Characteristics of children admitted to hospital with acute SARS-CoV-2 infection in Canada in 2020

Drouin, Olivier; Hepburn, Charlotte Moore; Farrar, Daniel S.; Baerg, Krista; Chan, Kevin; Cyr, Claude; Donner, Elizabeth J.; Embree, Joanne E.; Farrell, Catherine; Forgie, Sarah; Giroux, Ryan; Kang, Kristopher T.; King, Melanie; Laffin, Melanie; Luu, Thuy Mai; Orkin, Julia; Papenburg, Jesse; Pound, Catherine M.; Price, Victoria E.; Purewal, Rupeena; Sadarangani, Manish; Salvadori, Marina I.; Top, Karina A.; Viel-Thériault, Isabelle; Kakkar, Fatima; Morris, Shaun K.

BACKGROUND: Risk factors for severe outcomes of SARS-CoV-2 infection are not well established in children. We sought to describe pediatric hospital admissions associated with SARS-CoV-2 infection in Canada and identify risk factors for more severe disease. METHODS: We conducted a national prospective study using the infrastructure of the Canadian Paediatric Surveillance Program (CPSP). Cases involving children who were admitted to hospital with microbiologically confirmed SARS-CoV-2 infection were reported from Apr. 8 to Dec. 31 2020, through weekly online questionnaires distributed to the CPSP network of more than 2800 pediatricians. We categorized hospital admissions as related to COVID-19, incidental, or for social or infection control reasons and determined risk factors for disease severity in hospital. RESULTS: Among 264 hospital admissions involving children with SARS-CoV-2 infection during the 9-month study period, 150 (56.8%) admissions were related to COVID-19 and 100 (37.9%) were incidental infections (admissions for other reasons and found to be positive for SARS-CoV-2 on screening). Infants (37.3%) and adolescents (29.6%) represented most cases. Among hospital admissions related to COVID-19, 52 (34.7%) had critical disease, 42 (28.0%) of whom required any form of respiratory or hemodynamic support, and 59 (39.3%) had at least 1 underlying comorbidity. Children with obesity, chronic neurologic conditions or chronic lung disease other than asthma were more likely to have severe or critical COVID-19. INTERPRETATION: Among children who were admitted to hospital with SARS-CoV-2 infection in Canada during the early COVID-19 pandemic period, incidental SARS-CoV-2 infection was common. In children admitted with acute COVID-19, obesity and neurologic and respiratory comorbidities were associated with more severe disease.