Prévost Blandine, Retbi Aurélia, Binder-Foucard Florence, Borde Aurélie, Bruandet Amélie, Corvol Harriet, Gilleron Véronique, Le Bourhis-Zaimi Maggie, Lenne Xavier, Muller Joris, Ouattara Eric, Séguret Fabienne, Tran Ba Loc Pierre, Tezenas du Montcel Sophie
Department of Pediatric Pulmonology, APHP Hôpital Trousseau, Sorbonne Université, Paris, France.
Sorbonne Université, Centre de Recherche Saint Antoine (CRSA), Inserm UMR_S938, Paris, France.
Front Pediatr. 2022 Sep 7;10:975826. doi: 10.3389/fped.2022.975826. eCollection 2022.
COVID-19 infection is less severe among children than among adults; however, some patients require hospitalization and even critical care. Using data from the French national medico-administrative database, we estimated the risk factors for critical care unit (CCU) admissions among pediatric COVID-19 hospitalizations, the number and characteristics of the cases during the successive waves from January 2020 to August 2021 and described death cases.
We included all children (age < 18) hospitalized with COVID-19 between January 1st, 2020, and August 31st, 2021. Follow-up was until September 30th, 2021 (discharge or death). Contiguous hospital stays were gathered in "care sequences." Four epidemic waves were considered (cut off dates: August 11th 2020, January 1st 2021, and July 4th 2021). We excluded asymptomatic COVID-19 cases, post-COVID-19 diseases, and 1-day-long sequences (except death cases). Risk factors for CCU admission were assessed with a univariable and a multivariable logistic regression model in the entire sample and stratified by age, whether younger than 2.
We included 7,485 patients, of whom 1988 (26.6%) were admitted to the CCU. Risk factors for admission to the CCU were being younger than 7 days [OR: 3.71 95% CI (2.56-5.39)], being between 2 and 9 years old [1.19 (1.00-1.41)], pediatric multisystem inflammatory syndrome (PIMS) [7.17 (5.97-8.6)] and respiratory forms [1.26 (1.12-1.41)], and having at least one underlying condition [2.66 (2.36-3.01)]. Among hospitalized children younger than 2 years old, prematurity was a risk factor for CCU admission [1.89 (1.47-2.43)]. The CCU admission rate gradually decreased over the waves (from 31.0 to 17.8%). There were 32 (0.4%) deaths, of which the median age was 6 years (IQR: 177 days-15.5 years).
Some children need to be more particularly protected from a severe evolution: newborns younger than 7 days old, children aged from 2 to 13 years who are more at risk of PIMS forms and patients with at least one underlying medical condition.
新冠病毒感染在儿童中比在成人中症状较轻；然而，一些患儿需要住院治疗，甚至进入重症监护。我们利用法国国家医疗行政数据库的数据，估算了儿科新冠住院病例进入重症监护病房（CCU）的风险因素、2020年1月至2021年8月连续几波疫情期间病例的数量和特征，并描述了死亡病例。
我们纳入了2020年1月1日至2021年8月31日期间因新冠病毒感染住院的所有儿童（年龄<18岁）。随访至2021年9月30日（出院或死亡）。连续的住院时间被汇总为“护理序列”。考虑了四波疫情（截止日期：2020年8月11日、2021年1月1日和2021年7月4日）。我们排除了无症状新冠病例、新冠后疾病以及持续1天的序列（死亡病例除外）。在整个样本中以及按年龄（是否小于2岁）分层后，使用单变量和多变量逻辑回归模型评估进入CCU的风险因素。
我们纳入了7485例患者，其中1988例（26.6%）进入了CCU。进入CCU的风险因素包括年龄小于7天[比值比（OR）：3.71，95%置信区间（CI）（2.56 - 5.39）]、年龄在2至9岁之间[1.19（1.00 - 1.41）]、儿童多系统炎症综合征（PIMS）[7.17（5.97 - 8.6）]和呼吸道症状类型[1.26（1.12 - 1.41）]，以及至少有一种基础疾病[2.66（2.36 - 3.01）]。在2岁以下住院儿童中，早产是进入CCU的一个风险因素[1.89（1.47 - 2.43）]。CCU收治率在几波疫情期间逐渐下降（从31.0%降至17.8%）。有32例（0.4%）死亡，其中位年龄为6岁（四分位间距：177天 - 15.5岁）。
一些儿童需要得到更特别的保护以防止病情严重发展：小于7日龄的新生儿、有更高PIMS症状类型风险的2至13岁儿童以及至少有一种基础疾病的患者。
