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; Overcoming COVID-19 Investigators

doi:10.3389/fped.2023.1260372

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

Front Pediatr. 2023 Oct 18:11:1260372. doi: 10.3389/fped.2023.1260372. eCollection 2023.

Authors

Aline B Maddux¹, Cameron C Young², Suden Kucukak², Laura D Zambrano³, Margaret M Newhams², Caitlin K Rollins⁴, Natasha B Halasa⁵, Shira J Gertz⁶, Elizabeth H Mack⁷, Stephanie Schwartz⁸, Michele Kong⁹, Laura L Loftis¹⁰, Katherine Irby¹¹, Courtney M Rowan¹², Keiko M Tarquinio¹³, Matt S Zinter¹⁴, Hillary Crandall¹⁵, Natalie Z Cvijanovich¹⁶, Jennifer E Schuster¹⁷, Julie C Fitzgerald¹⁸, Mary A Staat¹⁹, Charlotte V Hobbs²⁰, Ryan A Nofziger²¹, Steven Shein²², Heidi Flori²³, Melissa L Cullimore²⁴, Brandon M Chatani²⁵, Emily R Levy²⁶, Katri V Typpo²⁷, Janet R Hume²⁸, Angela P Campbell³, Adrienne G Randolph²⁹; Overcoming COVID-19 Investigators

Collaborators

Overcoming COVID-19 Investigators:
Michele Kong, Meghan Murdock, Heather Kelley, Candice Colston, Mary Glas Gaspers, Katri V Typpo, Ronald C Sanders Jr, 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

Affiliations

¹ Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States.
² Critical Care, and Pain Medicine, Department of Anesthesiology, Boston Children's Hospital, Boston, MA, United States.
³ COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, GA, United States.
⁴ Departments of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
⁵ Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States.
⁶ Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, NJ, United States.
⁷ Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, SC, United States.
⁸ Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill, NC, United States.
⁹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States.
¹⁰ Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, TX, United States.
¹¹ Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR, United States.
¹² Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, United States.
¹³ Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States.
¹⁴ Department of Pediatrics, Division of Critical Care, University of California San Francisco, San Francisco, CA, United States.
¹⁵ Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, UT, United States.
¹⁶ Division of Critical Care Medicine, UCSF Benioff Children's Hospital, Oakland, CA, United States.
¹⁷ Division of Pediatric Infectious Disease, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, United States.
¹⁸ Department of Anesthesiology and Critical Care, Perelman School of Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
¹⁹ Department of Pediatrics, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States.
²⁰ Division of Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, United States.
²¹ Division of Critical Care Medicine, Akron Children's Hospital, Akron, OH, United States.
²² Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH, United States.
²³ Division of Pediatric Critical Care Medicine, Department of Pediatrics, C. S. Mott Children's Hospital and University of Michigan, Ann Arbor, MI, United States.
²⁴ Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, NE, United States.
²⁵ Division of Pediatric Infectious Disease, Department of Pediatrics, AdventHealth for Children, Orlando, FL, United States.
²⁶ Division of Pediatric Infectious Diseases, Division of Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States.
²⁷ Diamond Children's Banner Children's Medical Center, University of Arizona, Tucson, AZ, United States.
²⁸ Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States.
²⁹ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.

Abstract

Objective: To 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.

Methods: Across 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).

Results: Of 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.

Discussion: Among 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.

Keywords: COVID-19; COVID-19 post-intensive care syndrome; MIS-C; SARS-CoV-2; critical care outcomes; multisystem inflammatory syndrome in children; pediatrics; post-acute COVID-19 syndrome.

© 2023 Maddux, Young, Kucukak, Zambrano, Newhams, Rollins, Halasa, Gertz, Mack, Schwartz, Kong, Loftis, Irby, Rowan, Tarquinio, Zinter, Crandall, Cvijanovich, Schuster, Fitzgerald, Staat, Hobbs, Nofziger, Shein, Flori, Cullimore, Chatani, Levy, Typpo, Hume, Campbell, Randolph and the Overcoming COVID-19 Investigators.

Abstract

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