COVID-19 Mortality in Children: A Referral Center Experience from Iran (Mofid Children’s Hospital, Tehran, Iran)

Armin, Shahnaz; Fahimzad, Seyed Alireza; Tabatabaei, Sedigheh Rafiei; Ghanaiee, Roxana Mansour; Marhamati, Noushin; Ahmadizadeh, Seyyedeh Narjes; Behzad, Azita; Hashemi, Seyedeh Masumeh; Sadr, Saeed; Rajabnejad, Maryam; Jamee, Mahnaz; Karimi, Abdollah

doi:10.1155/2022/2737719

Cited by 12 publications

(19 citation statements)

References 41 publications

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“…These differences in ethnic groups may be indicative of wider disparities such as socioeconomic status, cultural differences, or access to healthcare, which are worthy of further study [ 41 ]. Our results are also in line with a recent systematic review up to May 2021, which also found higher odds of severe disease and death in CYP aged >10 years and underlying comorbidities, especially neurological or cardiac conditions [ 42 ], which is consistent with other published studies [ 11 , 15 , 42 , 43 ]. Notably, however, compared to children who died of other causes in England, previous analyses found that underlying health conditions were not overrepresented in children who died of COVID-19 [ 15 , 44 ], or among survivors and non-survivors in children hospitalised for COVID-19 [ 45 ].…”

Section: Discussionsupporting

confidence: 93%

COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study

Bertran¹,

Amin-Chowdhury²,

Davies

et al. 2022

PLoS Med

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Background Coronavirus Disease 2019 (COVID-19) deaths are rare in children and young people (CYP). The high rates of asymptomatic and mild infections complicate assessment of cause of death in CYP. We assessed the cause of death in all CYP with a positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) test since the start of the pandemic in England. Methods and findings CYP aged <20 years who died within 100 days of laboratory-confirmed SARS-CoV-2 infection between 01 March 2020 and 31 December 2021 in England were followed up in detail, using national databases, surveillance questionnaires, post-mortem reports, and clinician interviews. There were 185 deaths during the 22-month follow-up and 81 (43.8%) were due to COVID-19. Compared to non-COVID-19 deaths in CYP with a positive SARS-CoV-2 test, death due to COVID-19 was independently associated with older age (aOR 1.06 95% confidence interval (CI) 1.01 to 1.11, p = 0.02) and underlying comorbidities (aOR 2.52 95% CI 1.27 to 5.01, p = 0.008), after adjusting for age, sex, ethnicity group, and underlying conditions, with a shorter interval between SARS-CoV-2 testing and death. Half the COVID-19 deaths (41/81, 50.6%) occurred within 7 days of confirmation of SARS-CoV-2 infection and 91% (74/81) within 30 days. Of the COVID-19 deaths, 61 (75.3%) had an underlying condition, especially severe neurodisability (n = 27) and immunocompromising conditions (n = 12). Over the 22-month surveillance period, SARS-CoV-2 was responsible for 1.2% (81/6,790) of all deaths in CYP aged <20 years, with an infection fatality rate of 0.70/100,000 SARS-CoV-2 infections in this age group estimated through real-time, nowcasting modelling, and a mortality rate of 0.61/100,000. Limitations include possible under-ascertainment of deaths in CYP who were not tested for SARS-CoV-2 and lack of direct access to clinical data for hospitalised CYP. Conclusions COVID-19 deaths remain extremely rare in CYP, with most fatalities occurring within 30 days of infection and in children with specific underlying conditions.

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Section: Discussionsupporting

confidence: 93%

COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study

Bertran¹,

Amin-Chowdhury²,

Davies

et al. 2022

PLoS Med

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“…Moreover, these patients had an increased risk of in-hospital mortality than the other patients. These findings were consistent with the results of the previously conducted studies [ 17 , 18 , 30 , 31 ].…”

Section: Discussionsupporting

confidence: 93%

“…Pre-existing disorders were observed among 10.2% of the hospitalized children. This finding was consistent with the results of the previous study conducted in Iran [ 17 ]; however, it was much lower than the reported findings by Armin et al [ 18 ]. Comorbidities were a decisive risk factor for ICU admission and COVID-19 mortality.…”

Section: Discussionsupporting

confidence: 92%

“…COVID-19 mortality in paediatric patients ranged from 0% in Norway to 12% in some reports from Latin America [14][15][16]. The previous studies in Iran reported paediatric COVID-19 mortality at 5.3% [17] and 8.2% [18] which were higher than the reported values from high-income and developed countries [19,20]. The previous studies addressed younger ages, comorbidity, and dyspnoea as the significant risk factors for COVID-19 mortality [17,18,21].…”

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confidence: 99%

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In-hospital mortality of COVID-19 in Iranian children and youth: A multi-centre retrospective cohort study

et al. 2022

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Background COVID-19 presents as a mild and less severe respiratory disease among children. However, it is still lethal and could lead to death in paediatric cases. The current study aimed to investigate the clinical characteristics of children and young people hospitalized due to COVID-19 in Qazvin-Iran. We also investigated the risk factors of death due to COVID-19 in paediatric cases. Methods We performed a retrospective cohort study on 645 children and young people (ages 0-17) hospitalized since the beginning of the COVID-19 pandemic. The cases were confirmed with positive results of reverse transcription-polymerase chain reaction (RT-PCR). The data were retrieved from an electronic database of demographic, epidemiological, and clinical characteristics. Results The median age of the admitted patients was 4.0 years, 33.6% were under 12 months old, and 53.0% were female. Fever, cough, nausea/vomiting, dyspnoea, and myalgia were the most common symptoms presented by 50.5%, 47.6%, 24.2%, and 23.0% of the patients, respectively. Overall, we observed 16 cases of death and the in-hospital fatality rate was 2.5%. We also found comorbidity as an independent risk factor of death (odds ratio (OR) = 3.8, 95% confidence interval (CI) = 1.2-12.1, P -value = 0.022). Finally, we observed an increased risk of death in patients with dyspnoea (OR = 11.0, 95% CI = 2.8-43.7). Conclusion In-hospital mortality was relatively high in paediatric patients who were hospitalized due to COVID-19 in Iran. The risk of hospitalization, ICU admission, and death was higher among children with younger ages, underlying causes, and dyspnoea.

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“…Age groups were determined based on the World Health Organization Guideline on “COVID-19 disease in children and adolescents.” 12 The clinical severity was determined using the classification system proposed by Dong et al and summarized in Table 1 . 13 14 15 16 17 The medical records of parents and siblings were investigated and the source of infection was determined as a household contact if the SARS-CoV-2 RT-qPCR test of a household contact was positive within 5 days' of the case.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Alpha Variant (B.1.1.7), Viral Load, and Age on the Clinical Course of Pediatric COVID-19 Patients

Unalan-Altintop

Celep

Milletli-Sezgin

et al. 2022

J Pediatr Infect Dis

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Objective The research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly consists of adult patients, leaving its impact on children understudied. This study aims to investigate the correlations between viral load, clinical course, age, and Alpha variant (B.1.1.7) in children. Methods The study was conducted on children under the age of 18 years, who were admitted to Amasya University Sabuncuoglu Serefeddin Research and Training Hospital in Turkey between February and April 2021. ΔCt values, which were obtained by real-time polymerase chain reaction (PCR), were analyzed to estimate the viral loads of the patients. Alpha variant (B.1.1.7) positivity was determined by real-time PCR. Results There was no difference between estimated viral loads of different clinical courses (p > 0.05), or between asymptomatic and symptomatic patients (p > 0.05). Viral loads were found to decrease with increasing age (p = 0.002). Also, a higher rate of symptomatic disease was found in children under the age of 4 years (p < 0.05). Alpha variant (B.1.1.7) was not found to be associated with severe disease in children (p > 0.05). Conclusion Our results demonstrate higher viral loads and symptomatic disease in children under the age of 4 years. Alpha variant (B.1.1.7) was not found to be related to disease severity. There has not been a consensus on the vaccination of the pediatric population worldwide. More studies are needed to understand the viral kinetics of SARS-CoV-2 and its severity on children to build effective vaccination strategies in children as public health restrictions are eased.

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COVID-19 Mortality in Children: A Referral Center Experience from Iran (Mofid Children’s Hospital, Tehran, Iran)

Cited by 12 publications

References 41 publications

COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study

COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study

In-hospital mortality of COVID-19 in Iranian children and youth: A multi-centre retrospective cohort study

The Impact of Alpha Variant (B.1.1.7), Viral Load, and Age on the Clinical Course of Pediatric COVID-19 Patients

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