Are infants at more risk of severe COVID-19?

Reports early on in the coronavirus 2019 (COVID-19) disease seemed to indicate that both very young age and comorbidities could increase the risk of severe progression of the disease in children, but no research findings had confirmed this yet. An examination of French children published in Pediatrics offers some crucial information on whether this is true.¹

Researchers performed a national prospective surveillance of children hospitalized with COVID-19 in 60 hospitals in France. A positive infection was defined as a positive real-time reverse transcriptase polymerase chain reaction on a nasopharyngeal swab. Severe disease evolution was defined as requiring either hemodynamic or ventilatory support and ventilatory support was defined as use of noninvasive ventilation, including high-flow oxygen via nasal cannula, continuous positive airway pressure, and bilevel positive airway pressure or the use of invasive ventilation. Hypoxemia and thrombocytopenia were defined as an oxygen saturation of <95% and a platelet count of <150 g/L, respectively.

A total of 397 children who were hospitalized with COVID-19 were included in the study. The researchers noted several clinical patterns including paucisymptomatic children who were admitted for surveillance, lower respiratory tract infection, and or multisystem inflammatory syndrome in children. Children aged <90 days old comprised 145 of the studied cases, but only 4 of the children had severe disease. After excluding both children hospitalized for a diagnosis not related to COVID-19 (n = 62) or those with multisystem inflammatory syndrome in children (n = 29), 23 of the children had severe deaths and there were 6 deaths. The researchers found that factors independently linked to severity were age ≥ 10 years (odds ratio [OR] = 3.4, 95% CI: 1.1–10.3), hypoxemia (OR = 8.9, 95% CI: 2.6–29.7), C-reactive protein level ≥80 mg/L (OR = 6.6 95% CI: 1.4–27.5).

The researchers concluded that young age does not appear to be a risk factor for severe COVID-19. In fact, very young children were at the lowest risk of having severe disease evolution.

Reference

1. Ouldali N, Yang D, Madhi F et al. Factors associated with severe SARS-CoV-2 infection. Pediatrics. 2020:e2020023432. doi:10.1542/peds.2020-023432