Children aged 17 and younger are at low risk of getting severe health issues, according to an international study examining the risk factors for severe outcomes in children with COVID-19 in 10 countries.
Of the 10,382 patients, 3,221 tested positive for COVID-19 upon visiting the emergency department between March 7, 2020, to June 15, 2021. Among the COVID-19 positive children, 735 (22.8 percent) were hospitalized and of those, 107 (3.3 percent) experienced severe outcomes within 14 days.
“Fortunately, the risk of developing severe disease in children with COVID-19 discharge from the emergency department is very low,” Dr. Todd Florin, a co-lead of the study and the director of Research in Emergency Medicine at Ann & Robert H. Lurie Children’s Hospital of Chicago, said in a news release. “Our findings can provide reassurance to parents and clinicians for children well enough to be managed in the community, while also providing important insights on which children may be at particular risk for severe outcomes.”
Researchers defined a severe outcome as the occurrence of a cardiac condition, a respiratory disorder, an infection, a neurological problem, or a death. “In the absence of documentation of one of the aforementioned events, the performance of any of the following interventions was deemed to represent a severe outcome: chest drainage, extracorporeal membrane oxygenation [a life support machine], inotropic support, positive pressure ventilation (invasive or noninvasive), and renal replacement therapy.”
Dr. Stephen Freedman, a pediatrician at Calgary’s Cumming School of Medicine, said the study attempted to “quantify the frequency of and risk factors for severe outcomes” in COVID-19 pediatric patients.
“We found that older age, having a pre-existing chronic condition and symptom duration were important risk factors for severe outcomes,” Freedman said.
The researchers found that having had a prior episode of pneumonia and seeking emergency care four to seven days after initial symptoms rather than “0–3 days before seeking care” were associated with severe outcomes.
This is the first study to identify “symptom duration prior to hospital presentation as a risk factor for severe pediatric COVID-19.” The researchers noted that this finding may “reflect the natural history of infection in youths, with symptom progression appearing between 4 and 7 days being more likely to lead to both hospital presentation and severe outcomes.”
Serious complications occurred more in kids five and older and were less common in children younger than 1 year old, a finding that differed from earlier studies that had identified young infants as a high-risk group.
“In contrast with some other studies, we did not find that very young infants were at a higher risk for severe outcomes,” the authors wrote. “In some studies where very young infants were identified as being at higher risk, the outcome of interest was hospitalization or ICU admission, whereas we required specific intensive care interventions or complications.”
The study also found that children with underlying health conditions were almost twice as likely to experience severe outcomes compared to those considered healthy upon their initial visit to the emergency department.
Notably, asthma was not found to be a risk factor in children with COVID-19 as other studies have suggested.
“Although asthma has been suggested as a risk factor for severe illness in youths with COVID-19, our study, as well as a registry-based study in the United States, did not confirm this association,” the authors said.
One of the study’s limitations is that the findings overestimate the risk of severe outcomes in COVID-positive children who were recruited in emergency departments and “should not be interpreted to reflect the risk faced by community-based cases.”
Scientists from the University of Calgary’s Cumming School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, and University of California-Davis Medical Center co-led the study.
“With emergency departments across the world seeing an influx of patients due to the COVID-19 pandemic and stressing capacity, this study will help address the surge by providing an estimate of the risk among pediatric COVID-19 patients screened in an emergency department,” said Dr. Nathan Kuppermann, study co-lead and chair of Emergency Medicine at University of California Davis Medical Center. “It will support emergency physicians triage of pediatric patients more efficiently by knowing who has risk factors for severe outcomes and focus advanced level care to those who do.”
