Multicenter cohort study of children hospitalized with SARS-CoV-2 infection

ROBINSON, J.; Barton, M.; Papenburg, J.; Ulloa-Gutierrez, R.; Brenes-Chacon, H.; Yock-Corrales, A.; Ivankovich-Escoto, G.; Soriano-Fallas, A.; Mezerville, M. H.-d.; Bitnun, A.; Morris, S. K.; El Tal, T.; Yeh, E. A.; Gill, P.; Laxer, R. M.; Nateghian, A.; Haghighi Aski, B.; Manafif, A.; Lefebvre, M.-A.; Caya, C.; Cooke, S.; Dewan, T.; Restivo, L.; Theriault, I.; Trajtman, A.; Dwilow, R.; Bullard, J.; Sadarangani, M.; Roberts, A.; Le Saux, N.; Bowes, J.; Wong, J. K.; Purewal, R.; Lautermilch, J.; Leifso, K.; Foo, C.; Newhook, L. A.; Bayliss, A.; Petel, D.

Background: A cohort study was conducted to describe and compare the burden and characteristics of SARS-CoV-2 infection in hospitalized children in three countries. Methods: This was a retrospective cohort of consecutive children admitted to 15 hospitals (13 in Canada and one each in Iran and Costa Rica) up to November 16, 2020. Cases were included if they had SARS-CoV-2 infection or multi-system inflammatory syndrome in children (MIS-C) with molecular detection of SARS-CoV-2 or positive SARS-CoV-2 serology. Results: Of 211 included cases (Canada N=95; Costa Rica N=84; Iran N=32), 103 (49%) had a presumptive diagnosis of COVID-19 or MIS-C at admission while 108 (51%) were admitted with other diagnoses. Twenty-one (10%) of 211 met criteria for MIS-C. Eighty-seven (41%) had comorbidities. Children admitted in Canada were older than those admitted to non-Canadian sites (median 4.1 versus 2.2 years; p<0.001) and less likely to require mechanical ventilation (3/95 [3%] versus 15/116 [13%]; p<0.05). Requirement for oxygen or ICU occurred in 64 (30%) and death in four, three of whom. had malignancies. Age < 30 days, admission outside of Canada, presence of at least one comorbidity and chest imaging compatible with COVID-19 predicted severe disease. Conclusions: Approximately half of hospitalized children with confirmed SARS-CoV-2 infection or MIS-C were admitted with other suspected diagnoses. Disease was more severe at non-Canadian sites. Neonates, children with comorbidities and those with chest radiographs compatible with COVID-19 were at increased risk for severe disease.