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da Silva Alves C, Baptista Pestana R, Morais-Almeida M. Recent insights into the impacts of COVID-19 on pediatric asthma. Expert Rev Clin Immunol 2024:1-20. [PMID: 39136081 DOI: 10.1080/1744666x.2024.2390641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 08/28/2024]
Abstract
INTRODUCTION The emergence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the subsequent coronavirus disease 2019 (COVID-19) pandemic has raised questions about its impact on pediatric asthma. This review analyzes the latest research to offer a comprehensive understanding of the dynamics between COVID-19 and pediatric asthma. AREAS COVERED This narrative review examines the effects of COVID-19 on pediatric asthma, exploring clinical outcomes, immune responses, recommended treatments, the impact of SARS-CoV-2 strains, and COVID-19 vaccination. Data were sourced from databases (PubMed, Embase, and BioRxiv/MedRxiv) from January 2020 to November 2023. EXPERT OPINION In response to the COVID-19 pandemic, the international scientific community rapidly developed extensive knowledge, demonstrating unprecedented cooperation. Despite these advances, questions remain about SARS-CoV-2 infection and pediatric asthma. Most research consists of epidemiological studies with varying methods, sometimes yielding contradictory results. While asthma generally did not increase the risk of severe COVID-19 in children, uncontrolled asthma was a risk factor, highlighting the importance of maintaining asthma management. Telemedicine has proven effective for asthma control and will continue to grow, despite its limitations. Notably, allergic asthma may have a protective role against severe COVID-19. We recommend COVID-19 vaccination in the pediatric age group, including those with asthma.
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Affiliation(s)
- Carolina da Silva Alves
- Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal
- Pulmonology Department, Doutor Fernando da Fonseca Hospital, Amadora, Portugal
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Aparicio C, Willis ZI, Nakamura MM, Wolf J, Little C, Maron GM, Sue PK, Anosike BI, Miller C, Bio LL, Singh P, James SH, Oliveira CR. Risk Factors for Pediatric Critical COVID-19: A Systematic Review and Meta-Analysis. J Pediatric Infect Dis Soc 2024; 13:352-362. [PMID: 38780125 DOI: 10.1093/jpids/piae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 05/21/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Risk stratification is a cornerstone of the Pediatric Infectious Diseases Society COVID-19 treatment guidance. This systematic review and meta-analysis aimed to define the clinical characteristics and comorbidities associated with critical COVID-19 in children and adolescents. METHODS Two independent reviewers screened the literature (Medline and EMBASE) for studies published through August 31, 2023, that reported outcome data on patients aged ≤21 years with COVID-19. Critical disease was defined as an invasive mechanical ventilation requirement, intensive care unit admission, or death. Random-effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was explored through subgroup analyses. RESULTS Among 10,178 articles, 136 studies met the inclusion criteria for review. Data from 70 studies, which collectively examined 172,165 children and adolescents with COVID-19, were pooled for meta-analysis. In previously healthy children, the absolute risk of critical disease from COVID-19 was 4% (95% CI, 1%-10%). Compared with no comorbidities, the pooled OR for critical disease was 3.95 (95% CI, 2.78-5.63) for the presence of one comorbidity and 9.51 (95% CI, 5.62-16.06) for ≥2 comorbidities. Key risk factors included cardiovascular and neurological disorders, chronic pulmonary conditions (excluding asthma), diabetes, obesity, and immunocompromise, all with statistically significant ORs > 2.00. CONCLUSIONS While the absolute risk for critical COVID-19 in children and adolescents without underlying health conditions is relatively low, the presence of one or more comorbidities was associated with markedly increased risk. These findings support the importance of risk stratification in tailoring pediatric COVID-19 management.
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Affiliation(s)
- Camila Aparicio
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zachary I Willis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Mari M Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children's Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Cordell Little
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gabriela M Maron
- Department of Infectious Diseases, St. Jude Children's Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Paul K Sue
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Brenda I Anosike
- Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christine Miller
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Laura L Bio
- Department of Pharmacy, Lucile Packard Children's Hospital, Stanford, California, USA
| | - Prachi Singh
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Scott H James
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Carlos R Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
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Bauhofer AFL, Miranda E, Ussivane É, Chissaque A, António L, Campos F, Pololo R, Iahaia F, Gatambire A, Ráice F, Djedje M, Salência J, Maholela P, Gonçalves L, Inlamea O, de Deus N. Burden of COVID-19 in the Pediatric Population at Hospital Central de Maputo, Mozambique, October 2020 to October 2022. Viruses 2024; 16:1112. [PMID: 39066275 PMCID: PMC11281548 DOI: 10.3390/v16071112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 07/28/2024] Open
Abstract
The epidemiology and characteristics of SARS-CoV-2 in the hospitalized Mozambican pediatric population are scarce. We aimed to assess the burden of COVID-19 in the pediatric population at Hospital Central de Maputo and identify comorbidities and factors associated with death among hospitalized COVID-19 cases. A cross-sectional study was conducted from October 2020 to October 2022. Available records were retrieved from admission books. Univariate and bivariate analyses were reported to describe the sample characteristics. The frequency of pediatric cases admitted with COVID-19 was 0.6% (95% confidence interval (CI): 0.5-0.6; 364/63,753), and the frequency of pediatric cases hospitalized with COVID-19 was 2.5% (95% CI: 2.2-2.9; 173/6807). The monthly frequency of pediatric cases admitted and hospitalized with COVID-19 ranged from 0.1% to 5.4% and from 0.2% to 42.1%, respectively. In children hospitalized with COVID-19, underweight was the most observed comorbidity (17.4%; 19/109); death was observed in 30% (95% CI: 22.2-39.1; 33/110), and it was significantly higher in underweight children than in non-underweight children (61.5% [8/13] vs. 21.3% [16/75]; p-value = 0.005). Given the heightened risk of mortality among undernourished children compared to non-undernourished children, vaccination for COVID-19 should be prioritized for undernourished children.
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Affiliation(s)
- Adilson Fernando Loforte Bauhofer
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal;
| | - Emerson Miranda
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Édio Ussivane
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Assucênio Chissaque
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal
| | - Luciana António
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Fernanda Campos
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Ramígio Pololo
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Fátima Iahaia
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Aline Gatambire
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Fátima Ráice
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Marlene Djedje
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Judite Salência
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Plácida Maholela
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Luzia Gonçalves
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira 100, 1349-008 Lisboa, Portugal;
- Centro de Estatística e Aplicações, Universidade de Lisboa, 1749-016 Lisboa, Portugal
- Z-Stat4life, Espaço Cowork Baldaya, Palácio Baldaya, Estrada de Benfica N° 701ª, 1549-011 Lisboa, Portugal
| | - Osvaldo Inlamea
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
| | - Nilsa de Deus
- Instituto Nacional de Saúde, Marracuene 3943, Mozambique (N.d.D.)
- Departamento de Ciências Biológicas, Faculdade de Ciências, Universidade Eduardo Mondlane, Av. Julius Nyerere-Campus Universitário, Maputo 257, Mozambique
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Lara ST, Rein LE, Simanek AM, Totoraitis MF, Rausch DJ, Weston BW, Ahn KW, Meurer JR, Beyer KMM. Asthma as a Risk Factor for Hospitalization in Children and Youth With COVID-19: A Retrospective Cohort Study. Pediatr Infect Dis J 2024; 43:437-443. [PMID: 38241639 DOI: 10.1097/inf.0000000000004248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Studies examining the association between asthma and hospitalization among children and youth with coronavirus disease 2019 (COVID-19) have yielded mixed results. Both asthma and COVID-19 hospitalization are characterized by racial, ethnic and socioeconomic disparities which also pattern geographically, yet no studies to date have adjusted for neighborhood context in the assessment of this association. METHODS Mixed effects logistic regression was used to estimate the association between asthma and hospitalization due to COVID-19 in a sample of 28,997 children and youth diagnosed with COVID-19 in Milwaukee County, Wisconsin, from March 1, 2020, to May 31, 2022. Models adjusted for individual-level sociodemographic factors (age, gender, race, ethnicity and city/suburb residence) and season of diagnosis were examined as moderators. Random intercepts by census tract accounted for geographic variation in neighborhood factors and census tract-level measures of education, health and environment, and social and economic factors were assessed via childhood opportunity indices. RESULTS Asthma history was statistically significantly associated with hospitalization due to COVID-19 among children and youth. Hospitalization rates varied statistically significantly by census tract, and results were unchanged after accounting for childhood opportunity indices and census tract. Season of diagnosis was not found to moderate the effect of asthma history on COVID-19 hospitalization. CONCLUSION Our study suggests that asthma history is a risk factor for hospitalization in the context of COVID-19 infection among children and youth, warranting observation and follow-up of children with asthma as well as continued measures to prevent COVID-19 in this population.
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Affiliation(s)
- Shana T Lara
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
| | - Lisa E Rein
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
| | - Amanda M Simanek
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
- Michael Reese Foundation Center for Health Equity Research, Rosalind Franklin University, Chicago, IL
| | - Michael F Totoraitis
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
- City of Milwaukee Health Department, Milwaukee, WI
| | - Darren J Rausch
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
- Greenfield Health Department, Milwaukee, WI
| | - Benjamin W Weston
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Kwang Woo Ahn
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
| | - John R Meurer
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Kirsten M M Beyer
- From the Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI
- Milwaukee County COVID-19 Epidemiology Intel Team, Milwaukee, WI
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5
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Willis ZI, Oliveira CR, Abzug MJ, Anosike BI, Ardura MI, Bio LL, Boguniewicz J, Chiotos K, Downes K, Grapentine SP, Hersh AL, Heston SM, Hijano DR, Huskins WC, James SH, Jones S, Lockowitz CR, Lloyd EC, MacBrayne C, Maron GM, Hayes McDonough M, Miller CM, Morton TH, Olivero RM, Orscheln RC, Schwenk HT, Singh P, Soma VL, Sue PK, Vora SB, Nakamura MM, Wolf J. Guidance for prevention and management of COVID-19 in children and adolescents: A consensus statement from the Pediatric Infectious Diseases Society Pediatric COVID-19 Therapies Taskforce. J Pediatric Infect Dis Soc 2024; 13:159-185. [PMID: 38339996 DOI: 10.1093/jpids/piad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Since November 2019, the SARS-CoV-2 pandemic has created challenges for preventing and managing COVID-19 in children and adolescents. Most research to develop new therapeutic interventions or to repurpose existing ones has been undertaken in adults, and although most cases of infection in pediatric populations are mild, there have been many cases of critical and fatal infection. Understanding the risk factors for severe illness and the evidence for safety, efficacy, and effectiveness of therapies for COVID-19 in children is necessary to optimize therapy. METHODS A panel of experts in pediatric infectious diseases, pediatric infectious diseases pharmacology, and pediatric intensive care medicine from 21 geographically diverse North American institutions was re-convened. Through a series of teleconferences and web-based surveys and a systematic review with meta-analysis of data for risk factors, a guidance statement comprising a series of recommendations for risk stratification, treatment, and prevention of COVID-19 was developed and refined based on expert consensus. RESULTS There are identifiable clinical characteristics that enable risk stratification for patients at risk for severe COVID-19. These risk factors can be used to guide the treatment of hospitalized and non-hospitalized children and adolescents with COVID-19 and to guide preventative therapy where options remain available.
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Affiliation(s)
- Zachary I Willis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Carlos R Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Mark J Abzug
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Brenda I Anosike
- Department of Pediatrics, The Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Monica I Ardura
- Department of Pediatrics, ID Host Defense Program, Nationwide Children's Hospital & The Ohio State University, Columbus, OH, USA
| | - Laura L Bio
- Department of Pharmacy, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Juri Boguniewicz
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Kathleen Chiotos
- Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Divisions of Critical Care Medicine and Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kevin Downes
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Steven P Grapentine
- Department of Pharmacy, University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | - Adam L Hersh
- Department of Pediatrics, Division of Infectious Diseases, University of Utah, Salt Lake City, UT, USA
| | - Sarah M Heston
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Diego R Hijano
- Department of Infectious Diseases, St. Jude Children's Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - W Charles Huskins
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Scott H James
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Jones
- Department of Pharmacy, Boston Children's Hospital, Boston, MA, USA
| | | | - Elizabeth C Lloyd
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | | | - Gabriela M Maron
- Department of Infectious Diseases, St. Jude Children's Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Molly Hayes McDonough
- Center for Healthcare Quality & Analytics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christine M Miller
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Theodore H Morton
- Department of Pharmacy, St Jude's Children's Research Hospital, Memphis, Tennessee, USA
| | - Rosemary M Olivero
- Department of Pediatrics and Human Development, Michigan State College of Human Medicine and Helen DeVos Children's Hospital of Corewell Health, Grand Rapids, MI, USA
| | | | - Hayden T Schwenk
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | - Prachi Singh
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Vijaya L Soma
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Paul K Sue
- Department of Pediatrics, Columbia University, New York, NY, USA
| | - Surabhi B Vora
- Department of Pediatrics, University of Washington School of Medicine, and Division of Infectious Diseases, Seattle Children's Hospital, Seattle, WA, USA
| | - Mari M Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children's Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
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Barry MC, Pathak EB, Swanson J, Cen R, Menard J, Salemi JL, Nembhard WN. Epidemiology of COVID-19 in Infants in the United States: Incidence, Severity, Fatality, and Variants of Concern. Pediatr Infect Dis J 2024; 43:217-225. [PMID: 38134379 DOI: 10.1097/inf.0000000000004201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
BACKGROUND The clinical spectrum of infant COVID-19 ranges from asymptomatic infection to life-threatening illness, yet epidemiologic surveillance has been limited for infants. METHODS Using COVID-19 case data (restricted to reporting states) and national mortality data, we calculated incidence, hospitalization, mortality and case fatality rates through March 2022. RESULTS Reported incidence of COVID-19 was 64.1 new cases per 1000 infant years (95% CI: 63.3-64.9). We estimated that 594,012 infants tested positive for COVID-19 nationwide by March 31, 2022. Viral variant comparisons revealed that incidence was 7× higher during the Omicron (January-March 2022) versus the pre-Delta period (June 2020-May 2021). The cumulative case hospitalization rate was 4.1% (95% CI: 4.0%-4.3%). For every 74 hospitalized infants, one infant death occurred, but overall COVID-19-related infant case fatality was low, with 7.0 deaths per 10,000 cases (95% CI: 5.6-8.7). Nationwide, 333 COVID-19 infant deaths were reported. Only 13 infant deaths (3.9%) were the result of usually lethal congenital anomalies. The majority of infant decedents were non-White (28.2% Black, 26.1% Hispanic, 8.1% Asian, Indigenous or multiracial). CONCLUSIONS More than half a million US infants contracted COVID-19 by March 2022. Longitudinal assessment of long-term infant SARS-CoV-2 infection sequelae remains a critical research gap. Extremely low infant vaccination rates (<5%), waning adult immunity and continued viral exposure risks suggest that infant COVID-19 will remain a persistent public health problem. Our study underscores the need to increase vaccination rates for mothers and infants, decrease viral exposure risks and improve health equity.
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Affiliation(s)
- Megan C Barry
- From the College of Public Health, University of South Florida, Tampa, Florida
| | | | - Justin Swanson
- From the College of Public Health, University of South Florida, Tampa, Florida
| | - Ruiqi Cen
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Janelle Menard
- Women's Institute for Independent Social Enquiry, Olney, Maryland
| | - Jason L Salemi
- From the College of Public Health, University of South Florida, Tampa, Florida
| | - Wendy N Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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7
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Aparicio C, Willis ZI, Nakamura MM, Wolf J, Little C, Maron GM, Sue PK, Anosike BI, Miller C, Bio LL, Singh P, James SH, Oliveira CR. Risk Factors for Pediatric Critical COVID-19: A Systematic Review and Meta-Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.17.24301452. [PMID: 38293040 PMCID: PMC10827273 DOI: 10.1101/2024.01.17.24301452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Background Risk stratification is a cornerstone of the Pediatric Infectious Diseases Society COVID-19 treatment guidance. This systematic review and meta-analysis aimed to define the clinical characteristics and comorbidities associated with critical COVID-19 in children and adolescents. Methods Two independent reviewers screened the literature (Medline and EMBASE) for studies published through August 2023 that reported outcome data on patients aged ≤21 years with COVID-19. Critical disease was defined as an invasive mechanical ventilation requirement, intensive care unit admission, or death. Random effects models were used to estimate pooled odds ratios (OR) with 95% confidence intervals (CI), and heterogeneity was explored through subgroup analyses. Results Among 10,178 articles, 136 studies met the inclusion criteria for review. Data from 70 studies, which collectively examined 172,165 children and adolescents with COVID-19, were pooled for meta-analysis. In previously healthy children, the absolute risk of critical disease from COVID-19 was 4% (95% CI, 1%-10%). Compared with no comorbidities, the pooled OR for critical disease was 3.95 (95% CI, 2.78-5.63) for presence of one comorbidity and 9.51 (95% CI, 5.62-16.06) for ≥2 comorbidities. Key risk factors included cardiovascular and neurological disorders, chronic pulmonary conditions (excluding asthma), diabetes, obesity, and immunocompromise, all with statistically significant ORs >2.00. Conclusions While the absolute risk for critical COVID-19 in children and adolescents without underlying health conditions is relatively low, the presence of one or more comorbidities was associated with markedly increased risk. These findings support the importance of risk stratification in tailoring pediatric COVID-19 management.
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Affiliation(s)
- Camila Aparicio
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Zachary I. Willis
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mari M. Nakamura
- Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children’s Hospital, Boston, MA
| | - Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Cordell Little
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Gabriela M. Maron
- Department of Infectious Diseases, St. Jude Children’s Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Paul K. Sue
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Brenda I. Anosike
- Department of Pediatrics, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY
| | - Christine Miller
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Laura L. Bio
- Department of Pharmacy, Lucile Packard Children’s Hospital, Stanford, CA
| | - Prachi Singh
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Scott H. James
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL
| | - Carlos R. Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Mastrolia MV, De Cillia C, Orlandi M, Abu-Rumeileh S, Maccora I, Maniscalco V, Marrani E, Pagnini I, Simonini G. Clinical Syndromes Related to SARS-CoV-2 Infection and Vaccination in Pediatric Age: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2027. [PMID: 38004076 PMCID: PMC10673592 DOI: 10.3390/medicina59112027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
This narrative review aims to report the main clinical manifestations, therapeutic strategies, outcomes, and complications of acute SARS-CoV-2 infection in childhood and to summarize the data relating the SARS-CoV-2 vaccination efficacy and safety in pediatric age. SARS-CoV-2 infection mostly occurs asymptomatically in the pediatric population, while multisystem inflammatory syndrome in children (MIS-C) represents the most severe coronavirus disease 2019 (COVID-19)-related illness, a life-threatening event with a high morbidity rate. After the development of SARS-CoV-2 vaccines and their subsequent approval in children, the rate of infection as well as the number of its related complications have shown a drastic decrease. Fully vaccinated children are protected from the risk of developing a severe disease and a similar protective role has been observed in the reduction of complications, in particular MIS-C. However, long-lasting immunity has not been demonstrated, booster doses have been required, and reinfection has been observed. With regards to vaccine safety, adverse events were generally mild to moderate in all age groups: local adverse events were the most commonly reported. Nevertheless, a potential association between SARS-CoV-2 vaccine and the subsequent development of inflammatory manifestations has been suggested. Myocarditis has rarely been observed following vaccination; it appeared to be more frequent among adolescent males with a mild clinical course leading to a complete recovery. SARS-CoV-2 vaccine-related MIS-C cases have been described, although a univocal definition and an exact time interval with respect to vaccination has not been reported, thus not establishing a direct causal link. Current evidence about COVID-19 vaccination in children and adolescents suggest that benefits outweigh potential risks. Long-term data collection of the post-authorization safety surveillance programs will better define the real incidence of SARS-CoV-2 vaccine-related complications in the pediatric population.
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Affiliation(s)
- Maria Vincenza Mastrolia
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
| | - Camilla De Cillia
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Michela Orlandi
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Sarah Abu-Rumeileh
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Ilaria Maccora
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
| | - Valerio Maniscalco
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Department of Health Sciences, University of Florence, 50141 Firenze, Italy
| | - Edoardo Marrani
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
| | - Ilaria Pagnini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
| | - Gabriele Simonini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children's Hospital IRCCS, 50139 Firenze, Italy
- Neurofarba Department, University of Florence, 50141 Firenze, Italy
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9
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Schott W, Tao S, Shea L. Prevalence of high-risk conditions for severe COVID-19 among Medicaid-enrolled children with autism and mental health diagnoses in the United States. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2145-2157. [PMID: 36799305 PMCID: PMC9941459 DOI: 10.1177/13623613231155265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
LAY ABSTRACT Children are at risk of varying severity of illness and even death from COVID-19. We aim to determine whether autistic children or children with mental health conditions have more underlying health conditions that put people at risk of severe illness from COVID-19. We use data from a national sample of Medicaid-enrolled children for the years 2008-2016. These data include children across the 50 states and the District of Columbia. We compare the prevalence of underlying conditions among autistic children and children with mental health condition to that of other children in Medicaid. This study included 888,487 autistic children, 423,397 with any mental health condition (but not autism), and 932,625 children without any of these diagnoses. We found 29.5% of autistic children and 25.2% of children with mental health conditions had an underlying condition with high risk for severe illness from COVID, compared to 14.1% of children without these diagnoses. Autistic children had over twice the odds of having any underlying conditions, when accounting for age, race, sex, and other characteristics. Children with mental health conditions had 70% higher odds of having these underlying conditions. Mitigation measures in schools and other areas could minimize risk of short- and long-term impacts from COVID for autistic and all children.
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10
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Oruganti S, Rodrigues PRS, White D, Watkins WJ, Shapey S, Barrow A, Al Samsam R, Ali S, Gajraj M, Skone R, Jardine M, Evans J, Struik S, Song JE, Abood L, Paquete B, Foulkes S, Saunders B, Strang A, Kotecha SJ, Phillips B, Evans A, Buchanan I, Bowes S, Ali B, Gore M, Thomas-Turner R, Andrews R, Zaher S, Sharma S, Chakraborty M, Parkinson E, Liberatore F, Woolley T, Edkins S, Davies LC, Moet L, McLaren JE, Watson GL, O'Donnell V, Hood K, Ghazal P. Immune and metabolic markers for identifying and investigating severe Coronavirus disease and Sepsis in children and young people (pSeP/COVID ChYP study): protocol for a prospective cohort study. BMJ Open 2023; 13:e067002. [PMID: 36972964 PMCID: PMC10069273 DOI: 10.1136/bmjopen-2022-067002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Early recognition and appropriate management of paediatric sepsis are known to improve outcomes. A previous system's biology investigation of the systemic immune response in neonates to sepsis identified immune and metabolic markers that showed high accuracy for detecting bacterial infection. Further gene expression markers have also been reported previously in the paediatric age group for discriminating sepsis from control cases. More recently, specific gene signatures were identified to discriminate between COVID-19 and its associated inflammatory sequelae. Through the current prospective cohort study, we aim to evaluate immune and metabolic blood markers which discriminate between sepses (including COVID-19) from other acute illnesses in critically unwell children and young persons, up to 18 years of age. METHODS AND ANALYSIS We describe a prospective cohort study for comparing the immune and metabolic whole-blood markers in patients with sepsis, COVID-19 and other illnesses. Clinical phenotyping and blood culture test results will provide a reference standard to evaluate the performance of blood markers from the research sample analysis. Serial sampling of whole blood (50 μL each) will be collected from children admitted to intensive care and with an acute illness to follow time dependent changes in biomarkers. An integrated lipidomics and RNASeq transcriptomics analyses will be conducted to evaluate immune-metabolic networks that discriminate sepsis and COVID-19 from other acute illnesses. This study received approval for deferred consent. ETHICS AND DISSEMINATION The study has received research ethics committee approval from the Yorkshire and Humber Leeds West Research Ethics Committee 2 (reference 20/YH/0214; IRAS reference 250612). Submission of study results for publication will involve making available all anonymised primary and processed data on public repository sites. TRIAL REGISTRATION NUMBER NCT04904523.
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Affiliation(s)
- Sivakumar Oruganti
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | | | - Daniel White
- School of Medicine, Cardiff University, Cardiff, UK
| | - William John Watkins
- Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Selyf Shapey
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Anna Barrow
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Rim Al Samsam
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Sara Ali
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Malcolm Gajraj
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Richard Skone
- Department of Paediatric Intensive Care, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Michelle Jardine
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Jennifer Evans
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Siske Struik
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Jong Eun Song
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | | | - Barbara Paquete
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Sian Foulkes
- Paediatric Critical Care Unit, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | - Benjamin Saunders
- Infectious Diseases services for Wales, Noah's Ark Children's Hospital for Wales, Cardiff, UK
| | | | | | - Bethan Phillips
- Children's and Young Adults Research Unit, University Hospital of Wales, Cardiff, UK
| | - Awen Evans
- Children's and Young Adults Research Unit, University Hospital of Wales, Cardiff, UK
| | - Iona Buchanan
- Children's and Young Adults Research Unit, University Hospital of Wales, Cardiff, UK
| | - Susan Bowes
- Children's and Young Adults Research Unit, University Hospital of Wales, Cardiff, UK
| | - Begum Ali
- Children's and Young Adults Research Unit, University Hospital of Wales, Cardiff, UK
| | - Maya Gore
- Children's and Young Adults Research Unit, University Hospital of Wales, Cardiff, UK
| | - Rhian Thomas-Turner
- Children's and Young Adults Research Unit, University Hospital of Wales, Cardiff, UK
| | | | - Summia Zaher
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK
| | - Simran Sharma
- Infection and Immunity, Cardiff University, Cardiff, UK
- Women's Unit, Cardiff and Vale NHS Trust, Cardiff, UK
| | | | | | | | | | - Sarah Edkins
- School of Medicine, Cardiff University, Cardiff, UK
| | | | - Linda Moet
- School of Medicine, Cardiff University, Cardiff, UK
| | | | | | - Valerie O'Donnell
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kerry Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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11
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Yun YF, Feng ZY, Zhang JJ. COVID-19 and liver dysfunction in children: Current views and new hypotheses. World J Hepatol 2023; 15:353-363. [PMID: 37034238 PMCID: PMC10075013 DOI: 10.4254/wjh.v15.i3.353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/14/2023] [Accepted: 03/17/2023] [Indexed: 04/11/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) poses an extremely serious global impact on public healthcare for individuals of all ages, including children. Increasing evidence has shown that liver abnormalities are commonly found in children with COVID-19, and age-related features in innate and adaptive response have been demonstrated. However, there are few reports and studies on COVID-19 related liver injury in children, and the data are scattered. So that many contradictions have arose. This situation is not only due to the serious ethical issues in studying pediatric patients with COVID-19, but also because of the short duration and wide coverage of the COVID-19 epidemic, the severity and complexity of clinical cases varied, as did the inclusion criteria for case reporting and patient outcomes. Therefore, we totaled the incidences, characteristics and pathomechanism of liver injury in children since the COVID-19 outbreak. The etiology of COVID-19-related liver injury is divided into three categories: (1) The direct mechanism involves severe acute respiratory syndrome coronavirus 2 binding to angiotensin-converting enzyme 2 in the liver or bile duct to exert direct toxicity; (2) the indirect mechanisms include an inflammatory immune response and hypoxia; and (3) COVID-19-related treatments, such as mechanical ventilation and antiviral drugs, may cause liver injury. In summary, this minireview provides fundamental insights into COVID-19 and liver dysfunction in children.
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Affiliation(s)
- Yang-Fang Yun
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing 210023, Jiangsu Province, China
| | - Zhi-Yuan Feng
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing 210023, Jiangsu Province, China
| | - Jing-Jing Zhang
- State Key Laboratory of Analytical Chemistry for Life Science, School of Chemistry and Chemical Engineering, Chemistry and Biomedicine Innovation Center, Nanjing University, Nanjing 210023, Jiangsu Province, China
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12
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Pasternack D, Singh RK, Minocha PK, Farkas JS, Ramaswamy P, Better D, Verma S, Phoon CK. Characteristics of Cardiac Abnormalities in Pediatric Patients With Acute COVID-19. Cureus 2023; 15:e36093. [PMID: 37065296 PMCID: PMC10097430 DOI: 10.7759/cureus.36093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) is known to cause cardiac abnormalities in adults. Cardiac abnormalities are well-described in multisystem inflammatory syndrome in children, but effects in children with acute COVID-19 are less understood. In this multicenter study, we assessed the cardiac effects of acute COVID-19 among hospitalized children (<21 years) admitted to three large healthcare systems in New York City. Methods We performed a retrospective observational study. We examined electrocardiograms, echocardiograms, troponin, or B-type natriuretic peptides. Results Of 317 admitted patients, 131 (41%) underwent cardiac testing with 56 (43%) demonstrating cardiac abnormalities. Electrocardiogram abnormalities were the most common (46/117 patients (39%)), including repolarization abnormalities and QT prolongation. Elevated troponin occurred in 14/77 (18%) patients and B-type natriuretic peptide in 8/39 (21%) patients. Ventricular dysfunction was identified in 5/27 (19%) patients with an echocardiogram, all of whom had elevated troponin. Ventricular dysfunction resolved by first outpatient follow-up. Conclusion Electrocardiogram and troponin can assist clinicians in identifying children at risk for cardiac injury in acute COVID-19.
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13
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Blind JE, Sapko M, Killough A, Thornton H, Watson JR. Implementation and Patient Outcomes of a Pediatric COVID-19 Monoclonal Antibody Program. J Pediatric Infect Dis Soc 2022; 11:565-574. [PMID: 36201341 PMCID: PMC9619745 DOI: 10.1093/jpids/piac107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The severity and reach of the COVID-19 pandemic drove the development of various therapeutic approaches to combat SARS-CoV-2, including several neutralizing monoclonal antibody (mAb) therapies. A January 2021 pediatric consensus statement opposed routine use and recommended individualized risk assessments when considering COVID-19 mAb therapies in children and adolescents due to limited data. This report describes the implementation of a mAb referral process and the clinical outcomes of patients who received a mAb infusion in a pediatric hospital. METHODS We developed a tiered allocation system based on underlying medical conditions and incorporated it into a standardized COVID-19 mAb referral and approval process. Demographics and clinical data were collected on all patients who received mAb therapy for treatment or post-exposure prophylaxis. Data recorded included sociodemographics, qualifying underlying medical conditions, clinical manifestations of infection, and overall course of treatment and disease. RESULTS A total of 182 patients ≤21 years old received a COVID-19 mAb infusion between November 27, 2020 and January 26, 2022. Patient age ranged from 10 months to 21 years, with a median age of 15 years. In total, 7 patients (4%) had suspected adverse reactions during the infusion, and 15 (8%) patients required a COVID-19-related visit within 30 days of the mAb infusion. CONCLUSIONS A tiered allocation process may provide the framework for the stratification and efficient distribution of mAb therapies. Future research must focus on the efficacy of these therapies in the pediatric population, standardized therapeutic prioritization, and the optimal timeframe for mAb delivery to prevent progression to severe disease.
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Affiliation(s)
- Jill E Blind
- Corresponding Author: Jill Blind, Department of Pharmacy, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, 614-722-2000,
| | - Matt Sapko
- Alternate Corresponding Author: Matthew Sapko, Department of Pharmacy, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, 614-722-2000,
| | - Alex Killough
- Department of Pharmacy, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Hannah Thornton
- Department of Pharmacy, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Joshua R Watson
- Department of Pediatrics, Center for Clinical Excellence, Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio, USA
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14
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Choudhary R, Webber BJ, Womack LS, Dupont HK, Chiu SK, Wanga V, Gerdes ME, Hsu S, Shi DS, Dulski TM, Idubor OI, Wendel AM, Agathis NT, Anderson K, Boyles T, Click ES, Da Silva J, Evans ME, Gold JA, Haston JC, Loga P, Maloney SA, Martinez M, Natarajan P, Spicer KB, Swancutt M, Stevens VA, Rogers-Brown J, Chandra G, Light M, Barr FE, Snowden J, Kociolek LK, McHugh M, Wessel DL, Simpson JN, Gorman KC, Breslin KA, DeBiasi RL, Thompson A, Kline MW, Boom JA, Singh IR, Dowlin M, Wietecha M, Schweitzer B, Morris SB, Koumans EH, Ko JY, Siegel DA, Kimball AA. Factors Associated With Severe Illness in Patients Aged <21 Years Hospitalized for COVID-19. Hosp Pediatr 2022; 12:760-783. [PMID: 35670605 PMCID: PMC9773098 DOI: 10.1542/hpeds.2022-006613] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe coronavirus disease 2019 (COVID-19)-related pediatric hospitalizations during a period of B.1.617.2 (Δ) variant predominance and to determine age-specific factors associated with severe illness. METHODS We abstracted data from medical charts to conduct a cross-sectional study of patients aged <21 years hospitalized at 6 United States children's hospitals from July to August 2021 for COVID-19 or with an incidental positive severe acute respiratory syndrome coronavirus 2 test. Among patients with COVID-19, we assessed factors associated with severe illness by calculating age-stratified prevalence ratios (PR). We defined severe illness as receiving high-flow nasal cannula, positive airway pressure, or invasive mechanical ventilation. RESULTS Of 947 hospitalized patients, 759 (80.1%) had COVID-19, of whom 287 (37.8%) had severe illness. Factors associated with severe illness included coinfection with respiratory syncytial virus (RSV) (PR 3.64) and bacteria (PR 1.88) in infants; RSV coinfection in patients aged 1 to 4 years (PR 1.96); and obesity in patients aged 5 to 11 (PR 2.20) and 12 to 17 years (PR 2.48). Having ≥2 underlying medical conditions was associated with severe illness in patients aged <1 (PR 1.82), 5 to 11 (PR 3.72), and 12 to 17 years (PR 3.19). CONCLUSIONS Among patients hospitalized for COVID-19, factors associated with severe illness included RSV coinfection in those aged <5 years, obesity in those aged 5 to 17 years, and other underlying conditions for all age groups <18 years. These findings can inform pediatric practice, risk communication, and prevention strategies, including vaccination against COVID-19.
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Affiliation(s)
- Rewa Choudhary
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bryant J. Webber
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Air Force Institute of Technology, Wright-Patterson AFB, Ohio
| | - Lindsay S. Womack
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Hannah K. Dupont
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Sophia K. Chiu
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valentine Wanga
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan E. Gerdes
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sophia Hsu
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Dallas S. Shi
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa M. Dulski
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Osatohamwen I. Idubor
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Arthur M. Wendel
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Nickolas T. Agathis
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristi Anderson
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tricia Boyles
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eleanor S. Click
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Juliana Da Silva
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E. Evans
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeremy A.W. Gold
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julia C. Haston
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pamela Loga
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A. Maloney
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marisol Martinez
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pavithra Natarajan
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin B. Spicer
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark Swancutt
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie A. Stevens
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica Rogers-Brown
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gyan Chandra
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan Light
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Larry K. Kociolek
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Matthew McHugh
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | | | | | | | | | - Aaron Thompson
- Children’s Hospital New Orleans, New Orleans, Louisiana
- Tulane University School of Medicine and LSU Health, New Orleans, Louisiana
| | - Mark W. Kline
- Children’s Hospital New Orleans, New Orleans, Louisiana
- Tulane University School of Medicine and LSU Health, New Orleans, Louisiana
| | - Julie A. Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
| | - Ila R. Singh
- Texas Children’s Hospital, Houston, Texas
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Michael Dowlin
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | | | - Beth Schweitzer
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sapna Bamrah Morris
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emilia H. Koumans
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Y. Ko
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - David A. Siegel
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Anne A. Kimball
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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15
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Elias C, Feteira-Santos R, Camarinha C, de Araújo Nobre M, Costa AS, Bacelar-Nicolau L, Furtado C, Nogueira PJ. COVID-19 in Portugal: a retrospective review of paediatric cases, hospital and PICU admissions in the first pandemic year. BMJ Paediatr Open 2022; 6:e001499. [PMID: 36053592 PMCID: PMC9438012 DOI: 10.1136/bmjpo-2022-001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/19/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND COVID-19 is considered by WHO a pandemic with public health emergency repercussions. Children often develop a mild disease with good prognosis and the recognition of children at risk is essential to successfully manage paediatric COVID-19. Quality epidemiological surveillance data are required to characterise and assess the pandemic. METHODS Data on all reported paediatric COVID-19 cases, in Portugal, were retrospectively assessed from a fully anonymised dataset provided by the Directorate General for Health (DGS). Paediatric hospital admission results were obtained from the DGS vaccine recommendations and paediatric intensive care unit (PICU) admission results from the EPICENTRE.PT group. Reported cases and PICU admissions from March 2020 to February 2021 and hospital admissions between March and December 2020 were analysed. RESULTS 92 051 COVID-19 cases were studied, 50.5% males, average age of 10.1 years, corresponding to 5.4% of children in Portugal. The most common symptoms were cough and fever, whereas gastrointestinal symptoms were infrequent. The most common comorbidity was asthma. A high rate of missing surveillance data was noticed, on presentation of disease and comorbidity variables, which warrants a cautious interpretation of results. Hospital admission was required in 0.93% of cases and PICU on 3.48 per 10 000 cases. PICU admission for Multisystem Inflammatory Syndrome in Children (MIS-C) was more frequent in children with no comorbidities and males, severe COVID-19 was rarer and occurred mainly in females and infants. Case fatality rate and mortality rates were low, 1.8 per 100 000 cases and 1.2 per 1 000 000 cases, respectively. CONCLUSIONS The overall reported case incidence was 5.4 per 100 children and adolescents and <1% of cases required hospital admission. MIS-C was more frequent in patients with no comorbidities and males. Mortality and case fatality rates were low. Geographic adapted strategies, and information systems to facilitate surveillance are required to improve surveillance data quality.
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Affiliation(s)
- Cecilia Elias
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Unidade de Saúde Pública Francisco George, Lisboa, Portugal
| | - Rodrigo Feteira-Santos
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Catarina Camarinha
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel de Araújo Nobre
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Clinica Universitaria Estomatologia, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Andreia Silva Costa
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisboa, Potugal
- CRC-W-Católica Research Centre for Psychological, Family and Social Wellbeing, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Leonor Bacelar-Nicolau
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Cristina Furtado
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Paulo Jorge Nogueira
- EPI Task-Force FMUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- Laboratório Associaodo TERRA, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisboa, Potugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa; Comprehensive Health Research Center (CHRC), Lisbon, Portugal
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16
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Bjornstad EC, Seifert ME, Sanderson K, Feig DI. Kidney implications of SARS-CoV2 infection in children. Pediatr Nephrol 2022; 37:1453-1467. [PMID: 34453600 PMCID: PMC8397606 DOI: 10.1007/s00467-021-05249-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 12/15/2022]
Abstract
Research indicates that severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection can impact every organ, and the effects can range from asymptomatic to severe disease. Since it was first discovered in December 2019, our understanding has grown about its impact on kidney disease. In general, children have less severe disease than adults, and this tendency appears to extend to special pediatric kidney populations (e.g., chronic kidney disease and immunosuppressed patients with solid organ transplants or nephrotic syndrome). However, in a fraction of infected children, SARS-CoV2 causes an array of kidney manifestations, ranging from acute kidney injury to thrombotic microangiopathy, with potential implications for increased risk of morbidity and mortality. Additional considerations surround the propensity for clotting extracorporeal circuits in children with SARS-CoV2 infection that are receiving kidney replacement therapy. This review provides an update on our current understanding of SARS-CoV2 for pediatric nephrologists and highlights knowledge gaps to be addressed by future research during this ongoing pandemic, particularly the social disparities magnified during this period.
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Affiliation(s)
- Erica C Bjornstad
- Department of Pediatrics, Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michael E Seifert
- Department of Pediatrics, Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Keia Sanderson
- Department of Medicine, Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel I Feig
- Department of Pediatrics, Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
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17
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Obesity and COVID-19 in Children and Adolescents: Reciprocal Detrimental Influence—Systematic Literature Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137603. [PMID: 35805260 PMCID: PMC9266144 DOI: 10.3390/ijerph19137603] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 12/11/2022]
Abstract
The dramatic lifestyle changes forced by COVID-19-related lockdown promoted weight gain, with a stronger impact on obese subjects, at higher risk of severe infection. The PubMed database was searched to identify original studies assessing: (1) the extent and risk factors of lockdown-induced weight increase; and (2) the impact of obesity on the risk of hospital admission in children and adolescents. A systematic literature review and meta-analyses were performed. Twenty out of 13,986 identified records were included. A significant weight increase was reported in the majority of subjects, with no apparent gender or age differences. It was induced by a higher consumption of hypercaloric/hyperglycemic/junk food and/or the reduction of physical activity, often associated with an altered sleep–wake cycle. On the other hand, obesity increased the risk of hospitalization (OR = 4.38; 95% C.I. 1.46–13.19; p = 0.009; I2 = 96%) as compared to the normal weight population. COVID-19 and obesity represent epidemic conditions with reciprocal detrimental impact. Urgent public health interventions, targeting the various age and social strata, and involving governmental authorities, health care personnel, teachers and families are warranted to increase awareness and actively promote healthy lifestyles to contrast pediatric obesity and its detrimental consequences at a global level.
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18
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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19
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Mongkonsritragoon W, Prueksapraoprong C, Kewcharoen J, Tokavanich N, Prasitlumkum N, Huang J, Poowuttikul P. Prevalence and risk associated with asthma in children hospitalized with SARS-CoV-2: a meta-analysis and systematic review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1382-1384.e1. [PMID: 35123100 PMCID: PMC8808430 DOI: 10.1016/j.jaip.2021.12.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 01/22/2023]
Affiliation(s)
| | | | - Jakrin Kewcharoen
- Department of Internal Medicine, University of Hawaii, Honolulu, Hawaii
| | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
| | - Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, Calif
| | - Jenny Huang
- Division of Allergy/Immunology and Rheumatology, Children's Hospital of Michigan, Central Michigan University, Detroit, Mich
| | - Pavadee Poowuttikul
- Division of Allergy/Immunology and Rheumatology, Children's Hospital of Michigan, Central Michigan University, Detroit, Mich
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20
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Abstract
Purpose of Review Due to the rapidly changing landscape of COVID-19, the purpose of this review is to provide a concise and updated summary of pediatric COVID-19 diagnosis and management. Recent Findings The relative proportion of pediatric cases have significantly increased following the emergence of the Omicron variant (from < 2% in the early pandemic to 25% from 1/27 to 2/3/22). While children present with milder symptoms than adults, severe disease can still occur, particularly in children with comorbidities. There is a relative paucity of pediatric data in the management of COVID-19 and the majority of recommendations remain based on adult data. Summary Fever and cough remain the most common clinical presentations, although atypical presentations such as "COVID toes," anosmia, and croup may be present. Children are at risk for post-infectious complications such as MIS-C and long COVID. Nucleic acid amplification tests through respiratory PCR remain the mainstay of diagnosis. The mainstay of management remains supportive care and prevention through vaccination is highly recommended. In patients at increased risk of progression, interventions such as monoclonal antibody therapy, PO Paxlovid, or IV remdesivir × 3 days should be considered. In patients with severe disease, the use of remdesivir, dexamethasone, and immunomodulatory agents (tocilizumab, baricitinib) is recommended. Children can be at risk for thrombosis from COVID-19 and anticoagulation is recommended in children with markedly elevated D-dimer levels or superimposed clinical risk factors for hospital associated venous thromboembolism.
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Affiliation(s)
- Frank Zhu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Medical College of Wisconsin, Suite 450C, 999 North 92nd Street, Wauwatosa, Milwaukee, WI 53226 USA
| | - Jocelyn Y. Ang
- Division of Pediatric Infectious Diseases, Children’s Hospital of Michigan, Detroit, MI USA
- Department of Pediatrics, Central Michigan University College of Medicine, Mount Pleasant, MI USA
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI USA
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21
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Choi JH, Choi SH, Yun KW. Risk Factors for Severe COVID-19 in Children: A Systematic Review and Meta-Analysis. J Korean Med Sci 2022; 37:e35. [PMID: 35132841 PMCID: PMC8822112 DOI: 10.3346/jkms.2022.37.e35] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been the most important global issue since December 2019. Although the clinical course of COVID-19 is known to be milder in children than in adults, associated hospitalizations among children have increased since the emergence of contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and the achievement of a high vaccination rate in adults. Considering these global and domestic situations, we believe that risk stratification in children with COVID-19 is urgently needed for decision making regarding hospitalization priority in children infected with SARS-CoV-2 and vaccination priority against COVID-19. METHODS This systematic review and meta-analysis was performed by comprehensively searching the PubMed, EMBASE, Scopus and KoreaMed databases through August 25, 2021. The criteria for enrollment were "severe COVID-19" as poor outcomes (intensive care unit admission, invasive mechanical ventilation, and/or death) and underlying comorbidities before SARS-CoV-2 infection. RESULTS Among 872 screened studies, 17 articles were included in the systematic review, and 10 articles were included in the meta-analysis. Neonate (risk ratio [RR], 2.69; 95% confidence interval [CI], 1.83-3.97), prematurity in young infants (RR, 2.00; 95% CI, 1.63-2.46), obesity (RR, 1.43; 95% CI, 1.24-1.64), diabetes (RR, 2.26; 95% CI, 1.95-2.62), chronic lung disease (RR, 2.62; 95% CI, 1.71-4.00), heart disease (RR, 1.82; 95% CI, 1.58-2.09), neurologic disease (RR, 1.18; 95% CI, 1.05-1.33), and immunocompromised status (RR, 1.44; 95% CI, 1.01-2.04) were significant risk factors for severe COVID-19 in children. In the subgroup analysis, age younger than 3 months (RR, 0.26; 95% CI, 0.11-0.66), asthma (RR, 1.08; 95% CI, 0.98-1.20), and neurodevelopmental disorders (RR, 0.88; 95% CI, 0.75-1.04) were not risk factors for severe COVID-19. CONCLUSION Children with comorbidities such as obesity, diabetes, heart disease, chronic lung diseases other than asthma, seizure disorders, and an immunocompromised status had a high prevalence of severe COVID-19. Neonate and premature infants had a high risk of severe COVID-19. Defining the high-risk group for severe COVID-19 could help to guide hospital admission and priority for vaccination against SARS-CoV-2.
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Affiliation(s)
- Jae Hong Choi
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Soo-Han Choi
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
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22
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Martin B, DeWitt PE, Russell S, Anand A, Bradwell KR, Bremer C, Gabriel D, Girvin AT, Hajagos JG, McMurry JA, Neumann AJ, Pfaff ER, Walden A, Wooldridge JT, Yoo YJ, Saltz J, Gersing KR, Chute CG, Haendel MA, Moffitt R, Bennett TD. Characteristics, Outcomes, and Severity Risk Factors Associated With SARS-CoV-2 Infection Among Children in the US National COVID Cohort Collaborative. JAMA Netw Open 2022; 5:e2143151. [PMID: 35133437 PMCID: PMC8826172 DOI: 10.1001/jamanetworkopen.2021.43151] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/15/2021] [Indexed: 01/20/2023] Open
Abstract
Importance Understanding of SARS-CoV-2 infection in US children has been limited by the lack of large, multicenter studies with granular data. Objective To examine the characteristics, changes over time, outcomes, and severity risk factors of children with SARS-CoV-2 within the National COVID Cohort Collaborative (N3C). Design, Setting, and Participants A prospective cohort study of encounters with end dates before September 24, 2021, was conducted at 56 N3C facilities throughout the US. Participants included children younger than 19 years at initial SARS-CoV-2 testing. Main Outcomes and Measures Case incidence and severity over time, demographic and comorbidity severity risk factors, vital sign and laboratory trajectories, clinical outcomes, and acute COVID-19 vs multisystem inflammatory syndrome in children (MIS-C), and Delta vs pre-Delta variant differences for children with SARS-CoV-2. Results A total of 1 068 410 children were tested for SARS-CoV-2 and 167 262 test results (15.6%) were positive (82 882 [49.6%] girls; median age, 11.9 [IQR, 6.0-16.1] years). Among the 10 245 children (6.1%) who were hospitalized, 1423 (13.9%) met the criteria for severe disease: mechanical ventilation (796 [7.8%]), vasopressor-inotropic support (868 [8.5%]), extracorporeal membrane oxygenation (42 [0.4%]), or death (131 [1.3%]). Male sex (odds ratio [OR], 1.37; 95% CI, 1.21-1.56), Black/African American race (OR, 1.25; 95% CI, 1.06-1.47), obesity (OR, 1.19; 95% CI, 1.01-1.41), and several pediatric complex chronic condition (PCCC) subcategories were associated with higher severity disease. Vital signs and many laboratory test values from the day of admission were predictive of peak disease severity. Variables associated with increased odds for MIS-C vs acute COVID-19 included male sex (OR, 1.59; 95% CI, 1.33-1.90), Black/African American race (OR, 1.44; 95% CI, 1.17-1.77), younger than 12 years (OR, 1.81; 95% CI, 1.51-2.18), obesity (OR, 1.76; 95% CI, 1.40-2.22), and not having a pediatric complex chronic condition (OR, 0.72; 95% CI, 0.65-0.80). The children with MIS-C had a more inflammatory laboratory profile and severe clinical phenotype, with higher rates of invasive ventilation (117 of 707 [16.5%] vs 514 of 8241 [6.2%]; P < .001) and need for vasoactive-inotropic support (191 of 707 [27.0%] vs 426 of 8241 [5.2%]; P < .001) compared with those who had acute COVID-19. Comparing children during the Delta vs pre-Delta eras, there was no significant change in hospitalization rate (1738 [6.0%] vs 8507 [6.2%]; P = .18) and lower odds for severe disease (179 [10.3%] vs 1242 [14.6%]) (decreased by a factor of 0.67; 95% CI, 0.57-0.79; P < .001). Conclusions and Relevance In this cohort study of US children with SARS-CoV-2, there were observed differences in demographic characteristics, preexisting comorbidities, and initial vital sign and laboratory values between severity subgroups. Taken together, these results suggest that early identification of children likely to progress to severe disease could be achieved using readily available data elements from the day of admission. Further work is needed to translate this knowledge into improved outcomes.
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Affiliation(s)
- Blake Martin
- Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora
| | - Peter E. DeWitt
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora
| | - Seth Russell
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora
| | - Adit Anand
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | | | - Carolyn Bremer
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Davera Gabriel
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Janos G. Hajagos
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Julie A. McMurry
- Translational and Integrative Sciences Center, University of Colorado, Aurora
- Center for Health AI, University of Colorado, Aurora
| | - Andrew J. Neumann
- Translational and Integrative Sciences Center, University of Colorado, Aurora
- Center for Health AI, University of Colorado, Aurora
| | - Emily R. Pfaff
- North Carolina Translational and Clinical Sciences Institute), University of North Carolina at Chapel Hill, Chapel Hill
| | - Anita Walden
- Center for Health AI, University of Colorado, Aurora
| | - Jacob T. Wooldridge
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Yun Jae Yoo
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Ken R. Gersing
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland
| | - Christopher G. Chute
- Johns Hopkins University School of Medicine, Baltimore, Maryland
- Schools of Public Health, and Nursing, Johns Hopkins University, Baltimore, Maryland
| | | | - Richard Moffitt
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Tellen D. Bennett
- Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora
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23
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Harwood R, Yan H, Talawila Da Camara N, Smith C, Ward J, Tudur-Smith C, Linney M, Clark M, Whittaker E, Saatci D, Davis PJ, Luyt K, Draper ES, Kenny SE, Fraser LK, Viner RM. Which children and young people are at higher risk of severe disease and death after hospitalisation with SARS-CoV-2 infection in children and young people: A systematic review and individual patient meta-analysis. EClinicalMedicine 2022; 44:101287. [PMID: 35169689 PMCID: PMC8832134 DOI: 10.1016/j.eclinm.2022.101287] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/06/2022] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to describe pre-existing factors associated with severe disease, primarily admission to critical care, and death secondary to SARS-CoV-2 infection in hospitalised children and young people (CYP), within a systematic review and individual patient meta-analysis. METHODS We searched Pubmed, European PMC, Medline and Embase for case series and cohort studies published between 1st January 2020 and 21st May 2021 which included all CYP admitted to hospital with ≥ 30 CYP with SARS-CoV-2 or ≥ 5 CYP with PIMS-TS or MIS-C. Eligible studies contained (1) details of age, sex, ethnicity or co-morbidities, and (2) an outcome which included admission to critical care, mechanical invasive ventilation, cardiovascular support, or death. Studies reporting outcomes in more restricted groupings of co-morbidities were eligible for narrative review. We used random effects meta-analyses for aggregate study-level data and multilevel mixed effect models for IPD data to examine risk factors (age, sex, comorbidities) associated with admission to critical care and death. Data shown are odds ratios and 95% confidence intervals (CI).PROSPERO: CRD42021235338. FINDINGS 83 studies were included, 57 (21,549 patients) in the meta-analysis (of which 22 provided IPD) and 26 in the narrative synthesis. Most studies had an element of bias in their design or reporting. Sex was not associated with critical care or death. Compared with CYP aged 1-4 years (reference group), infants (aged <1 year) had increased odds of admission to critical care (OR 1.63 (95% CI 1.40-1.90)) and death (OR 2.08 (1.57-2.86)). Odds of death were increased amongst CYP over 10 years (10-14 years OR 2.15 (1.54-2.98); >14 years OR 2.15 (1.61-2.88)).The number of comorbid conditions was associated with increased odds of admission to critical care and death for COVID-19 in a step-wise fashion. Compared with CYP without comorbidity, odds ratios for critical care admission were: 1.49 (1.45-1.53) for 1 comorbidity; 2.58 (2.41-2.75) for 2 comorbidities; 2.97 (2.04-4.32) for ≥3 comorbidities. Corresponding odds ratios for death were: 2.15 (1.98-2.34) for 1 comorbidity; 4.63 (4.54-4.74) for 2 comorbidities and 4.98 (3.78-6.65) for ≥3 comorbidities. Odds of admission to critical care were increased for all co-morbidities apart from asthma (0.92 (0.91-0.94)) and malignancy (0.85 (0.17-4.21)) with an increased odds of death in all co-morbidities considered apart from asthma. Neurological and cardiac comorbidities were associated with the greatest increase in odds of severe disease or death. Obesity increased the odds of severe disease and death independently of other comorbidities. IPD analysis demonstrated that, compared to children without co-morbidity, the risk difference of admission to critical care was increased in those with 1 comorbidity by 3.61% (1.87-5.36); 2 comorbidities by 9.26% (4.87-13.65); ≥3 comorbidities 10.83% (4.39-17.28), and for death: 1 comorbidity 1.50% (0.00-3.10); 2 comorbidities 4.40% (-0.10-8.80) and ≥3 co-morbidities 4.70 (0.50-8.90). INTERPRETATION Hospitalised CYP at greatest vulnerability of severe disease or death with SARS-CoV-2 infection are infants, teenagers, those with cardiac or neurological conditions, or 2 or more comorbid conditions, and those who are obese. These groups should be considered higher priority for vaccination and for protective shielding when appropriate. Whilst odds ratios were high, the absolute increase in risk for most comorbidities was small compared to children without underlying conditions. FUNDING RH is in receipt of a fellowship from Kidney Research UK (grant no. TF_010_20171124). JW is in receipt of a Medical Research Council Fellowship (Grant No. MR/R00160X/1). LF is in receipt of funding from Martin House Children's Hospice (there is no specific grant number for this). RV is in receipt of a grant from the National Institute of Health Research to support this work (grant no NIHR202322). Funders had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript.
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Affiliation(s)
- Rachel Harwood
- Molecular and Integrative Biology, Centre for Pre-Clinical Imaging, Institute of Systems, University of Liverpool, Crown Street, Liverpool L69 3BX, United Kingdom
- Department of Paediatric Surgery, Alder Hey in the Park, Liverpool, United Kingdom
| | - Helen Yan
- Medical School, UCL, London, United Kingdom
| | | | - Clare Smith
- NHS England and NHS Improvement, London, United Kingdom
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Joseph Ward
- UCL Great Ormond St. Institute of Child Health, London, United Kingdom
| | - Catrin Tudur-Smith
- Department of Statistics, University of Liverpool, Liverpool, United Kingdom
| | - Michael Linney
- Royal College of Paediatrics and Child Health, London, United Kingdom
- University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Matthew Clark
- NHS England and NHS Improvement, London, United Kingdom
| | - Elizabeth Whittaker
- Department of Paediatric Infectious Diseases, St Mary's Hospital, London, United Kingdom
- Imperial College London, London, United Kingdom
| | | | - Peter J. Davis
- NHS England and NHS Improvement, London, United Kingdom
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Karen Luyt
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Elizabeth S. Draper
- PICANet, Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Simon E Kenny
- Molecular and Integrative Biology, Centre for Pre-Clinical Imaging, Institute of Systems, University of Liverpool, Crown Street, Liverpool L69 3BX, United Kingdom
- Department of Paediatric Surgery, Alder Hey in the Park, Liverpool, United Kingdom
- NHS England and NHS Improvement, London, United Kingdom
| | - Lorna K. Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, United Kingdom
| | - Russell M. Viner
- UCL Great Ormond St. Institute of Child Health, London, United Kingdom
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24
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Jackson WM, Price JC, Eisler L, Sun LS, Lee JJ. COVID-19 in Pediatric Patients: A Systematic Review. J Neurosurg Anesthesiol 2022; 34:141-147. [PMID: 34870638 DOI: 10.1097/ana.0000000000000803] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 08/21/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The coronavirus disease (COVID)-19 pandemic has been an enormous global health burden, resulting in hundreds of millions of documented infections and more than 3 million deaths. Increasing reports characterizing the effects of COVID-19 in pediatric populations have been published during the course of the pandemic. We performed a systematic review to assess the scope of diagnosis, treatment, and management of COVID-19 in pediatric patients. MATERIALS AND METHODS We searched the Cochrane Database of Systematic Reviews, PubMed, CINAHL, and Embase for studies published between January 1, 2020, and May 1, 2021. Each result was screened by 2 authors independently, and discordant findings were adjudicated by a third party. Data extracted included demographic data, symptom data, and clinical data including mortality, severe illness, laboratory data, radiologic data, and treatment. Bias assessment was performed using the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. RESULTS We found a total of 16,266 search results, and we accepted 63 manuscripts into the review. The quality of evidence was low. It was difficult to estimate the risk of mortality in pediatric patients with COVID-19 given the quality of the evidence, but overall it is likely below 1%. The most common symptoms in symptomatic pediatric COVID-19 patients were fever (58%) and cough (50%). There was a high proportion of asymptomatic infection (65%). DISCUSSION Pediatric COVID-19 infection is mild and frequently asymptomatic. There is a low risk of severe illness or death in children who contract COVID-19. High-quality studies should be conducted to develop best practices for prevention, diagnosis, and management of symptomatic illness.
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Affiliation(s)
| | | | | | - Lena S Sun
- Departments of Anesthesiology
- Pediatrics, Columbia University, New York, NY
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25
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Woodruff RC, Campbell AP, Taylor CA, Chai SJ, Kawasaki B, Meek J, Anderson EJ, Weigel A, Monroe ML, Reeg L, Bye E, Sosin DM, Muse A, Bennett NM, Billing LM, Sutton M, Talbot HK, McCaffrey K, Pham H, Patel K, Whitaker M, McMorrow M, Havers F. Risk Factors for Severe COVID-19 in Children. Pediatrics 2022; 149:e2021053418. [PMID: 34935038 PMCID: PMC9213563 DOI: 10.1542/peds.2021-053418] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Describe population-based rates and risk factors for severe coronavirus disease 2019 (COVID-19) (ie, ICU admission, invasive mechanical ventilation, or death) among hospitalized children. METHODS During March 2020 to May 2021, the COVID-19-Associated Hospitalization Surveillance Network identified 3106 children hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection in 14 states. Among 2293 children primarily admitted for COVID-19, multivariable generalized estimating equations generated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) of the associations between demographic and medical characteristics abstracted from medical records and severe COVID-19. We calculated age-adjusted cumulative population-based rates of severe COVID-19 among all children. RESULTS Approximately 30% of hospitalized children had severe COVID-19; 0.5% died during hospitalization. Among hospitalized children aged <2 years, chronic lung disease (aRR: 2.2; 95% CI: 1.1-4.3), neurologic disorders (aRR: 2.0; 95% CI: 1.5‒2.6), cardiovascular disease (aRR: 1.7; 95% CI: 1.2‒2.3), prematurity (aRR: 1.6; 95% CI: 1.1‒2.2), and airway abnormality (aRR: 1.6; 95% CI: 1.1‒2.2) were associated with severe COVID-19. Among hospitalized children aged 2 to 17 years, feeding tube dependence (aRR: 2.0; 95% CI: 1.5‒2.5), diabetes mellitus (aRR: 1.9; 95% CI: 1.6‒2.3) and obesity (aRR: 1.2; 95% CI: 1.0‒1.4) were associated with severe COVID-19. Severe COVID-19 occurred among 12.0 per 100 000 children overall and was highest among infants, Hispanic children, and non-Hispanic Black children. CONCLUSIONS Results identify children at potentially higher risk of severe COVID-19 who may benefit from prevention efforts, including vaccination. Rates establish a baseline for monitoring changes in pediatric illness severity after increased availability of COVID-19 vaccines and the emergence of new variants.
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Affiliation(s)
- Rebecca C. Woodruff
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Angela P. Campbell
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher A. Taylor
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shua J. Chai
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia
- California Emerging Infections Program, Oakland, California
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut
| | - Evan J. Anderson
- Departments of Medicine and Pediatrics, Emory School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
| | - Andy Weigel
- Iowa Department of Public Health, Des Moines, Iowa
| | | | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Erica Bye
- Minnesota Department of Health, St Paul, Minnesota
| | - Daniel M. Sosin
- New Mexico Emerging Infections Program, Santa Fe, New Mexico
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Alison Muse
- New York State Department of Health, Albany, New York
| | - Nancy M. Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon
| | | | | | - Huong Pham
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kadam Patel
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology, Atlanta, Georgia
| | - Michael Whitaker
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith McMorrow
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
| | - Fiona Havers
- Coronavirus Disease 2019–Associated Hospitalization Surveillance Network, Division for Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service Commissioned Corps, Rockville, Maryland
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26
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Nikolopoulou GB, Maltezou HC. COVID-19 in Children: Where do we Stand? Arch Med Res 2022; 53:1-8. [PMID: 34311990 PMCID: PMC8257427 DOI: 10.1016/j.arcmed.2021.07.002] [Citation(s) in RCA: 124] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/26/2021] [Accepted: 07/01/2021] [Indexed: 01/05/2023]
Abstract
From the beginning of the coronavirus disease 2019 (COVID-19) pandemic it became evident that children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain mostly asymptomatic or mildly symptomatic. We reviewed the epidemiologic and clinical features of children with SARS-CoV-2 infection. The true prevalence of asymptomatic SARS-CoV-2 infection is most likely underestimated, as asymptomatic children are less frequently tested. Serologic surveys indicate that half of children tested positive for SARS-CoV-2 report no symptoms. Anosmia/ageusia is not frequent in children but it is the strongest predictor of a positive SARS-CoV-2 test. In general, children with COVID-19 are at lower risk of hospitalization and life-threatening complications. Nevertheless, cases of severe disease or a post-infectious multisystem hyperinflammatory syndrome named multisystem inflammatory syndrome in children (MIS-C) have been described. Rarely children with severe COVID-19 develop neurologic complications. In addition, studies indicate that school closures have a limited impact on SARS-CoV-2 transmission, much less than other social distancing measures. The past months new SARS-CoV-2 variants emerged with higher transmissibility and an increased impact on morbidity and deaths. The role of children in the transmission dynamics of these variants must be elucidated. Lastly, preliminary results from COVID-19 vaccine trials indicate very good efficacy and tolerability in children. Very recently the United States Centers for Disease Control and Prevention and other public health authorities recommend vaccination of children 12 years or older to protect them but mostly to contribute to the achievement of herd immunity.
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Affiliation(s)
| | - Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece,Address reprint requests to: Helena C. Maltezou, Dr. Directorate of Research, Studies and Documentation, National Public Health Organization, 3-5 Agrafon Street, Marousi, 15123 Athens, Greece; Phone: 0030-210-5212175
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27
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Rudan I, Adeloye D, Katikireddi SV, Murray J, Simpson C, Shah SA, Robertson C, Sheikh A. The COVID-19 pandemic in children and young people during 2020-2021: Learning about clinical presentation, patterns of spread, viral load, diagnosis and treatment. J Glob Health 2021; 11:01010. [PMID: 35047182 PMCID: PMC8763336 DOI: 10.7189/jogh.11.01010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Igor Rudan
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Davies Adeloye
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Josie Murray
- COVID-19 Surveillance Lead, Public Health Scotland, Fife, UK
| | - Colin Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, New Zealand
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK and Public Health Scotland, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - EAVE II collaboration
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
- MRC/CSO Social & Public Health Sciences Unit, Glasgow, UK
- COVID-19 Surveillance Lead, Public Health Scotland, Fife, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, New Zealand
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK and Public Health Scotland, Glasgow, UK
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28
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Shi Q, Wang Z, Liu J, Wang X, Zhou Q, Li Q, Yu Y, Luo Z, Liu E, Chen Y. Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis. EClinicalMedicine 2021; 41:101155. [PMID: 34693233 PMCID: PMC8523335 DOI: 10.1016/j.eclinm.2021.101155] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents. METHODS We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19. We used random-effects models to estimate the effect size with 95% confidence interval (CI). FINDINGS We identified 56 studies comprising 79,104 individuals. Mortality was higher in patients with multisystem inflammatory syndrome (MIS-C) (odds ratio [OR]=58.00, 95% CI 6.39-526.79) and who were admitted to intensive care (OR=12.64, 95% CI 3.42-46.68). Acute respiratry distress syndrme (ARDS) (OR=29.54, 95% CI 12.69-68.78) and acute kidney injury (AKI) (OR=55.02, 95% CI 6.26-483.35) increased the odds to be admitted to intensive care; shortness of breath (OR=16.96, 95% CI 7.66-37.51) increased the need of respiratory support; and neurological diseases (OR=5.16, 95% CI 2.30-11.60), C-reactive protein (CRP) level ≥80 mg/L (OR=11.70, 95% CI 4.37-31.37) and D-dimer level ≥0.5ug/mL (OR=20.40, 95% CI 1.76-236.44) increased the odds of progression to severe or critical disease. INTERPRETATION Congenital heart disease, chronic pulmonary disease, neurological diseases, obesity, MIS-C, shortness of breath, ARDS, AKI, gastrointestinal symptoms, elevated CRP and D-dimer are associated with unfavourable prognosis in children and adolescents with COVID-19.
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Affiliation(s)
- Qianling Shi
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
| | - Zijun Wang
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Jiao Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Xingmei Wang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Qi Zhou
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
| | - Qinyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Yang Yu
- Department of Tumor Surgery, Lanzhou University Second Hospital, Lanzhou 730000, China
- The Second School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing 400000, China
- Chongqing Key Laboratory of Pediatrics, Chongqing 400000, China
| | - Yaolong Chen
- Lanzhou University Institute of Health Data Science, Lanzhou 730000, China
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou 730000, China
- Lanzhou University GRADE Center, Lanzhou 730000, China
- Guideline International Network Asia, Lanzhou 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou 730000, China
- Affiliate of the Cochrane China Network, Lanzhou University, Lanzhou 730000, China
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29
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McCormick DW, Richardson LC, Young PR, Viens LJ, Gould CV, Kimball A, Pindyck T, Rosenblum HG, Siegel DA, Vu QM, Komatsu K, Venkat H, Openshaw JJ, Kawasaki B, Siniscalchi AJ, Gumke M, Leapley A, Tobin-D'Angelo M, Kauerauf J, Reid H, White K, Ahmed FS, Richardson G, Hand J, Kirkey K, Larson L, Byers P, Garcia A, Ojo M, Zamcheck A, Lash MK, Lee EH, Reilly KH, Wilson E, de Fijter S, Naqvi OH, Harduar-Morano L, Burch AK, Lewis A, Kolsin J, Pont SJ, Barbeau B, Bixler D, Reagan-Steiner S, Koumans EH. Deaths in Children and Adolescents Associated With COVID-19 and MIS-C in the United States. Pediatrics 2021; 148:e2021052273. [PMID: 34385349 PMCID: PMC9837742 DOI: 10.1542/peds.2021-052273] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To describe the demographics, clinical characteristics, and hospital course among persons <21 years of age with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated death. METHODS We conducted a retrospective case series of suspected SARS-CoV-2-associated deaths in the United States in persons <21 years of age during February 12 to July 31, 2020. All states and territories were invited to participate. We abstracted demographic and clinical data, including laboratory and treatment details, from medical records. RESULTS We included 112 SARS-CoV-2-associated deaths from 25 participating jurisdictions. The median age was 17 years (IQR 8.5-19 years). Most decedents were male (71, 63%), 31 (28%) were Black (non-Hispanic) persons, and 52 (46%) were Hispanic persons. Ninety-six decedents (86%) had at least 1 underlying condition; obesity (42%), asthma (29%), and developmental disorders (22%) were most commonly documented. Among 69 hospitalized decedents, common complications included mechanical ventilation (75%) and acute respiratory failure (82%). The sixteen (14%) decedents who met multisystem inflammatory syndrome in children (MIS-C) criteria were similar in age, sex, and race and/or ethnicity to decedents without MIS-C; 11 of 16 (69%) had at least 1 underlying condition. CONCLUSIONS SARS-CoV-2-associated deaths among persons <21 years of age occurred predominantly among Black (non-Hispanic) and Hispanic persons, male patients, and older adolescents. The most commonly reported underlying conditions were obesity, asthma, and developmental disorders. Decedents with coronavirus disease 2019 were more likely than those with MIS-C to have underlying medical conditions.
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Affiliation(s)
| | | | | | | | | | - Anne Kimball
- Coronavirus Disease 2019 Response Team
- Epidemic Intelligence Service
| | | | | | | | - Quan M Vu
- Coronavirus Disease 2019 Response Team
| | - Ken Komatsu
- Arizona Department of Health Services, Phoenix, Arizona
| | - Heather Venkat
- Arizona Department of Health Services, Phoenix, Arizona
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John J Openshaw
- California Department of Public Health, Sacramento, California
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Megan Gumke
- Florida Department of Health, Tallahassee, Florida
| | | | | | - Judy Kauerauf
- Illinois Department of Public Health, Springfield, Illinois
| | - Heather Reid
- Illinois Department of Public Health, Springfield, Illinois
| | - Kelly White
- Indiana Department of Health, Indianapolis, Indiana
| | - Farah S Ahmed
- Kansas Department of Health and Environment, Topeka, Kansas
| | | | - Julie Hand
- Louisiana Department of Health, Baton Rouge, Louisiana
| | - Kim Kirkey
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Linnea Larson
- Minnesota Department of Health, Saint Paul, Minnesota
| | - Paul Byers
- Mississippi State Department of Health, Jackson, Mississippi
| | - Ali Garcia
- Nevada Department of Health and Human Services, Carson City, Nevada
| | - Mojisola Ojo
- New Jersey Department of Health, Trenton, New Jersey
| | | | - Maura K Lash
- New York City Department of Health and Mental Hygiene, New York City, New York
| | - Ellen H Lee
- New York City Department of Health and Mental Hygiene, New York City, New York
| | - Kathleen H Reilly
- New York City Department of Health and Mental Hygiene, New York City, New York
| | - Erica Wilson
- North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | | | - Ozair H Naqvi
- Oklahoma State Department of Health, Oklahoma City, Oklahoma
| | - Laurel Harduar-Morano
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia
- Pennsylvania Department of Health, Harrisburg, Pennsylvania
| | - Anna-Kathryn Burch
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina
| | - Adele Lewis
- Tennessee Department of Health, Nashville, Tennessee
| | | | - Stephen J Pont
- Texas Department of State Health Services, Austin, Texas
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30
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Bhargava S, Lumba R, Mally P, Bailey S, Verma S. Horizontal Transmission of COVID-19 in a 24-Week Premature Infant and Post-discharge Follow-Up. Cureus 2021; 13:e18455. [PMID: 34650838 PMCID: PMC8489781 DOI: 10.7759/cureus.18455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has rapidly spread across the globe. The clinical spectrum of infection with SARS-CoV-2 among the most vulnerable extremely premature patient population in the neonatal intensive care units (NICUs), particularly those with chronic lung disease (CLD), remains unclear. Additionally, post-COVID conditions have been described in children with limited published data among infants. Symptoms in children appear similar to those described in the adults. We report a case of SARS-CoV-2 infection in a 24-week preterm infant with CLD acquired via horizontal transmission while still in the NICU. We also provide follow-up data on patient until one year post-discharge. Our patient developed fever prompting testing for SARS-CoV-2. Although extremely premature infants with CLD are known to be at high risk for morbidities if they acquire respiratory viral infections, infection with SARS-CoV-2 in this case report presented with relatively mild clinical symptoms. He remained clinically stable on respiratory support (nasal cannula) with eventual weaning to room air. Our patient was followed until one year post-discharge (chronological age: 20 months) and had follow-up by various subspecialties for chronic lung disease, hypothyroidism, chronic kidney disease, and poor growth. We did not observe any specific post-COVID symptoms. This case illustrates that horizontal transmission of SARS-CoV-2 infection among extremely premature infants with CLD is possible in the NICU but likely presents with mild clinical symptoms during acute infection and less chances of post-COVID conditions. Additionally, this case highlights the need for adherence to infection prevention guidelines to prevent nosocomial transmission amid the ongoing pandemic.
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Affiliation(s)
- Sweta Bhargava
- Department of Pediatrics, Division of Neonatology, New York University Grossman School of Medicine, New York, USA.,Department of Pediatrics, Division of Neonatology, Bellevue Hospital Center, New York, USA
| | - Rishi Lumba
- Department of Pediatrics, Division of Neonatology, New York University Grossman School of Medicine, New York, USA
| | - Pradeep Mally
- Department of Pediatrics, Division of Neonatology, New York University Grossman School of Medicine, New York, USA.,Department of Pediatrics, Division of Neonatology, Bellevue Hospital Center, New York, USA
| | - Sean Bailey
- Department of Pediatrics, Division of Neonatology, New York University Grossman School of Medicine, New York, USA.,Department of Pediatrics, Division of Neonatology, Bellevue Hospital Center, New York, USA
| | - Sourabh Verma
- Department of Pediatrics, Division of Neonatology, New York University Grossman School of Medicine, New York, USA.,Department of Pediatrics, Division of Neonatology, Bellevue Hospital Center, New York, USA
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31
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Paret M, Lalani K, Hedari C, Jaffer A, Narayanan N, Noor A, Lighter J, Madan RP, Shust GF, Ratner AJ, Raabe VN. SARS-CoV-2 Among Infants <90 Days of Age Admitted for Serious Bacterial Infection Evaluation. Pediatrics 2021; 148:peds.2020-044685. [PMID: 34193619 DOI: 10.1542/peds.2020-044685] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in infants hospitalized for a serious bacterial infection (SBI) evaluation and clinically characterize young infants with SARS-CoV-2 infection. METHODS A retrospective chart review was conducted on infants <90 days of age hospitalized for an SBI evaluation. The study was conducted at 4 inpatient facilities in New York City from March 15, 2020, to December 15, 2020. RESULTS We identified 148 SBI evaluation infants who met inclusion criteria. A total of 22 infants (15%) tested positive for SARS-CoV-2 by nasopharyngeal reverse transcription polymerase chain reaction; 31% of infants admitted during periods of high community SARS-CoV-2 circulation tested positive for SARS-CoV-2, compared with 3% when community SARS-CoV-2 circulation was low (P < .001). The mean age of infants with SARS-CoV-2 was higher than that of SARS-CoV-2-negative infants (33 [SD: 17] days vs 23 [SD: 23] days, respectively; P = .03), although no age difference was observed when analysis was limited only to febrile infants. An isolated fever was the most common presentation of SARS-CoV-2 (n = 13; 59%). Admitted infants with SARS-CoV-2 were less likely to have positive urine culture results (n = 1 [5%] versus n = 25 [20%], respectively; P = .002), positive cerebrospinal culture results (n = 0 [0%] versus n = 5 [4%], respectively; P = .02), or be admitted to intensive care (n = 2 [9%] versus n = 47 [37%]; P < .001), compared with infants without SARS-CoV-2. CONCLUSIONS SARS-CoV-2 was common among young infants hospitalized for an SBI evaluation during periods of high but not low community SARS-CoV-2 circulation in New York City, although most infants did not require intensive care admission.
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Affiliation(s)
| | - Karim Lalani
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York
| | | | - Annum Jaffer
- Department of Pediatrics, Grossman School of Medicine, New York University, New York, New York
| | - Nisha Narayanan
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Grossman School of Medicine, New York University, New York, New York
| | - Asif Noor
- Division of Infectious Diseases and Immunology, Department of Medicine, Grossman School of Medicine, New York University, New York, New York
| | | | | | | | - Adam J Ratner
- Division of Pediatric Infectious Diseases.,Division of Pediatric Infectious Diseases, Department of Pediatrics, Long Island School of Medicine, New York University, Mineola, New York
| | - Vanessa N Raabe
- Division of Pediatric Infectious Diseases .,Department of Microbiology, Grossman School of Medicine, New York University, New York, New York
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32
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Martin B, DeWitt PE, Russell S, Anand A, Bradwell KR, Bremer C, Gabriel D, Girvin AT, Hajagos JG, McMurry JA, Neumann AJ, Pfaff ER, Walden A, Wooldridge JT, Yoo YJ, Saltz J, Gersing KR, Chute CG, Haendel MA, Moffitt R, Bennett TD. Children with SARS-CoV-2 in the National COVID Cohort Collaborative (N3C). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.07.19.21260767. [PMID: 34341796 PMCID: PMC8328064 DOI: 10.1101/2021.07.19.21260767] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE SARS-CoV-2. OBJECTIVE To determine the characteristics, changes over time, outcomes, and severity risk factors of SARS-CoV-2 affected children within the National COVID Cohort Collaborative (N3C). DESIGN Prospective cohort study of patient encounters with end dates before May 27th, 2021. SETTING 45 N3C institutions. PARTICIPANTS Children <19-years-old at initial SARS-CoV-2 testing. MAIN OUTCOMES AND MEASURES Case incidence and severity over time, demographic and comorbidity severity risk factors, vital sign and laboratory trajectories, clinical outcomes, and acute COVID-19 vs MIS-C contrasts for children infected with SARS-CoV-2. RESULTS 728,047 children in the N3C were tested for SARS-CoV-2; of these, 91,865 (12.6%) were positive. Among the 5,213 (6%) hospitalized children, 685 (13%) met criteria for severe disease: mechanical ventilation (7%), vasopressor/inotropic support (7%), ECMO (0.6%), or death/discharge to hospice (1.1%). Male gender, African American race, older age, and several pediatric complex chronic condition (PCCC) subcategories were associated with higher clinical severity (p ≤ 0.05). Vital signs (all p≤0.002) and many laboratory tests from the first day of hospitalization were predictive of peak disease severity. Children with severe (vs moderate) disease were more likely to receive antimicrobials (71% vs 32%, p<0.001) and immunomodulatory medications (53% vs 16%, p<0.001). Compared to those with acute COVID-19, children with MIS-C were more likely to be male, Black/African American, 1-to-12-years-old, and less likely to have asthma, diabetes, or a PCCC (p < 0.04). MIS-C cases demonstrated a more inflammatory laboratory profile and more severe clinical phenotype with higher rates of invasive ventilation (12% vs 6%) and need for vasoactive-inotropic support (31% vs 6%) compared to acute COVID-19 cases, respectively (p<0.03). CONCLUSIONS In the largest U.S. SARS-CoV-2-positive pediatric cohort to date, we observed differences in demographics, pre-existing comorbidities, and initial vital sign and laboratory test values between severity subgroups. Taken together, these results suggest that early identification of children likely to progress to severe disease could be achieved using readily available data elements from the day of admission. Further work is needed to translate this knowledge into improved outcomes.
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Affiliation(s)
- Blake Martin
- Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA
| | - Peter E. DeWitt
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA
| | - Seth Russell
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA
| | - Adit Anand
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | | | - Carolyn Bremer
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Davera Gabriel
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Janos G. Hajagos
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Julie A. McMurry
- Translational and Integrative Sciences Center, University of Colorado, Aurora, CO, USA,Center for Health AI, University of Colorado, Aurora, CO, USA
| | - Andrew J. Neumann
- Translational and Integrative Sciences Center, University of Colorado, Aurora, CO, USA,Center for Health AI, University of Colorado, Aurora, CO, USA
| | - Emily R. Pfaff
- North Carolina Translational and Clinical Sciences Institute (NC TraCS), University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anita Walden
- Center for Health AI, University of Colorado, Aurora, CO, USA
| | - Jacob T. Wooldridge
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Yun Jae Yoo
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Ken R. Gersing
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Christopher G. Chute
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Schools of Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Richard Moffitt
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, USA
| | - Tellen D. Bennett
- Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA,Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora, CO, USA
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33
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Webb NE, Osburn TS. Characteristics of Hospitalized Children Positive for SARS-CoV-2: Experience of a Large Center. Hosp Pediatr 2021; 11:e133-e141. [PMID: 34011567 DOI: 10.1542/hpeds.2021-005919] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Define the spectrum of disease in pediatric inpatients with a positive SARS-CoV-2 test result in a manner relevant to pediatric hospital medicine. METHODS Retrospective case series of all patients aged <22 years hospitalized at our institution with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction test result between May 1, 2020, and September 30, 2020. Demographic, clinical, and outcome data were collected and analyzed. RESULTS Three distinct presentations were associated with acute SARS-CoV-2 positivity. Patients had incidental infection (40%), were potentially symptomatic (47%), or were significantly symptomatic (14%). The average length of stay differed between the significantly symptomatic group and the incidental and potentially symptomatic groups (P =.002). Average age differed among these groups, with significantly symptomatic patients older by >2 years. Fifty-five percent of incidental and 47% of potentially symptomatic patients had at least 1 identified comorbidity, whereas 90% of significantly symptomatic patients had at least 1 (P = .01). There was a significant relationship between obesity (P = .001) and asthma (P = .004) and severe disease. Additionally, there was a statistically significant difference between groups with respect to fever, hypoxia, supplemental oxygen use, duration of supplemental oxygen, and ICU admission, with a significantly higher percentage of patients in the significantly symptomatic group meeting each of these criteria (P < .001 for all categories). CONCLUSIONS Pediatric patients hospitalized with SARS-CoV-2 fall into distinct categories, which are critical to understanding the true pathology of SARS-Cov-2 as it relates to hospitalized pediatric patients. Most hospitalized patients who test positive for SARS-CoV-2 are asymptomatic or have a reason for hospitalization other than coronavirus disease 2019.
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Affiliation(s)
- Nicole E Webb
- Division of Hospital Medicine, Valley Children's Healthcare, Madera, California
| | - T Shea Osburn
- Division of Hospital Medicine, Valley Children's Healthcare, Madera, California
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34
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Farronato M, Dolci C, Boccalari E, Izadi S, Salvatierra Rios LH, Festa M, Panetta V, De Vito D, Tartaglia GM. Serological Profile of Children and Young Adults with at Least One SARS-CoV-2 Positive Cohabitant: An Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1488. [PMID: 33557402 PMCID: PMC7914765 DOI: 10.3390/ijerph18041488] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 12/15/2022]
Abstract
At the end of 2019, a new disease caused by the novel coronavirus SARS-CoV-2 appeared in Wuhan Province in China. Children seemed to be infected less frequently than adults, and family clusters seemed to play an important role in the spread of the pandemic. The aim of this study is to evaluate the serological profile of children and young adults between 4 and 16 years of age in order to assess the transmission patterns of COVID-19 between cohabitants. The subjects lived with at least one cohabitant who tested positive for the disease using a nasopharyngeal swab. To avoid contact with the disease, families were interviewed by telephone. Forty-nine children and adolescents with a mean age of 11 years were then subjected to a rapid lateral flow chromatographic test. Of them, seven (14.3%) were immunoglobulin G (IgG)-positive, and four (8.2%) were immunoglobulin M (IgM)-positive. In total, 16.3% of the tested sample had antibodies against SARS-CoV-2: this may confirm the lower vulnerability of children to COVID-19, despite the small sample size. The time from the negativization of the cohabitant until the test day may have influenced the results, especially when this timeframe is wide.
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Affiliation(s)
- Marco Farronato
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20122 Milan, Italy; (M.F.); (C.D.); (E.B.); (S.I.); (L.H.S.R.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carolina Dolci
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20122 Milan, Italy; (M.F.); (C.D.); (E.B.); (S.I.); (L.H.S.R.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa Boccalari
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20122 Milan, Italy; (M.F.); (C.D.); (E.B.); (S.I.); (L.H.S.R.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sara Izadi
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20122 Milan, Italy; (M.F.); (C.D.); (E.B.); (S.I.); (L.H.S.R.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Luis Hernan Salvatierra Rios
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20122 Milan, Italy; (M.F.); (C.D.); (E.B.); (S.I.); (L.H.S.R.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maurizio Festa
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20122 Milan, Italy; (M.F.); (C.D.); (E.B.); (S.I.); (L.H.S.R.); (M.F.)
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Valentina Panetta
- L’Altrastatistica Consultancy & Training, Biostatistics Office, 00175 Rome, Italy;
| | - Danila De Vito
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari “Aldo Moro”, 70124 Bari, Italy;
| | - Gianluca Martino Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20122 Milan, Italy; (M.F.); (C.D.); (E.B.); (S.I.); (L.H.S.R.); (M.F.)
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35
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Wolf J, Abzug MJ, Wattier RL, Sue PK, Vora SB, Zachariah P, Dulek DE, Waghmare A, Olivero R, Downes KJ, James SH, Pinninti SG, Yarbrough A, Aldrich ML, MacBrayne CE, Soma VL, Grapentine SP, Oliveira CR, Hayes M, Kimberlin DW, Jones SB, Bio LL, Morton TH, Hankins JS, Marόn-Alfaro GM, Timberlake K, Young JL, Orscheln RC, Schwenk HT, Goldman DL, Groves HE, Huskins WC, Rajapakse NS, Lamb GS, Tribble AC, Lloyd EE, Hersh AL, Thorell EA, Ratner AJ, Chiotos K, Nakamura MM. Initial Guidance on Use of Monoclonal Antibody Therapy for Treatment of Coronavirus Disease 2019 in Children and Adolescents. J Pediatric Infect Dis Soc 2021; 10:629-634. [PMID: 33388760 PMCID: PMC7799019 DOI: 10.1093/jpids/piaa175] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND In November 2020, the US Food and Drug Administration (FDA) provided Emergency Use Authorizations (EUA) for 2 novel virus-neutralizing monoclonal antibody therapies, bamlanivimab and REGN-COV2 (casirivimab plus imdevimab), for the treatment of mild to moderate coronavirus disease 2019 (COVID-19) in adolescents and adults in specified high-risk groups. This has challenged clinicians to determine the best approach to use of these products. METHODS A panel of experts in pediatric infectious diseases, pediatric infectious diseases pharmacy, pediatric intensive care medicine, and pediatric hematology from 29 geographically diverse North American institutions was convened. Through a series of teleconferences and web-based surveys, a guidance statement was developed and refined based on review of the best available evidence and expert opinion. RESULTS The course of COVID-19 in children and adolescents is typically mild and there is no high-quality evidence supporting any high-risk groups. There is no evidence for safety and efficacy of monoclonal antibody therapy for treatment of COVID-19 in children or adolescents, limited evidence of modest benefit in adults, and evidence for potential harm associated with infusion reactions or anaphylaxis. CONCLUSIONS Based on evidence available as of December 20, 2020, the panel suggests against routine administration of monoclonal antibody therapy (bamlanivimab, or casirivimab and imdevimab), for treatment of COVID-19 in children or adolescents, including those designated by the FDA as at high risk of progression to hospitalization or severe disease. Clinicians and health systems choosing to use these agents on an individualized basis should consider risk factors supported by pediatric-specific evidence and ensure the implementation of a system for safe and timely administration that does not exacerbate existing healthcare disparities.
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Affiliation(s)
- Joshua Wolf
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA,Corresponding author: Dr. Joshua Wolf MBBS, PhD, FRACP, Department of Infectious Diseases, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS 320, Memphis, TN 38105, USA, Tel: 901 595 3300; Fax: 901 595 3099,
| | - Mark J Abzug
- Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Rachel L Wattier
- Division of Infectious Diseases and Global Health, Department of Pediatrics, University of California–San Francisco, San Francisco, California, USA
| | - Paul K Sue
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Surabhi B Vora
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle; Children’s Hospital, Seattle, Washington, USA
| | - Philip Zachariah
- Division of Infectious Diseases, Department of Pediatrics, Columbia University, New York, New York, USA
| | - Daniel E Dulek
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University and Monroe Carell Jr. Children’s Hospital, Nashville, Tennessee, USA
| | - Alpana Waghmare
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle; Children’s Hospital, Seattle, Washington, USA,Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rosemary Olivero
- Section of Infectious Diseases, Department of Pediatrics and Human Development, Helen DeVos Children’s Hospital of Spectrum Health, Michigan State College of Human Medicine, Grand Rapids, Michigan, USA
| | - Kevin J Downes
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Scott H James
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Swetha G Pinninti
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - April Yarbrough
- Department of Pharmacy, Children’s of Alabama, Birmingham, Alabama, USA
| | - Margaret L Aldrich
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital at Montefiore, New York, New York, USA
| | | | - Vijaya L Soma
- Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, United States
| | - Steven P Grapentine
- Department of Pharmacy, University of California–San Francisco Benioff Children’s Hospital, San Francisco, California, USA
| | - Carlos R Oliveira
- Division of Infectious Diseases and Global Health, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Molly Hayes
- Antimicrobial Stewardship Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David W Kimberlin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sarah B Jones
- Department of Pharmacy, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Laura L Bio
- Department of Pharmacy, Lucile Packard Children’s Hospital Stanford, Palo Alto, California, USA
| | - Theodore H Morton
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Gabriella M Marόn-Alfaro
- Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Kathryn Timberlake
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer L Young
- Department of Pharmacy, St. Louis Children’s Hospital, St. Louis, Missouri, USA
| | - Rachel C Orscheln
- Division of Infectious Diseases, Department of Pediatrics, Washington University and St. Louis Children’s Hospital, St. Louis, Missouri, USA
| | - Hayden T Schwenk
- Division of Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children’s Hospital Stanford, Stanford, California, USA
| | - David L Goldman
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital at Montefiore, New York, New York, USA
| | - Helen E Groves
- Division of Infectious Diseases, Department of Pediatrics,; Hospital for Sick Children, Toronto, Ontario, Canada
| | - W Charles Huskins
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Nipunie S Rajapakse
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Gabriella S Lamb
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Alison C Tribble
- Department of Pediatrics, Division of Infectious Diseases, University of Michigan and CS Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | - Elizabeth E Lloyd
- Department of Pediatrics, Division of Infectious Diseases, University of Michigan and CS Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | - Adam L Hersh
- Division of Infectious Diseases, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah, USA
| | - Emily A Thorell
- Division of Infectious Diseases, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah, USA
| | - Adam J Ratner
- Department of Pediatrics, Division of Infectious Diseases, New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, United States,Department of Microbiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Kathleen Chiotos
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA,Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mari M Nakamura
- Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA,Antimicrobial Stewardship Program, Boston Children’s Hospital, Boston, Massachusetts, USA,Co-Corresponding author: Mari M. Nakamura, MD, MPH, Division of Infectious Diseases, Department of Pediatrics, Boston Children’s Hospital, 300 Longwood Avenue, Mailstop BCH 3052, Boston, MA 02115, Tel: 617 355 1561,
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