Frontiers in Pediatrics (Oct 2023)

Risk factors for health impairments in children after hospitalization for acute COVID-19 or MIS-C

  • Aline B. Maddux,
  • Cameron C. Young,
  • Suden Kucukak,
  • Laura D. Zambrano,
  • Margaret M. Newhams,
  • Caitlin K. Rollins,
  • Natasha B. Halasa,
  • Shira J. Gertz,
  • Elizabeth H. Mack,
  • Stephanie Schwartz,
  • Michele Kong,
  • Laura L. Loftis,
  • Katherine Irby,
  • Courtney M. Rowan,
  • Keiko M. Tarquinio,
  • Matt S. Zinter,
  • Hillary Crandall,
  • Natalie Z. Cvijanovich,
  • Jennifer E. Schuster,
  • Julie C. Fitzgerald,
  • Mary A. Staat,
  • Charlotte V. Hobbs,
  • Ryan A. Nofziger,
  • Steven Shein,
  • Heidi Flori,
  • Melissa L. Cullimore,
  • Brandon M. Chatani,
  • Emily R. Levy,
  • Katri V. Typpo,
  • Janet R. Hume,
  • Angela P. Campbell,
  • Adrienne G. Randolph,
  • the Overcoming COVID-19 Investigators,
  • Michele Kong,
  • Meghan Murdock,
  • Heather Kelley,
  • Candice Colston,
  • Mary Glas Gaspers,
  • Katri V. Typpo,
  • Ronald C. Sanders,
  • Katherine Irby,
  • Natalie Z. Cvijanovich,
  • Matt S. Zinter,
  • Aline B. Maddux,
  • Emily Port,
  • Rachel Mansour,
  • Sara Shankman,
  • Brandon M. Chatani,
  • Keiko M. Tarquinio,
  • Kaitlin Jones,
  • Courtney M. Rowan,
  • Adrienne G. Randolph,
  • Margaret M. Newhams,
  • Cameron C. Young,
  • Suden Kucukak,
  • Caitlin Rollins,
  • Tanya Novak,
  • Janet Chou,
  • Mary Beth Son,
  • Julia Clarke,
  • Brooke Sens,
  • Eve Listerud,
  • Sabrina Chen,
  • Kasey Stewart,
  • Heidi R. Flori,
  • Mary K. Dahmer,
  • Janet R. Hume,
  • Emily R. Levy,
  • Supriya Behl,
  • Noelle M. Drapeau,
  • Charlotte V. Hobbs,
  • Lora Martin,
  • Lacy Malloch,
  • Maygan Martin,
  • Kayla Patterson,
  • Cameron Sanders,
  • Kengo Inagaki,
  • Sarah McGraw,
  • Anita Dhanrajani,
  • Jennifer E. Schuster,
  • Abigail Kietzman,
  • Shannon Hill,
  • Melissa L. Cullimore,
  • Russell J. McCulloh,
  • Shira J. Gertz,
  • Stephanie P. Schwartz,
  • Tracie C. Walker,
  • Ryan A. Nofziger,
  • Mary Allen Staat,
  • Steven Shein,
  • Rajashri Rasal,
  • Julie C. Fitzgerald,
  • Ryan Burnett,
  • Jenny Bush,
  • Elizabeth H. Mack,
  • Natasha B. Halasa,
  • Meena Golcha,
  • Laura Stewart,
  • Laura L. Loftis,
  • Hillary Crandall,
  • Krow Ampofo,
  • Manish M. Patel,
  • Leora R. Feldstein,
  • Mark W. Tenforde,
  • Ashley M. Jackson,
  • Angela Campbell,
  • Laura D. Zambrano

DOI
https://doi.org/10.3389/fped.2023.1260372
Journal volume & issue
Vol. 11

Abstract

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ObjectiveTo identify risk factors for persistent impairments after pediatric hospitalization for acute coronavirus disease 2019 (COVID-19) or multisystem inflammatory syndrome in children (MIS-C) during the SARS-CoV-2 pandemic.MethodsAcross 25 U.S. Overcoming COVID-19 Network hospitals, we conducted a prospective cohort study of patients <21-years-old hospitalized for acute COVID-19 or MIS-C (May 2020 to March 2022) surveyed 2- to 4-months post-admission. Multivariable regression was used to calculate adjusted risk ratios (aRR) and 95% confidence intervals (CI).ResultsOf 232 children with acute COVID-19, 71 (30.6%) had persistent symptoms and 50 (21.6%) had activity impairments at follow-up; for MIS-C (n = 241), 56 (23.2%) had persistent symptoms and 58 (24.1%) had activity impairments. In adjusted analyses of patients with acute COVID-19, receipt of mechanical ventilation was associated with persistent symptoms [aRR 1.83 (95% CI: 1.07, 3.13)] whereas obesity [aRR 2.18 (95% CI: 1.05, 4.51)] and greater organ system involvement [aRR 1.35 (95% CI: 1.13, 1.61)] were associated with activity impairment. For patients with MIS-C, having a pre-existing respiratory condition was associated with persistent symptoms [aRR 3.04 (95% CI: 1.70, 5.41)] whereas obesity [aRR 1.86 (95% CI: 1.09, 3.15)] and greater organ system involvement [aRR 1.26 (1.00, 1.58)] were associated with activity impairments.DiscussionAmong patients hospitalized, nearly one in three hospitalized with acute COVID-19 and one in four hospitalized with MIS-C had persistent impairments for ≥2 months post-hospitalization. Persistent impairments were associated with more severe illness and underlying health conditions, identifying populations to target for follow-up.

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