillance Unit from children < 18 years with confirmed SARS-CoV-2 infection. All 33 paediatric hospitals in Switzerland reported non-hospitalised and hospitalised cases from March 1 to October 31, 2020 during both pandemic peaks. In total, 678 children were included. The median age was 12.2 years (IQR 5.0–14.6), 316 (46.6%) were female and 106 (15.6%) had comorbidities. Overall, 126 (18.6%) children were hospitalised of whom 16 (12.7%) required ICU admission. Comorbidities were the only factor associated with hospital admission in a multivariable regression analysis (odds ratio 3.23, 95%CI 1.89 to 5.50;<jats:italic>p</jats:italic>-value < 0.01). Children with preexisting comorbidities did not require ICU admission more often. Hospitalised children more often presented with fever (96 [76.2%] vs 209 [38.1%],<jats:italic>p</jats:italic>-value < 0.01) and rash (16 [12.8%] vs 6 [1.1%],<jats:italic>p</jats:italic>-value < 0.01). Anosmia/dysgeusia was more prevalent in non-hospitalised children (73 [13.3%] vs 3 [2.4%],<jats:italic>p</jats:italic>-value < 0.01). In hospitalised children, oxygen treatment was required in 34 (27.0%), inotropes in nine (7.3%) and mechanical ventilation in eight (6.3%) cases. Complications were reported in 28 (4.1%) children with cardiovascular complications being most frequent (12 [1.8%]). Three deaths were recorded.</jats:p><jats:p><jats:italic>Conclusion</jats:italic>: This study confirms that COVID-19 is mostly a mild disease in children. Fever, rash and comorbidities are associated with higher admission rates. Continuous observation is necessary to further understand paediatric COVID-19, guide therapy and evaluate the necessity for vaccination in children.<jats:table-wrap><jats:table><jats:tbody><jats:tr><jats:td colspan="2"><jats:bold>What is Known:</jats:bold><jats:italic>• Clinical manifestations of SARS-CoV-2 infection in children vary from asymptomatic to critical disease requiring intensive care unit admission.</jats:italic><jats:italic>• Most studies are based on hospitalised children only; currently, there is limited data on non-hospitalised children.</jats:italic></jats:td></jats:tr><jats:tr><jats:td colspan="2"><jats:bold>What is New:</jats:bold><jats:italic>• The clinical spectrum and severity of COVID-19 is influenced by age: in children less than 2 years, fever, cough and rhinorrhoea are the most common symptoms and in adolescents, fever, cough and headache are more common.</jats:italic><jats:italic>• Hospitalised children more often presented with fever and rash, while anosmia/dysgeusia is more prevalent in non-hospitalised children.</jats:italic><jats:italic>• Children with pre-existing comorbidities are more frequently hospitalised but do not require ICU admission more often.</jats:italic></jats:td></jats:tr></jats:tbody></jats:table></jats:table-wrap></jats:p>

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