We assessed characteristics associated with pediatric COVID-19 hospitalizations and risk factors for severe disease among hospitalized children ≥6 months.
Using data from COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) during October 1, 2022-April 30, 2024, we described demographic characteristics, underlying medical conditions, COVID-19 vaccination status, and clinical outcomes, including severe disease (ICU admission, mechanical ventilation, extracorporeal membrane oxygenation, in-hospital death), of hospitalized children 6 months-17 years residing in the COVID-NET catchment area with laboratory-confirmed SARS-CoV-2 infection. Multivariable log-linked Poisson generalized estimating equations were conducted to assess risk factors for severe disease among children 6-23 months and 2-17 years.
Of 2,490 children hospitalized for COVID-19, 1114 (44.7%) were 6-23 months; 1358 (54.1%) were male. Overall, 1464 (58.9%) had ≥1 underlying conditions: 471 (41.8%) of children 6-23 months, 290 (61.6%) 2-4 years, 383 (79.2%) 5-11 years, and 320 (77.0%) 12-17 years. 100 (3.8%) were up-to-date with recommended COVID-19 vaccination. Among children 6-23 months, severe disease was associated with underlying chronic lung (adjusted risk ratio [aRR] 1.5, 95% CI: 1.2-1.8) and cardiovascular disease (aRR: 1.4, 95% CI: 1.1-1.7). Among children ≥2 years, severity was associated with chronic lung disease (aRR: 1.9, 95% CI: 1.5-2.3), diabetes (aRR: 1.5, 95% CI: 1.2-1.8), and neurologic disorders (aRR: 1.4, 95% CI: 1.2-1.6).
Most hospitalized children ≥6 months had ≥1 underlying conditions and <5% were up-to-date with COVID-19 vaccination. Specific conditions were associated with increased risk of severe illness. Increasing COVID-19 vaccination, particularly among children with high-risk conditions, may reduce pediatric COVID-19 hospitalizations and severe outcomes.
Competing Interests
CONFLICT OF INTEREST DISCLOSURES: Dr. Taylor reports owning stock in Pfizer, Amgen, and Lilly. Dr. Sachdev has nothing to disclose. Mr. Meek reports grants from CDC, during the conduct of the study. Ms. Reeg reports grants from CDC, during the conduct of the study. Dr. Smelser reports grants from CDC, during the conduct of the study. Dr. Sutton reports grants from CDC Emerging Infections Program during the conduct of the study. Dr. Talbot reports grants from CDC, outside the submitted work. The remaining authors report nothing to disclose.
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