child looking at a colorful mural of a healthcare workerShare on Pinterest
A boy stands in front of a graffiti painted by artist Kai ‘Uzey’ Wohlgemuth featuring a nurse as Superwoman on a wall in Hamm, western Germany, on April 8, 2020, referring to the spread of the novel coronavirus COVID-19. INA FASSBENDER/Getty Images

  • Severe outcomes among pediatric patients with SARS-CoV-2 infections are poorly understood.
  • A new study seeks to quantify severe outcome frequency and risk factors for these patients.
  • Clinicians should consider age, underlying chronic illness, and symptom duration when treating pediatric patients.

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While COVID-19 is generally mild in children, there are instances of serious outcomes in some youths who test positive for the SARS-CoV-2 virus. A recent study in JAMA Network Open sought to clarify the impact of SARS-CoV-2 infection and the risk of severe COVID-19 outcomes on young people worldwide.

At the onset of the COVID-19 pandemic, those under 18 years old represented 1.7% of all reported cases. Many believe these early estimates were inaccurate due to early testing capacity and the usually mild, or even asymptomatic, nature of the disease in children.

As of January 13, 2022, individuals under 18 years of age represented 17.8% of all new COVID-19 cases. The number of children hospitalized for the disease increased nearly fivefold between June and August 2021.

The study, conducted through the Pediatric Emergency Research Network—COVID-19, focused on answering the question: What proportion of SARS-CoV-2-positive youths tested in emergency departments experience severe outcomes within 14 days?

Severe outcomes were categorized as cardiac events, such as myocarditis, neurological issues, such as encephalitis, respiratory problems, such as pneumonia, infectious issues, such as sepsis, and death.

Study participants were selected from emergency departments across eight countries, including Argentina, Canada, Costa Rica, Italy, Paraguay, Singapore, Spain, and the United States.

Among the 10,300 participants, 3,222 tested positive for SARS-CoV-2 infection. Of those, 23% were hospitalized, 3% experienced severe outcomes within 2 weeks after their visit to the emergency department, and four of the children died.

The researchers identified the possible risk factors leading to severe outcomes. These included a patient age between 5–18 years, a preexisting chronic illness, a previous episode of pneumonia, and presenting to the hospital 4–7 days after symptom onset.

While some of these same risk factors have been identified in other pediatric COVID-19 studies, this study shows contrasting results in other areas. For example, participants who were very young infants did not appear to be at a higher risk for severe outcomes. In addition, while asthma has been suggested as a risk factor for severe illness in those youths with COVID-19, the study’s results did not support this association.

Dr. Stephen Freedman, pediatrician and professor at the Cumming School of Medicine, University of Calgary, Canada, and study co-lead author told MNT, “It was interesting and somewhat unexpected that we found that young children were at the lowest risk of severe outcomes.”

Among the 2,500 SARS-CoV-2-positive youths discharged from the emergency departments, only 0.5% experienced severe outcomes during the follow-up period.

The study also indicated that children deemed healthy at their initial emergency department visit rarely deteriorated significantly after that first visit.

Dr. James Wood, assistant professor of clinical pediatrics at the Indiana University School of Medicine and infectious disease physician at Riley Hospital for Children, Indianapolis, was asked by MNT to comment on this study. He noted that very few children who tested positive and were discharged developed severe outcomes.

“This is important as it shows the ability of emergency department clinicians to appropriately recognize who is safe to be discharged home the majority of the time,” said Wood. “Understanding these risk factors is important as clinicians have to make decisions about who needs to be hospitalized and who would benefit from treatment.”

The researchers conclude by stressing risk factors such as age, underlying chronic illness, and symptom duration should be considerations when making clinical care decisions for children under 18 who test positive for SARS-CoV-2 infection.

When asked about future research needs regarding children and COVID-19, Freedman said, “It will be important to explore outcomes within specific groups, for example, young infants, and to evaluate whether laboratory parameters can also assist in identifying children at increased risk of severe outcomes.”

Freedman stressed that the study does not imply that 3% of all children infected with SARS-CoV-2 have severe outcomes since the participants did not represent the entire population of children who had the infection.

“However, we did also find that when compared to children who were SARS-CoV-2 test negative, those who tested positive and were hospitalized were more likely to have severe outcomes,” said Freedman.

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