More Obese, Diabetic, Chronically Ill Kids Hospitalized With COVID-19

By Ronnie Cohen

June 15, 2021

(Reuters Health) - Children with diabetes, obesity and cardiac and circulatory congenital anomalies were more likely to be hospitalized with COVID-19 and to be severely ill during while hospitalized, a new study finds.

The Centers for Disease Control and Prevention examination of more than 43,000 children and adolescents with COVID-19 also showed that epilepsy, convulsions, hypertension, trauma, asthma, sleep and stress disorders heightened the risk of hospitalization, death and the need for intensive care and mechanical ventilation.

"The study demonstrates there are a lot of conditions that might lead to hospitalization, and the more immunizations we can give to children, the more we'll be able to prevent hospitalization from COVID-19," said pediatrician Dr. Annabelle de St. Maurice, co-chief infection-prevention officer at UCLA and one of the authors of a commentary accompanying the study in JAMA Network Open.

Dr. Alyson B. Goodman, the study's senior author, also stressed the importance of vaccinating eligible children. In addition, Goodman, a pediatrician and medical epidemiologist at the CDC, told Reuters Health in a phone interview that she would like the study to serve to remind healthcare practitioners and public health authorities about the importance of preventing and controlling chronic conditions, like obesity.

"This brings us back to the issue of preventing these common diseases," she said. "I hope the study sheds light and provides renewed efforts around improving prevention of chronic diseases for all Americans and providing evidence-based management and treatment options for children and families."

The CDC team examined an all-payer database of 3.8 million patients ages 18 and younger seen at 900 geographically dispersed U.S. hospitals from March 2020 through January 2021.

Of those, 43,465 tested positive for COVID-19, and 4,302, or 10%, were admitted to hospitals, 30% of them to intensive-care units, 6.4% requiring invasive mechanical ventilation. Thirty-eight died.

Most of the hospitalized children were 12 to 18 years old and either Hispanic or Black, reflecting national trends for pediatric COVID-19.

In children younger than 2 years old, prematurity and cardiac and circulatory congenital anomalies were the most frequent risk factor for severe COVID-19. Asthma and neurodevelopmental disorders were more common among hospitalized children ages 2 and older.

Chronic disease was present in 22% of the children and in far more - 54% - of those hospitalized.

Patients with Type 1 diabetes were 4.6 times more likely to be hospitalized and 2.4 times more likely to be severely ill when hospitalized. The researchers defined severe illness as requiring intensive care or mechanical ventilation and dying.

The results about chronic disease failed to surprise de St. Maurice, she said in a phone interview. But the associations between COVID-19, hospitalizations and mental health diagnoses did take her aback.

Children who suffered with trauma, stress-related disorders and depression were nearly twice as likely to be hospitalized, and children with other anxiety diagnoses were at increased risk of hospitalization and severe illness.

de St. Maurice and Goodman both said it was impossible to disentangle whether children diagnosed with mental health conditions, or any conditions for that matter, arrived at the hospital for other reasons and just happened to test positive for COVID-19, or if the novel coronavirus caused symptoms that led them to seek hospital care.

"Really the mental health component of it was surprising to me," said de St. Maurice. "What it shows to me is just how far reaching this pandemic is."

COVID-19 hospitalizations rose among U.S. adolescents in March and April, and nearly a third of those hospitalized needed intensive care, according to CDC data released this month.

In May, the Food and Drug Administration expanded its Emergency Use Authorization for Pfizer's COVID-19 vaccine to include 12 to 15 year olds. (https://bit.ly/358kVZP) But until adolescents are fully vaccinated, CDC Director Rochelle Walensky urged them to continue wearing masks and maintaining social distance to protect themselves and their relatives, friends and communities. (https://bit.ly/3ieKdxb)

"I am deeply concerned by the numbers of hospitalized adolescents and saddened to see the number of adolescents who required treatment in intensive care units or mechanical ventilation," Walensky said after seeing the March and April hospitalization numbers. "Much of this suffering can be prevented." (https://bit.ly/3cx4k5T)

SOURCE: https://bit.ly/3fY7a6b and https://bit.ly/3pHymJP JAMA Network Open, online June 7, 2021.

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