Indications for Hospitalization in Children with SARS-CoV-2 Infection during the Omicron Wave in New York City

Abstract

The emergence of the Omicron variant was accompanied by an acute increase in COVID-19 cases and hospitalizations in New York City. An increased incidence of COVID-19-associated croup in children during the Omicron wave has been recognized, suggesting that there may be other changes in clinical symptoms and severity. To better understand clinical outcomes and health care utilization in children infected with SARS-CoV-2 during the Omicron wave, we performed a cross-sectional study in pediatric patients aged ≤18 years who were tested for SARS-CoV-2 in pediatric emergency departments within a large medical system in New York City from 2 December 2021 to 23 January 2022. We described the clinical characteristics and outcomes of pediatric patients who presented to the pediatric emergency department and were hospitalized with SARS-CoV-2 infection during the Omicron wave in New York City. There were 2515 children tested in the ED for SARS-CoV-2 of whom 794 (31.6%) tested positive. Fifty-eight children were hospitalized for a COVID-19-related indication, representing 7.3% of all COVID-19-positive children and 72% of hospitalized COVID-19-positive children. Most (64%) children hospitalized for a COVID-19-related indication were less than 5 years old. Indications for hospitalization included respiratory symptoms, clinical monitoring of patients with comorbid conditions, and exacerbations of underlying disease. Eleven (19%) hospitalized children were admitted to the ICU and six (10%) required mechanical ventilation. Children infected with COVID-19 during the Omicron wave, particularly those less than 5 years old, were at risk for hospitalization. A majority of hospitalizations were directly related to COVID-19 infection although clinical indications varied with less than a half being admitted for respiratory diseases including croup. Our findings underscore the need for an effective COVID-19 vaccine in those less than 5 years old, continued monitoring for changes in clinical outcomes and health care utilization in children as more SARS-CoV-2 variants emerge, and understanding that children are often admitted for non-respiratory diseases with COVID-19.

Burden of Pediatric SARS-CoV-2 Hospitalizations during the Omicron Wave in Germany

“…In addition, 26% (N = 1591) of children and adolescents with confirmed SARS-CoV-2 infections were admitted for reasons unrelated to this infection ( Figure 1 D). Other studies have had similar findings regarding incidentally positively tested patients [ 7 ]. For this reason, cases falling into this category should be excluded from analysis when evaluating the SARS-CoV-2-related burden on hospital systems.…”

The diversity in the clinical features of children hospitalized with COVID‐19 during the nonvariant, Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron (B.1.1.529) variant periods of SARS CoV‐2: Caution for neurological symptoms in Omicron variant

“…Our results were in line with research from the United States, the United Kingdom, and Germany that found a higher percentage of newborns and young children hospitalized with COVID‐19 during the Omicron wave 7–10 . A similar observation was also emphasized in studies in different regions 11–14 . Possible reasons for the increase in hospitalizations in this group may be the increase in the total number of cases due to the higher transmission rate of the Omicron variant and the relaxation of restrictive measures.…”

Burden of Pediatric SARS-CoV-2 Hospitalizations during the Omicron Wave in Germany

“…In addition, 26% (N=1,591) of children and adolescents with confirmed SARS-CoV-2 infections were admitted for reasons unrelated to this infection (Figure 1D). Other studies have had similar findings regarding incidentally-positive tested patients [7]. For this reason, cases falling into this category should be excluded from analysis when evaluating the SARS-CoV-2-related burden on hospital systems.…”