What contributes to severe COVID-19 in kids


Coronavirus disease 2019 (COVID-19) may be mild in most cases for children, but severe cases do happen. An investigation offers insight into what factors may contribute to those cases.

Much of the focus on coronavirus disease 2019 (COVID-19) has been on adult cases, but there were, in fact, over 2,000,000 pediatric cases in 2020. And although many of the cases were mild, some required mechanical ventilation or admission to the intensive care unit. A research letter in JAMA Network Open looked at the associations between patient characteristics and severe COVID-19 in pediatric patients who were hospitalized.1

The investigators used discharge data from the Premier Healthcare Database Special COVID-19 Release, which was used to find inpatient or emergency department cases with a primary or secondary COVID-19 discharge diagnosis from March 1 through October 31, 2020. In the report, severe COVID-19 was defined as requiring treating in either an intensive care unit or step-down unit, the use of invasive mechanical ventilation, or death.

The cohort included 20,714 patients with COVID-19. Slightly more than half of the cohort were girls aged 12 to 18 years. There were 8148 Hispanic or Latino patients and 5054 who were non-Hispanic Black. Roughly 29% of the patients had 1 or more chronic condition. A subcohort of 2430 patients required hospitalization because of COVID-19 and 756 patients had severe COVID-19. The investigators noted an increased link to COVID-19 in patients who had 1 or more chronic condition when compared to those who had none (adjusted odd ratio [aOR], 3.27; 95% CI, 2.44-4.37); children aged 2 to 11 years versus those aged 12 to 18 years (aORs, 1.53; 95% CI, 1.11-2.13 and 1.53; 95% CI, 1.04-2.23, respectively); and in male versus female patients (aOR, 1.52; 95% CI, 1.26-1.83). No statistically significant link was noted between either insurance type or race/ethnicity and severe COVID-19.

The investigators concluded that younger children seemed to have an increased association with severe COVID-19, although they did note that younger children might be admitted to the intensive care unit due more to an abundance of caution than actual disease severity. They also found independent links to severe COVID-19 with being male and pre-existing chronic conditions.


1. Preston L, Chevinsky J, Kompaniyets L, et al. Characteristics and disease severity of US children and adolescents diagnosed with COVID-19. JAMA Netw Open. 2021;4(4):e215298. doi:10.1001/jamanetworkopen.2021.5298

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Courtney Nelson, MD
Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief, Contemporary Pediatrics, professor of pediatrics, Feinberg School of Medicine, Northwestern University, pediatric infectious diseases attending, Ann & Robert H. Lurie Children's Hospital of Chicago
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