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s_cid=mm7045e1_w † † COVID-19 was confirmed with laboratory detection of SARS-CoV-2 by reverse transcription-polymerase chain reaction or antigen test. § § Patients with MIS-C as the reason for hospitalization included patients who met the clinical case definition for MIS-C (clinically severe illness requiring hospitalization in a person aged <21 years with fever, laboratory evidence of inflammation, multisystem [≥2] organ involvement and no alternative plausible diagnosis, and evidence of current or recent SARS-CoV-2 infection by reverse transcription polymerase chain reaction, serology or antigen test, or COVID-19 exposure within the 4 weeks preceding symptom onset [https:// emergency.cdc.gov/han/2020/han00432.asp]) and were hospitalized for diagnosis and management of MIS-C, based on chart review.

Objectives: To describe COVID-19-related pediatric hospitalizations during a period of B.1.617.2 (Delta) variant predominance and to determine age-specific factors associated with severe illness. Patients and Methods: We abstracted data from medical charts to conduct a cross-sectional study of patients aged &lt;21 years hospitalized at 6 US children's hospitals during July–August 2021 for COVID-19 or with an incidental positive SARS-CoV-2 test. Among patients with COVID-19, we assessed factors associated with severe illness by calculating age-stratified prevalence ratios (PR). We defined severe illness as receiving high-flow nasal cannula, positive airway pressure, or invasive mechanical ventilation. Results: Of 947 hospitalized patients, 759 (80.1%) had COVID-19, of whom 287 (37.8%) had severe illness. Factors associated with severe illness included coinfection with RSV (PR 3.64) and bacteria (PR 1.88) in infants; RSV coinfection in patients aged 1–4 years (PR 1.96); and obesity in patients aged 5–11 (PR 2.20) and 12–17 years (PR 2.48). Having ≥2 underlying medical conditions was associated with severe illness in patients aged &lt;1 (PR 1.82), 5–11 (PR 3.72), and 12–17 years (PR 3.19) Conclusions: Among patients hospitalized for COVID-19, factors associated with severe illness included RSV coinfection in those aged &lt;5 years, obesity in those aged 5–17 years, and other underlying conditions for all age groups &lt;18 years. These findings can inform pediatric practice, risk communication, and prevention strategies, including vaccination against COVID-19