Are medically complex children at greater risk of severe COVID-19?


The medically complex child is often at greater risk of a life-threatening infection than his or her non-complex peers. A study presented at the virtual 2021 Pediatric Academic Societies meeting examines whether the medically complex child is at greater risk of COVID-19.

Medical complexity in children can lead to a variety of complications and worries, particularly when it comes to infections because such children are often at the risk of life-threatening ones. A group of researchers at the Alfred I. DuPont Hospital for Children in Wilmington, Delaware, investigated whether children with medical complexities were at greater risk of serious COVID-19 outcomes than children who were not medically complex. At the virtual 2021 Pediatric Academic Societies meeting, Mounika Muttineni, DO, and Kelley German, MD, who are both residents at the hospital and members of the research team presented the study’s findings.

The team performed a retrospective chart review of electronic health records from March 2020 to October 2020. They used the 3M clinical risk group categories to classify patients and only included patients in clinical risk group 9, which is the most medically complex group. In this group, there were 3982 patients identified; 1328 severe acute respiratory syndrome coronavirus 2 tests ordered for 499 patients; and 54 patients who tested positive for COVID-19, of which 23 were found through pre-operation clearance testing.

In the subset of patients who tested positive for COVID-19, the team found that male patients were slightly more likely to be positive than female patients (12.0% vs 10.0%). Patients aged >13 years were more often positive (15%) than those aged <4 years (12%) or 5 to 12 years (6%). Hispanic patients (22%) were more often positive than their White (10%) and Black (8%) peers. The team also looked at the percentage of cases that were symptomatic versus asymptomatic. Girls were more likely to be asymptomatic than boys. Children aged 5 to 12 years were more likely to be asymptomatic than those aged <4 years and >13 years. Black and Hispanic children were less likely to be asymptomatic than their White peers.

In the sample, 12 patients were hospitalized with positive tests and 5 were asymptomatic and were in the hospital for reasons other than COVID-19. Fever was the most common symptom with respiratory distress the second most common. Three children needed increases respiratory support and 1 of those children was discharged with increased baseline respiratory settings. The average length of a hospital stay was 16 days, but there was at least one hospital stay lasting 40 days. There were no acute COVID-related deaths, but the investigators did noted that 2 of the deaths occurred in patients who had multisystem inflammatory syndrome in children symptoms, but were COVID-19 polymerase chain reaction test negative.

The team concluded that medical complexity did not appear to be linked to increased mortality because of COVID-19. They said that it’s possible that for patients who are in long-term care facilities that the continual surveillance could be a factor that prevented hospitalization and severe disease.


1. Muttineni M. The impact of COVID-19 pandemic on children with medical complexity. Pediatric Academic Societies Meeting 2021; May 3, 2021; virtual. Accessed May 3, 2021.

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