Neonatal past catches up when COVID-19 comes to town

Congenital anomalies are structural or functional changes that are present at birth.Whilst each is rare, together they are common, occurring in one in every 33 babies born in the United States. 1 Importantly, congenital anomalies remain a leading cause of severe childhood mortality, morbidity, and disability, especially in infancy.In adults, the presence of underlying medical conditions is known to increase the risk of severe illness from COVID-19, 2 but less is known about the risk factors in children.This is unfortunate as the impact of severe illness in children can be long-lasting.Congenital heart disease has been shown to lead to more severe COVID-19 outcomes. 3Whether other congenital anomalies predispose children to severe COVID-19 remains less well-understood, but the higher rates of severe illness from other common childhood infections, such as respiratory syncytial virus, 4 prompt further reflection.In this issue of Pediatric Research, Goodman et al. conducted a retrospective, observational cohort study to explore the relationship between a history of congenital anomalies and the severity of COVID-19 in paediatric patients. 5The authors utilised a large database of electronic health records (Cerner Real-World Data) to investigate 927,805 paediatrics patient hospital-based encounters with COVID-19 from 117 health systems across the United States between March 2020 to February 2022.Congenital anomalies were classified using the International Statistical Classification of Disease Codes (ICD-10-CM) and divided into 10 groups based on the system.COVID-19 severity was defined by the level of oxygen and respiratory support delivered, consistent with previous guidelines. 6A strength of the study was that cases were matched with children without a documented congenital anomaly who presented with SARS-CoV-2 infection using 1:1 propensity scores on age, sex, race, chronic illness (including obesity), healthcare funder, and time point within the pandemic.The authors identified that all categories of congenital anomalies (106,980 children) were associated with more severe COVID-19 than those without a history of congenital anomalies, with cardiovascular anomalies conferring the greatest risk.The increased odds of experiencing severe COVID-19 in children ranged from 1.16 95% CI 1.03, 1.31 for congenital head and neck anomalies to 3. 84 3.63, 4.06 for cardiovascular anomalies.It is not surprising that cardiovascular anomalies were most strongly associated with severe COVID-19, as pre-existing cardiac disease is a known risk factor for severe COVID-19 in adults. 7Cardiovascular anomalies in children are often associated with immune deficiencies and usually require surgery.In many cases, the surgery is not curative, and children experience lifelong cardiac