Risk factors for admission to the pediatric critical care unit among children hospitalized with COVID-19 in France

Blandine Prévost; Aurélia Retbi; Florence Binder-Foucard; Aurélie Borde; Amélie Bruandet; Harriet Corvol; Véronique Gilleron; Maggie Le Bourhis-Zaimi; Xavier Lenne; Joris Muller; Eric Ouattara; Fabienne Séguret; Pierre Tran Ba Loc; Sophie Tezenas du Montcel

doi:10.3389/fped.2022.975826

Risk factors for admission to the pediatric critical care unit among children hospitalized with COVID-19 in France

Front Pediatr. 2022 Sep 7:10:975826. doi: 10.3389/fped.2022.975826. eCollection 2022.

Authors

Blandine Prévost^{1

2}, Aurélia Retbi³, Florence Binder-Foucard⁴, Aurélie Borde⁵, Amélie Bruandet⁶, Harriet Corvol^{1

2}, Véronique Gilleron^{5

7}, Maggie Le Bourhis-Zaimi⁸, Xavier Lenne⁶, Joris Muller⁴, Eric Ouattara⁵, Fabienne Séguret⁹, Pierre Tran Ba Loc⁴, Sophie Tezenas du Montcel¹⁰

Affiliations

¹ Department of Pediatric Pulmonology, APHP Hôpital Trousseau, Sorbonne Université, Paris, France.
² Sorbonne Université, Centre de Recherche Saint Antoine (CRSA), Inserm UMR_S938, Paris, France.
³ Department of Medical Information, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Sorbonne Université, Paris, France.
⁴ Department of Public Health, Strasbourg University Hospital, Strasbourg, France.
⁵ Department of Medical Information, Medical Information Analysis and Coordination Unit (UCAIM - DIM), University Hospital Center Bordeaux, Bordeaux, France.
⁶ Department of Medical Information, Lille University Hospital Center, Lille, France.
⁷ Inserm U1219/Bordeaux Population Health Research Center, Population Health trAnslational Research (PHARes), University of Bordeaux, Bordeaux, France.
⁸ Department of Medical Information, Hospices Civils de Lyon, Lyon, France.
⁹ Unit of Evaluation and Epidemiologic Studies on National Hospitalization Databases, Department of Epidemiology, Biostatistics and Medical Information, University Hospital Center Montpellier, Montpellier, France.
¹⁰ Department of Medical Information, Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, CNRS, Inria, Inserm, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Sorbonne Université, Paris, France.

Abstract

Background: COVID-19 infection is less severe among children than among adults; however, some patients require hospitalization and even critical care. Using data from the French national medico-administrative database, we estimated the risk factors for critical care unit (CCU) admissions among pediatric COVID-19 hospitalizations, the number and characteristics of the cases during the successive waves from January 2020 to August 2021 and described death cases.

Methods: We included all children (age < 18) hospitalized with COVID-19 between January 1st, 2020, and August 31st, 2021. Follow-up was until September 30th, 2021 (discharge or death). Contiguous hospital stays were gathered in "care sequences." Four epidemic waves were considered (cut off dates: August 11th 2020, January 1st 2021, and July 4th 2021). We excluded asymptomatic COVID-19 cases, post-COVID-19 diseases, and 1-day-long sequences (except death cases). Risk factors for CCU admission were assessed with a univariable and a multivariable logistic regression model in the entire sample and stratified by age, whether younger than 2.

Results: We included 7,485 patients, of whom 1988 (26.6%) were admitted to the CCU. Risk factors for admission to the CCU were being younger than 7 days [OR: 3.71 95% CI (2.56-5.39)], being between 2 and 9 years old [1.19 (1.00-1.41)], pediatric multisystem inflammatory syndrome (PIMS) [7.17 (5.97-8.6)] and respiratory forms [1.26 (1.12-1.41)], and having at least one underlying condition [2.66 (2.36-3.01)]. Among hospitalized children younger than 2 years old, prematurity was a risk factor for CCU admission [1.89 (1.47-2.43)]. The CCU admission rate gradually decreased over the waves (from 31.0 to 17.8%). There were 32 (0.4%) deaths, of which the median age was 6 years (IQR: 177 days-15.5 years).

Conclusion: Some children need to be more particularly protected from a severe evolution: newborns younger than 7 days old, children aged from 2 to 13 years who are more at risk of PIMS forms and patients with at least one underlying medical condition.

Keywords: COVID-19; SARS-CoV-2; children; critical care; hospitalization.