J Korean Med Sci.  2022 Feb;37(5):e35. 10.3346/jkms.2022.37.e35.

Risk Factors for Severe COVID-19 in Children: A Systematic Review and Meta-Analysis

Affiliations
  • 1Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
  • 2Department of Pediatrics, Pusan National University Hospital, Busan, Korea
  • 3Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Abstract

Background
Coronavirus disease 2019 (COVID-19) has been the most important global issue since December 2019. Although the clinical course of COVID-19 is known to be milder in children than in adults, associated hospitalizations among children have increased since the emergence of contagious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and the achievement of a high vaccination rate in adults. Considering these global and domestic situations, we believe that risk stratification in children with COVID-19 is urgently needed for decision making regarding hospitalization priority in children infected with SARS-CoV-2 and vaccination priority against COVID-19.
Methods
This systematic review and meta-analysis was performed by comprehensively searching the PubMed, EMBASE, Scopus and KoreaMed databases through August 25, 2021. The criteria for enrollment were “severe COVID-19” as poor outcomes (intensive care unit admission, invasive mechanical ventilation, and/or death) and underlying comorbidities before SARS-CoV-2 infection.
Results
Among 872 screened studies, 17 articles were included in the systematic review, and 10 articles were included in the meta-analysis. Neonate (risk ratio [RR], 2.69; 95% confidence interval [CI], 1.83–3.97), prematurity in young infants (RR, 2.00; 95% CI, 1.63–2.46), obesity (RR, 1.43; 95% CI, 1.24–1.64), diabetes (RR, 2.26; 95% CI, 1.95–2.62), chronic lung disease (RR, 2.62; 95% CI, 1.71–4.00), heart disease (RR, 1.82; 95% CI, 1.58–2.09), neurologic disease (RR, 1.18; 95% CI, 1.05–1.33), and immunocompromised status (RR, 1.44; 95% CI, 1.01–2.04) were significant risk factors for severe COVID-19 in children. In the subgroup analysis, age younger than 3 months (RR, 0.26; 95% CI, 0.11–0.66), asthma (RR, 1.08; 95% CI, 0.98–1.20), and neurodevelopmental disorders (RR, 0.88; 95% CI, 0.75–1.04) were not risk factors for severe COVID-19.
Conclusion
Children with comorbidities such as obesity, diabetes, heart disease, chronic lung diseases other than asthma, seizure disorders, and an immunocompromised status had a high prevalence of severe COVID-19. Neonate and premature infants had a high risk of severe COVID-19. Defining the high-risk group for severe COVID-19 could help to guide hospital admission and priority for vaccination against SARS-CoV-2.

Keyword

COVID-19; Critical Illness; Children; Risk Factor; Meta-Analysis

Figure

  • Fig. 1 Flow diagram of the literature search.

  • Fig. 2 Meta-analysis of the impacts of 5 comorbidities on the severity of COVID-19 in children. (A) the impact of age. (B) the impact of prematurity. (C) the impact of obesity. (D) the impact of diabetes. (E) the impact of complex genetic disorders.COVID-19 = coronavirus disease 2019, CI = confidence interval, RR = risk ratio, DM = diabetes mellitus, P = prospective study, R = retrospective study, I = intensive care unit care, V = mechanical ventilator support, D = death, H = hemodynamic support.

  • Fig. 3 Meta-analysis of the impacts of 4 comorbidities on the severity of COVID-19 in children. (A) The impact of chronic lung disease and asthma. (B) The impact of heart disease. (C) The impact of neurologic disease. (D) The impact of immunocompromised status.COVID-19 = coronavirus disease 2019, CI = confidence interval, RR = risk ratio, DM = diabetes mellitus, P = prospective study, R = retrospective study, I = intensive care unit care, V = mechanical ventilator support, D = death, H = hemodynamic support, CLD = chronic lung disease, CHD = congenital heart disease, IC = immunocompromising status, IS = immunosuppressant drug use, HO = hemato-oncologic disease.


Cited by  1 articles

Complications of the Central Nervous System in Pediatric Patients With Common Cold Coronavirus Infection During 2014–2019
Hwanhee Park, Kyung-Ran Kim, Hee Jae Huh, Yoonsun Yoon, Esther Park, Joongbum Cho, Jiwon Lee, Jeehun Lee, Ji Hye Kim, Yae-Jean Kim
J Korean Med Sci. 2023;38(46):e358.    doi: 10.3346/jkms.2023.38.e358.


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