Young Age Not a Strong Risk Factor for Severe COVID-19

By Megan Brooks

February 16, 2021

NEW YORK (Reuters Health) - Contrary to initial reports, a study from France finds that very young children who get COVID-19 are not at increased risk for severe disease.

Dr. Francois Angoulvant of Necker-Enfants Malades University Hospital in Paris and colleagues studied all 397 children treated for confirmed SARS-CoV-2 infection in 60 hospitals between February 15 and June 1, 2020.

Children younger than three months of age accounted for 37% of cases (145 of 397), but only four (3%) of these children developed severe disease.

Excluding 29 children with multisystem inflammatory syndrome in children (MIS-C) and 62 hospitalized for something unrelated to SARS-CoV-2, 23 (11%) of the remaining 306 children had severe disease and six died.

"In contrast with preliminary reports, young age was not an independent factor associated with severe SARS-CoV-2 infection, and children < 90 days old were at the lowest risk of severe disease evolution," the authors report in Pediatrics.

They note that several children younger than one year old required transient nasal oxygen therapy, and several were transferred to the pediatric intensive-care unit for surveillance only due to their young age. However, they "evolved favorably in the large majority of cases, without ventilatory support."

One factor independently associated with severe COVID-19 was age 10 years or older (odds ratio, 3.4; 95% confidence interval, 1.1 to 10.3).

However, in an email to Reuters Health, Dr. Angoulvant noted that with appropriate treatment, "we did not observe difference" in outcome between children younger and older than 10 years. "With the accurate treatment, patient status improved in most of the cases in less than two days," the researcher added.

The two other factors independently associated with severe COVID-19 in their cohort was hypoxemia (OR, 8.9; 95% CI, 2.6 to 29.7) and C-reactive protein level of at least 80 mg/L (OR, 6.6; 95% CI, 1.4 to 27.5).

The authors hope identification of these factors associated with increased risk of severe disease "may help clinicians manage this infection in children."

SOURCE: Pediatrics, online February 12, 2021.