Factors associated with hospital and intensive care admission in paediatric SARS-CoV-2 infection: a prospective nationwide observational cohort study
Anita Uka, Michael Buettcher, Sara Bernhard‐Stirnemann, Yves Fougère, Dehlia Moussaoui, Lisa Kottanattu, Noémie Wagner, Petra Zimmermann, Nicole Ritz, Swiss Paediatric Surveillance Unit (SPSU), Manuela Albisetti, Vera Bernet, Camilla Betti, François Cachat, P. Caplazi, M-L. Decker, E. Durrer, Simon Fluri, Matthias Gebauer, Mario Gehri, Éric Giannoni, S. Grupe, Max Horn, A. L’Huiller, T Karen, Elias Kellner, Guido F. Laube, Bernard Laubscher, Juan Llor, Fanny Luterbacher, H. Madlon, Andreas Malzacher, Marco Antônio Trevizani Martins, Jean A. McDougall, Arnaud Merglen, Stefan Minocchieri, Vincent Muehlethaler, T. Neuhaus, A. Niederer, S. Nikorelou, M. Plebani, Ratnasabapathy, Christa Relly, Thomas Riedel, Marco Russo, Helena Schmid, K. Staudacher, M. Torres Escobar, Johannes H. Wildhaber, Andreas Wörner, Abdelaziz Zemmouri
Abstract
Coronavirus disease 2019 (COVID-19) is usually less severe in children compared to adults. This study describes detailed clinical characteristics, treatment and outcomes of children with COVID-19 in a non-hospitalised and hospitalised setting and quantifies factors associated with admission to hospital and intensive care unit in children with SARS-CoV-2 infection on a nationwide level. Data were collected through the Swiss Paediatric Surveillance Unit from children < 18 years with confirmed SARS-CoV-2 infection. All 33 paediatric hospitals in Switzerland reported non-hospitalised and hospitalised cases from March 1 to October 31, 2020 during both pandemic peaks. In total, 678 children were included. The median age was 12.2 years (IQR 5.0-14.6), 316 (46.6%) were female and 106 (15.6%) had comorbidities. Overall, 126 (18.6%) children were hospitalised of whom 16 (12.7%) required ICU admission. Comorbidities were the only factor associated with hospital admission in a multivariable regression analysis (odds ratio 3.23, 95%CI 1.89 to 5.50; p-value < 0.01). Children with preexisting comorbidities did not require ICU admission more often. Hospitalised children more often presented with fever (96 [76.2%] vs 209 [38.1%], p-value < 0.01) and rash (16 [12.8%] vs 6 [1.1%], p-value < 0.01). Anosmia/dysgeusia was more prevalent in non-hospitalised children (73 [13.3%] vs 3 [2.4%], p-value < 0.01). In hospitalised children, oxygen treatment was required in 34 (27.0%), inotropes in nine (7.3%) and mechanical ventilation in eight (6.3%) cases. Complications were reported in 28 (4.1%) children with cardiovascular complications being most frequent (12 [1.8%]). Three deaths were recorded.Conclusion: This study confirms that COVID-19 is mostly a mild disease in children. Fever, rash and comorbidities are associated with higher admission rates. Continuous observation is necessary to further understand paediatric COVID-19, guide therapy and evaluate the necessity for vaccination in children. What is Known: • Clinical manifestations of SARS-CoV-2 infection in children vary from asymptomatic to critical disease requiring intensive care unit admission. • Most studies are based on hospitalised children only; currently, there is limited data on non-hospitalised children. What is New: • The clinical spectrum and severity of COVID-19 is influenced by age: in children less than 2 years, fever, cough and rhinorrhoea are the most common symptoms and in adolescents, fever, cough and headache are more common. • Hospitalised children more often presented with fever and rash, while anosmia/dysgeusia is more prevalent in non-hospitalised children. • Children with pre-existing comorbidities are more frequently hospitalised but do not require ICU admission more often.