Risk Factors for Severe COVID-19 in Children.
Risk Factors for Severe COVID-19 in Children.
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儿童严重 COVID-19 的危险因素。
DOI：
10.1542/peds.2021-053418
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发表时间：
2022-01-01
期刊：
影响因子：
8
通讯作者：
P Havers, Fiona
中科院分区：
文献类型：
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作者：
Woodruff, Rebecca C;Campbell, Angela P;Taylor, Christopher A;Chai, Shua J;Kawasaki, Breanna;Meek, James;Anderson, Evan J;Weigel, Andy;Monroe, Maya L;Reeg, Libby;Bye, Erica;Sosin, Daniel M;Muse, Alison;Bennett, Nancy M;Billing, Laurie M;Sutton, Melissa;Talbot, H Keipp;McCaffrey, Keegan;Pham, Huong;Patel, Kadam;Whitaker, Michael;L McMorrow, Meredith;P Havers, Fiona
描述住院儿童中基于人群的重症 COVID-19 发生率和危险因素（即入住重症监护病房、有创机械通气或死亡）。 2020 年 3 月至 2021 年 5 月期间，COVID-19 相关住院监测网络 (COVID-NET) 发现 14 个州有 3,106 名实验室确诊的 SARS-CoV-2 感染儿童住院。在 2,293 名主要因 COVID-19 入院的儿童中，我们使用多变量广义估计方程来生成从患者电子病历中提取的人口统计特征和医疗特征与重症 COVID-19 之间关联的调整后风险比 (aRR) 和 95% 置信区间 (CI)。我们计算了所有儿童中年龄调整后的基于人群的重症 COVID-19 累积发病率。大约 30% 的住院儿童患有重症 COVID-19，0.5% 在住院期间死亡。 2岁以下住院儿童中，慢性肺部疾病（aRR=2.2，CI：1.1-4.3）、神经系统疾病（aRR=2.0，CI：1.5-2.6）、心血管疾病（aRR=1.7，CI：1.2-2.3）、早产（aRR=1.6，CI：1.1-2.2）和气道异常（aRR=1.6，CI：1.5-2.6） 1.1-2.2）与严重的 COVID-19 相关。在2-17岁住院儿童中，饲管依赖（aRR=2.0，CI：1.5-2.5）、糖尿病（aRR=1.9，CI：1.6-2.3）和肥胖（aRR=1.2，CI：1.0-1.4）与重症COVID-19相关。每 10 万名 18 岁以下儿童中，有 12 人患有严重的 COVID-19，其中婴儿、西班牙裔儿童和非西班牙裔黑人儿童的发病率最高。结果发现，患有严重疾病的潜在风险较高的儿童可能会受益于包括疫苗接种在内的 COVID-19 预防工作。随着 COVID-19 疫苗供应的增加和新变种的出现，重症 COVID-19 的发病率建立了监测儿科疾病严重程度变化的基线。这项调查提供了基于人群的比率，并确定了实验室确诊的 SARS-CoV-2 感染住院儿童中与严重疾病结果风险增加相关的潜在医疗状况。
Describe population-based rates and risk factors for severe COVID-19 (i.e., intensive care unit admission, invasive mechanical ventilation, or death) among hospitalized children. During March 2020–May 2021, the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) identified 3,106 children with laboratory-confirmed SARS-CoV-2 infection who were hospitalized in 14 states. Among a subset of 2,293 children primarily admitted for COVID-19, we used multivariable generalized estimating equations to generate adjusted risk ratios (aRRs) and 95% confidence intervals (CI) of the association between demographic and medical characteristics abstracted from patient electronic medical records and severe COVID-19. We calculated age-adjusted cumulative population-based rates of severe COVID-19 among all children. Approximately 30% of hospitalized children had severe COVID-19 and 0.5% died during hospitalization. Among hospitalized children aged <2 years, chronic lung disease (aRR=2.2, CI: 1.1–4.3), neurologic disorders (aRR=2.0, CI: 1.5‒2.6), cardiovascular disease (aRR=1.7, CI: 1.2‒2.3), prematurity (aRR=1.6, CI: 1.1‒2.2) and airway abnormality (aRR=1.6,CI: 1.1‒2.2) were associated with severe COVID-19. Among hospitalized children aged 2‒17 years, feeding tube dependence (aRR=2.0, CI: 1.5‒2.5), diabetes mellitus (aRR=1.9, CI: 1.6‒2.3) and obesity (aRR=1.2, CI: 1.0‒1.4) were associated with severe COVID-19. Severe COVID-19 occurred among 12.0 per 100,000 children aged <18 years, and was highest among infants, Hispanic children, and non-Hispanic Black children. Results identify children at potentially higher risk of severe disease who may benefit from COVID-19 prevention efforts, including vaccination. Rates of severe COVID-19 establish a baseline for monitoring changes in pediatric illness severity following increased availability of COVID-19 vaccines and the emergence of new variants. This investigation presents population-based rates and identifies underlying medical conditions associated with increased risk of severe disease outcomes among hospitalized children with laboratory-confirmed SARS-CoV-2 infection.