Characteristics and Outcomes of Children Hospitalized With COVID-19

Background: Early in the COVID-19 pandemic, children overall seemed less affected by severe illness. Older individuals and those with underlying medical conditions were thought to be at higher risk for severe disease. The purpose of this study was to describe the outcomes of children hospitalized with COVID-19 from the start of the pandemic through the surge of the Delta variant. Methods: This was an observational study of children and young adults aged 0-20 years admitted March 2020 - November 2021 with a positive test for COVID-19. Exclusion criteria were patients who required respiratory support unrelated to COVID-19 (eg, trauma, burn injury, drowning). Retrospective data included demographics, underlying medical conditions, vaccination status, respiratory support, multisystem inflammatory syndrome, and length of stay. Early pandemic was considered March 2020-June 2021 and the Delta variant July-November 2021. Descriptive statistics, Fisher exact, Chi-square, or Mann Whitney U test were used to analyze results. Results: There were 762 admissions analyzed representing 735 unique subjects. The median age and length of stay was 7.4 years and 2 days respectively. The majority were white (52%), non-Hispanic (83%), and not eligible for vaccination at time of admission (78%). Respiratory support was required by 34%, and oxygen was the most common form of support. Some subjects required readmission (27, 4%). There were 3 deaths overall, all of which occurred during the surge of the Delta variant. There were significant differences between early pandemic and the Delta variant for ethnicity (P = .004), vaccination status (P < .001) respiratory support (P < .001), and length of stay (P <.001). Conclusions: The majority of children were not eligible for the COVID-19 vaccine but there were more unvaccinated during the Delta variant. Most subjects did not have an underlying condition and less than half required respiratory support. Multisystem inflammatory syndrome was rare. During the surge of the Delta variant, more subjects were unvaccinated, required respiratory support, and had a longer length of stay.