Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea.
Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea.
J Korean Med Sci. 2023 Mar 6;38(9):e65. doi: 10.3346/jkms.2023.38.e65.
Data on the clinical characteristics of pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant infection are limited. We aimed to evaluate the clinical features and outcomes of children with SARS-CoV-2 infection before and after omicron variant dominance in Korea.
A multicenter retrospective cohort study was conducted in hospitalized patients aged ≤ 18 years with laboratory-confirmed SARS-CoV-2 infection at five university hospitals in South Korea. The study periods were divided into the delta (from August 23, 2021 to January 2, 2022) and omicron (from January 30 to March 31, 2022).
In total, 612 hospitalized patients were identified (211, delta; 401, omicron). During the omicron and delta periods, the proportions of individuals with serious illness (moderate, severe, and critical severity) were 21.2% and 11.8%, respectively ( = 0.034). Compared with the delta period, the proportions of patients with moderate illness increased significantly in the age groups of 0-4 years (14.2% vs. 3.4%) and 5-11 years (18.6% vs. 4.2%) during the omicron period. During the two periods, the proportions of patients with complex chronic diseases (delta, 16.0% vs. 4.3%, = 0.040; omicron, 27.1% vs. 12.7%; = 0.002), respiratory diseases except for asthma (delta, 8.0% vs. 0.0%, = 0.013; omicron, 9.4% vs. 1.6%; = 0.001), and neurologic diseases (delta, 28.0% vs. 3.2%, < 0.001; omicron, 40.0% vs. 5.1%, < 0.001) were significantly higher in patients with serious illness than in those with non-serious illness. During the delta period, the risk for serious illness was higher among patients with obesity (adjusted odds ratio [aOR], 8.18; 95% confidence interval [CI], 2.80-27.36) and neurologic diseases (aOR, 39.43; 95% CI, 6.90-268.3) and aged 12-18 years (aOR, 3.92; 95% CI, 1.46-10.85). However, the presence of neurologic disease (aOR, 9.80; 95% CI, 4.50-22.57) was the only risk factor for serious illness during the omicron period. During the omicron period, the proportions of patients with croup (11.0% vs. 0.5%) and seizures (13.2% vs. 2.8%) increased significantly compared with the delta period.
Compared with the delta period, the proportions of young children and patients with complex comorbidities were higher during the omicron period in Korea. Patients with complex chronic diseases, especially neurologic diseases, had a high risk of severe coronavirus disease 2019 in the two distinct variant-dominant periods.
关于严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）变异株感染的儿科患者临床特征的数据有限。我们旨在评估韩国在 omicron 变异株占主导地位之前和之后 SARS-CoV-2 感染儿童的临床特征和结局。
在韩国的五所大学医院，对患有实验室确诊 SARS-CoV-2 感染且年龄≤18 岁的住院患者进行了一项多中心回顾性队列研究。研究期间分为 delta（2021 年 8 月 23 日至 2022 年 1 月 2 日）和 omicron（2022 年 1 月 30 日至 3 月 31 日）。
共确定了 612 名住院患者（211 名，delta；401 名，omicron）。在 omicron 和 delta 期间，严重疾病（中度、重度和危重严重程度）患者的比例分别为 21.2%和 11.8%（ = 0.034）。与 delta 期相比，omicron 期 0-4 岁（14.2%比 3.4%）和 5-11 岁（18.6%比 4.2%）年龄组中度疾病患者的比例显著增加。在这两个时期，患有复杂慢性疾病（delta 期：16.0%比 4.3%， = 0.040；omicron 期：27.1%比 12.7%， = 0.002）、除哮喘外的呼吸系统疾病（delta 期：8.0%比 0.0%， = 0.013；omicron 期：9.4%比 1.6%， = 0.001）和神经系统疾病（delta 期：28.0%比 3.2%， < 0.001；omicron 期：40.0%比 5.1%， < 0.001）的严重疾病患者中，复杂慢性疾病患者的比例显著更高。在 delta 期，肥胖（调整后的优势比 [aOR]，8.18；95%置信区间 [CI]，2.80-27.36）和神经系统疾病（aOR，39.43；95%CI，6.90-268.3）以及 12-18 岁（aOR，3.92；95%CI，1.46-10.85）患者发生严重疾病的风险更高。然而，在 omicron 期，神经系统疾病（aOR，9.80；95%CI，4.50-22.57）是发生严重疾病的唯一危险因素。在 omicron 期，与 delta 期相比，喘鸣（11.0%比 0.5%）和癫痫发作（13.2%比 2.8%）的患者比例显著增加。
与 delta 期相比，在韩国 omicron 期，年幼儿童和患有复杂合并症的患者比例更高。患有复杂慢性疾病，特别是神经系统疾病的患者，在这两个不同的变异株占主导地位的时期发生严重的 2019 冠状病毒病的风险较高。
