Infection is associated with one in five childhood deaths in England and Wales: analysis of national death registrations data, 2013–15

Ferreras-Antolín, Laura; Oligbu, Godwin; Okike, Ifeanyichukwu; Ladhani, Shamez

doi:10.1136/archdischild-2019-318001

Cited by 17 publications

(10 citation statements)

References 15 publications

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“…Consequently, children with a positive SARS-CoV-2 test who die of other causes and those who succumb to their underlying conditions will be included in those figures. More recently, death registrations with mention of SARS-CoV-2/COVID-19 are routinely reported by the UK Office for National Statistics (ONS)[ 18 ] but, as we and others have previously reported, these too are limited by the information available on the death certificate, making it difficult to assess the contribution of SARS-CoV-2 infection to death [ 19 , 20 ]. During the first 12 months of the pandemic, for example, only 40% of deaths in CYP with confirmed infection in England were due to COVID-19 [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…Most children had meningitis or sepsis reflecting the success of our recruitment through our charity partner Meningitis Now. Health professionals (female n = 9, male 5) worked in General Practice [ 5 ], Emergency Care [ 5 ], Ambulance Service [ 2 ] and ‘Other’ health services [ 4 ]. Age range; between 21–29 and 50–59 years.…”

Section: Resultsmentioning

confidence: 99%

“…Globally, infection remains the leading cause of child mortality [ 1 ]. The most recent analysis of child mortality data (from 2013–15) in England and Wales found that infection was associated with 20% of all childhood deaths [ 2 ]. Child Death Reviews (CDR), which aim to identify modifiable factors in any child’s death, are reported by Local Safeguarding Children’s Boards and have been collated into annual reports for England by NHS Digital since 2018 and previously by the Department for Education [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Navigating uncertain illness trajectories for young children with serious infectious illness: a modified grounded theory study

Neill

Bray

Carter

et al. 2022

BMC Health Serv Res

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Background Infectious illness is the biggest cause of death in children due to a physical illness, particularly in children under five years. If mortality is to be reduced for this group of children, it is important to understand factors affecting their pathways to hospital. The aim of this study was to retrospectively identify organisational and environmental factors, and individual child, family, and professional factors affecting timing of admission to hospital for children under five years of age with a serious infectious illness (SII). Methods An explanatory modified grounded theory design was used in collaboration with parents. Two stages of data collection were conducted: Stage 1, interviews with 22 parents whose child had recently been hospitalised with a SII and 14 health professionals (HPs) involved in their pre-admission trajectories; Stage 2, focus groups with 18 parents and 16 HPs with past experience of SII in young children. Constant comparative analysis generated the explanatory theory. Results The core category was ‘navigating uncertain illness trajectories for young children with serious infectious illness’. Uncertainty was prevalent throughout the parents’ and HPs’ stories about their experiences of navigating social rules and overburdened health services for these children. The complexity of and lack of continuity within services, family lives, social expectations and hierarchies provided the context and conditions for children’s, often complex, illness trajectories. Parents reported powerlessness and perceived criticism leading to delayed help-seeking. Importantly, parents and professionals missed symptoms of serious illness. Risk averse services were found to refer more children to emergency departments. Conclusions Parents and professionals have difficulties recognising signs of SII in young children and can feel socially constrained from seeking help. The increased burden on services has made it more difficult for professionals to spot the seriously ill child.

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“…When research does include children with comorbidities, it usually focuses on specific types of comorbidities, such as febrile neutropenia [ 14 ]. The most compelling evidence that shows how children with comorbidities form a very fragile population comes from a recent key paper, showing half of the infection-related deaths in the UK occur in children with comorbidities [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Febrile children with comorbidities at the emergency department — a multicentre observational study

et al. 2022

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We aimed to describe characteristics and management of children with comorbidities attending European emergency departments (EDs) with fever. MOFICHE (Management and Outcome of Fever in children in Europe) is a prospective multicentre study (12 European EDs, 8 countries). Febrile children with comorbidities were compared to those without in terms of patient characteristics, markers of disease severity, management, and diagnosis. Comorbidity was defined as a chronic underlying condition that is expected to last > 1 year. We performed multivariable logistic regression analysis, displaying adjusted odds ratios (aOR), adjusting for patient characteristics. We included 38,110 patients, of whom 5906 (16%) had comorbidities. Most common comorbidities were pulmonary, neurologic, or prematurity. Patients with comorbidities more often were ill appearing (20 versus 16%, p < 0.001), had an ED-Paediatric Early Warning Score of > 15 (22 versus 12%, p < 0.001), or a C-reactive protein > 60 mg/l (aOR 1.4 (95%CI 1.3–1.6)). They more often required life-saving interventions (aOR 2.7, 95% CI 2.2–3.3), were treated with intravenous antibiotics (aOR 2.3, 95%CI 2.1–2.5), and were admitted to the ward (aOR 2.2, 95%CI 2.1–2.4) or paediatric intensive care unit (PICU) (aOR 5.5, 95% CI 3.8–7.9). They were more often diagnosed with serious bacterial infections (aOR 1.8, 95%CI 1.7–2.0), including sepsis/meningitis (aOR 4.6, 95%CI 3.2–6.7). Children most at risk for sepsis/meningitis were children with malignancy/immunodeficiency (aOR 14.5, 8.5–24.8), while children with psychomotor delay/neurological disease were most at risk for life-saving interventions (aOR 5.3, 4.1–6.9) or PICU admission (aOR 9.7, 6.1–15.5).Conclusions: Our data show how children with comorbidities are a population at risk, as they more often are diagnosed with bacterial infections and more often require PICU admission and life-saving interventions. What is Known:• While children with comorbidity constitute a large part of ED frequent flyers, they are often excluded from studies. What is New:• Children with comorbidities in general are more ill upon presentation than children without comorbidities.• Children with comorbidities form a heterogeneous group; specific subgroups have an increased risk for invasive bacterial infections, while others have an increased risk of invasive interventions such as PICU admission, regardless of the cause of the fever.

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Infection is associated with one in five childhood deaths in England and Wales: analysis of national death registrations data, 2013–15

Cited by 17 publications

References 15 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

Navigating uncertain illness trajectories for young children with serious infectious illness: a modified grounded theory study

Febrile children with comorbidities at the emergency department — a multicentre observational study

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