Abstract
OBJECTIVES: To characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among children and adolescents diagnosed or hospitalized with coronavirus disease 2019 (COVID-19) and to compare them in secondary analyses with patients diagnosed with previous seasonal influenza in 2017–2018. METHODS: International network cohort using real-world data from European primary care records (France, Germany, and Spain), South Korean claims and US claims, and hospital databases. We included children and adolescents diagnosed and/or hospitalized with COVID-19 at age <18 between January and June 2020. We described baseline demographics, comorbidities, symptoms, 30-day in-hospital treatments, and outcomes including hospitalization, pneumonia, acute respiratory distress syndrome, multisystem inflammatory syndrome in children, and death. RESULTS: A total of 242 158 children and adolescents diagnosed and 9769 hospitalized with COVID-19 and 2 084 180 diagnosed with influenza were studied. Comorbidities including neurodevelopmental disorders, heart disease, and cancer were more common among those hospitalized with versus diagnosed with COVID-19. Dyspnea, bronchiolitis, anosmia, and gastrointestinal symptoms were more common in COVID-19 than influenza. In-hospital prevalent treatments for COVID-19 included repurposed medications (<10%) and adjunctive therapies: systemic corticosteroids (6.8%–7.6%), famotidine (9.0%–28.1%), and antithrombotics such as aspirin (2.0%–21.4%), heparin (2.2%–18.1%), and enoxaparin (2.8%–14.8%). Hospitalization was observed in 0.3% to 1.3% of the cohort diagnosed with COVID-19, with undetectable (n < 5 per database) 30-day fatality. Thirty-day outcomes including pneumonia and hypoxemia were more frequent in COVID-19 than influenza. CONCLUSIONS: Despite negligible fatality, complications including hospitalization, hypoxemia, and pneumonia were more frequent in children and adolescents with COVID-19 than with influenza. Dyspnea, anosmia, and gastrointestinal symptoms could help differentiate diagnoses. A wide range of medications was used for the inpatient management of pediatric COVID-19.
| Original language | English |
|---|---|
| Article number | e2020042929 |
| Number of pages | 17 |
| Journal | Pediatrics |
| Volume | 148 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 1 Sept 2021 |
Bibliographical note
Funding Information:All authors have completed the International Committee of Medical Journal Editors uniform disclosure form at www.icmje.org/ coi_disclosure.pdf and declare the following. Dr Vizcaya reports personal fees from Bayer, outside the submitted work, and full-time employment at Bayer. Dr Golozar reports personal fees from Regeneron Pharmaceuticals, outside the submitted work, and she is a full-time employee at Regeneron Pharmaceuticals. Dr Hripcsak reports grants from the US National Library of Medicine, during the conduct of the study, and grants from Janssen Research & Development, outside the submitted work. Dr Sena reports personal fees from Janssen Research & Development, during the conduct of the study and personal fees from Janssen Research & Development, outside the submitted work. Dr Fortin is an employee of Janssen Research & Development, a subsidiary of Johnson & Johnson. Dr Blacketer is an employee of Janssen Research & Development and holds stock and stock option in the company. Dr Ryan is an employee of Janssen Research & Development and shareholder of Johnson & Johnson. Drs Kostka and Reich report being employees of IQVIA. Dr Suchard reports grants from the US National Institutes of Health and grants from the Department of Veterans Affairs, during the conduct of the study, and grants from IQVIA and personal fees from Janssen Research & Development, outside the submitted work. Dr Prieto-Alhambra reports grants and other from Applied Molecular Genetics (AMGEN); grants, nonfinancial support, and other from Union Chimique Belge (UCB) Biopharma; and grants from Les Laboratoires Servier, outside the submitted work, and Janssen, on behalf of Innovative Medicines Initiative-(IMI) funded European Health Data Evidence Network and EMIF consortiums. Synapse Management Partners have supported training programs organized by Dr Prieto-Alhambra's department and are open for external participants. Dr Nyberg was an employee of AstraZeneca until 2019 and holds some AstraZeneca shares. Dr DuVall received grants from Anolinx LLC; Astellas Pharma; AstraZeneca Pharmaceuticals LP; Boehringer Ingelheim International GmbH; Celgene Corporation; Eli Lilly and Company; Genentech Inc; Genomic Health, Inc; Gilead Sciences, Inc; GlaxoSmithKline PLC; Innocrin Pharmaceuticals Inc; Janssen Pharmaceuticals, Inc; Kantar Health; Myriad Genetic Laboratories, Inc; Novartis International AG; and Parexel International Corporation, outside the submitted work. The views expressed are those of the authors and do not necessarily represent the views or policy of the Department of Veterans Affairs or the US government. No other relationships or activities that could appear to have influenced the submitted work. FUNDING: The European Health Data Evidence Network has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement 806968. The Innovative Medicines Initiative 2 Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and European Federation of Pharmaceutical Industries and Associations (EFPIA). This research received partial support from the National Institute for Health Research Oxford Biomedical Research Centre, US National Institutes of Health, US Department of Veterans Affairs, Janssen Research & Development, and IQVIA. The University of Oxford received funding related to this work from the Bill & Melinda Gates Foundation (investment identifiers INV-016201 and INV-019257). The Institut Universitari per a la Recerca a l’AtencióPrimària de Salut Jordi Gol i Gurina received funding from the health department from the Generalitat de Catalunya with a grant for research projects on severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019 disease organized by the Direcció General de Recerca i Innovació en Salut. Dr Prieto-Alhambra received funding from the National Institute for Health Research Academy in the form of an National Institute for Health Research Senior Research Fellowship. Dr Ahmed reports funding from the National Institute for Health Research Oxford Biomedical Research Centre, Aziz Foundation, Wolfson Foundation, and the Royal College of Surgeons of England. Dr Morales is supported by a Wellcome Trust Clinical Research Career Development Fellowship (grant 214588/Z/18/Z). No funders had a direct role in this study. The views and opinions expressed are those of the authors and do not necessarily reflect those of the National Institute for Health Research Academy, National Institute for Health Research, Department of Veterans Affairs or the US government, National Health Service, or the Department of Health, England.
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