Baseline characteristics, management, and outcomes of 55,270 children and adolescents diagnosed with COVID-19 and 1,952,693 with influenza in France, Germany, Spain, South Korea and the United States: an international network cohort study

Duarte-Salles, Talita; Vizcaya, David; Pistillo, Andrea; Casajust, Paula; Sena, Anthony G.; Lai, Lana Yin Hui; Prats-Uribe, Albert; Ahmed, Waheed-Ul-Rahman; Alshammari, Thamir M; Alghoul, Heba; Alser, Osaid; Burn, Edward; You, Seng Chan; Areia, Carlos; Blacketer, Clair; DuVall, Scott; Falconer, Thomas; Fernandez-Bertolin, Sergio; Fortin, Stephen; Golozar, Asieh; Gong, Mengchun; Tan, Eng Hooi; Huser, Vojtech; Iveli, Pablo; Morales, Daniel R.; Nyberg, Fredrik; Posada, Jose D.; Recalde, Martina; Roel, Elena; Schilling, Lisa M.; Shah, Nigam H.; Shah, Karishma; Suchard, Marc A.; Zhang, Lin; Zhang, Ying; Williams, Andrew E.; Reich, Christian G.; Hripcsak, George; Rijnbeek, Peter; Ryan, Patrick; Kostka, Kristin; Prieto-Alhambra, Daniel

OBJECTIVES: To characterize the demographics, comorbidities, symptoms, in-hospital treatments, and health outcomes among children/adolescents diagnosed or hospitalized with COVID-19. Secondly, to describe health outcomes amongst children/adolescents diagnosed with previous seasonal influenza. DESIGN: International network cohort. SETTING: Real-world data from European primary care records (France/Germany/Spain), South Korean claims and US claims and hospital databases. PARTICIPANTS: Diagnosed and/or hospitalized children/adolescents with COVID-19 at age <18 between January and June 2020; diagnosed with influenza in 2017–2018. MAIN OUTCOME MEASURES: Baseline demographics and comorbidities, symptoms, 30-day in-hospital treatments and outcomes including hospitalization, pneumonia, acute respiratory distress syndrome (ARDS), multi-system inflammatory syndrome (MIS-C), and death. RESULTS: A total of 55,270 children/adolescents diagnosed and 3,693 hospitalized with COVID-19 and 1,952,693 diagnosed with influenza were studied. Comorbidities including neurodevelopmental disorders, heart disease, and cancer were all more common among those hospitalized vs diagnosed with COVID-19. The most common COVID-19 symptom was fever. Dyspnea, bronchiolitis, anosmia and gastrointestinal symptoms were more common in COVID-19 than influenza. In-hospital treatments for COVID-19 included repurposed medications (<10%), and adjunctive therapies: systemic corticosteroids (6.8% to 37.6%), famotidine (9.0% to 28.1%), and antithrombotics such as aspirin (2.0% to 21.4%), heparin (2.2% to 18.1%), and enoxaparin (2.8% to 14.8%). Hospitalization was observed in 0.3% to 1.3% of the COVID-19 diagnosed cohort, with undetectable (N<5 per database) 30-day fatality. Thirty-day outcomes including pneumonia, ARDS, and MIS-C were more frequent in COVID-19 than influenza. CONCLUSIONS: Despite negligible fatality, complications including pneumonia, ARDS and MIS-C were more frequent in children/adolescents with COVID-19 than with influenza. Dyspnea, anosmia and gastrointestinal symptoms could help differential diagnosis. A wide range of medications were used for the inpatient management of pediatric COVID-19.