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

Abstract

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.

In-hospital and long-term all-cause mortality in 75 years and older hospitalized patients with and without COVID-19

“…The comparatively high (36%) in-hospital mortality rate among older patients with COVID-19 confirms that frailty is a key prognostic factor for a poor COVID-19 outcome. As a confirmation of this, a recent work reported that since the beginning of the COVID-19 pandemic the in-hospital mortality rate among 645 Asiatic children and young people (ages 0-17) was 2.5% 17 .…”

COVID-19 among infants: key clinical features and remaining controversies

“…The frequency of all-cause mortality may be higher when maternal infection occurs much closer to delivery [ 110 ]. Another study found no difference in mortality between nonsevere (0%) versus severe (0.96%) disease among infants admitted to the hospital.10) Comorbidities may be associated with mortality, but it must also be considered that, in the face of congenital anomalies and other significant comorbidities, the cause of death may not always be truly ascribed to SARS-CoV-2 [ 23 , 32 , 111 ]. Deaths among children with MIS-C or MIS-N presentations have been published [ 9 , 46 , 49 , 112 , 113 ].…”

“…Regardless of the limitations of existing analyses, several themes have emerged. Among children with COVID-19, some 20%–35% are <1 year of age [ 10 , 12 , 78 , 111 , 128 , 129 ]. The rate of hospital admission may be higher for younger infected patients [ 11 , 128 , 130 ].…”

“…In contrast, in Scottish registries, there was no evidence of increased infection at a younger age; indeed, infants <1 month of age had among the lowest infection frequencies [ 106 , 130 ]. Some researchers found that age was not an independent risk factor for medical attention, hospital admission, or intensive care requirement after infection [ 6 , 41 , 111 ]. For infants <1 month or <1 year, more illnesses were non-severe than severe [ 10 , 41 ].…”

“…110) Another study found no difference in mortality between nonsevere (0%) versus severe (0.96%) disease among infants admitted to the hospital.10) Comorbidities may be associated with mortality, but it must also be considered that, in the face of congenital ano malies and other significant comorbidities, the cause of death may not always be truly ascribed to SARS-CoV-2. 23,32,111) Deaths among children with MIS-C or MIS-N presentations have been published. 9,46,49,112,113) Autopsy studies of deceased infants are meager, and most accumulation of COVID-19-related autopsy information stems from the findings among deceased adults.…”