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Nationwide Analysis of the Outcomes and Mortality of Hospitalized Infants with Concomitant Diagnosis of COVID-19Funding P.C. is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; grant no.: R01HD104909).
Objective Coronavirus disease 2019 (COVID-19) generally causes milder illness in the pediatric population. However, infants represent a higher-risk population with evolving symptomatology and severity. There is a paucity of large population-based data on the impact of COVID-19 on hospitalized infants.
Study Design In this large cohort study, the National Inpatient Sample database was queried for all infant hospital admissions between January and December 2020 in the United States, with and without a diagnosis of COVID-19 based on ICD-10-CM U07. The mortality and morbidity of infants with and without COVID-19 were evaluated. Parent-reported race and outcomes were also analyzed.
Results A weighted total of 3,754,236 infants who were hospitalized were identified, of which 4,265 patients (0.11%) had a concomitant diagnosis of COVID-19. Infants with COVID-19 had similar mortality and extracorporeal membrane oxygenation utilization. Infants with concomitant COVID-19 had a higher rate of respiratory failure, congestive heart failure, acute kidney injury, and coagulopathy. Compared with Caucasian infants and Asian infants, Hispanic and African American infants were more likely to have COVID-19 hospital admissions than hospitalizations without COVID-19 diagnosis. Patients with lower median household income represented the majority of the COVID-19 hospitalization. The infants with COVID-19 were more likely to have Medicaid or Medicare insurance and less likely to have private insurance.
Conclusion In this large cohort of hospitalized infants with COVID-19, the infection was associated with complications, including respiratory failure and endotracheal intubations but not associated with a higher risk for mortality. Infants from racial minorities and lower socioeconomic strata carry the highest burden of COVID-19 infection.
Infants with COVID-19 represent a higher-risk group with evolving symptomatology and severity.
Infants with COVID-19 had similar mortality rates and extracorporeal membrane oxygenation utilization as those without COVID-19.
Racial minorities and lower socioeconomic strata carry the highest burden of COVID-19 infection.
This large database analysis explores the outcomes of hospitalized infants with COVID-19 as well as the racial and socioeconomic disparities in the disease burden.
What's Known on This Subject
Infants with COVID-19 represent a vulnerable population with added comorbidities owing to prematurity and respiratory illnesses. The sample size and narrow geographic location limit current data regarding the incidence and impact of COVID-19 in infants.
What This Study Adds
Infants with COVID-19 are at risk for complications such as respiratory failure, heart failure, AKI, and coagulopathy. Infants with BPD were at increased risk for COVID-19 hospitalizations. Infants belonging to ethnic minorities carry a higher burden of COVID-19.
P.K. conceptualized and designed the data collection, drafted the initial manuscript, and critically reviewed and revised the manuscript. A.M. and A.I. conceptualized and designed the study, collected the data, performed the initial analysis, and critically reviewed and revised the manuscript. D.B. and A.G. conceptualized and designed the study, coordinated, and supervised the data collection, and critically reviewed and revised the manuscript. L.P., P.C., and M.S. coordinated and supervised the data collection and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
Received: 16 March 2023
Accepted: 04 August 2023
Accepted Manuscript online:
07 August 2023
Article published online:
08 September 2023
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- 1 De Rose DU, Piersigilli F, Ronchetti MP. et al; Study Group of Neonatal Infectious Diseases of The Italian Society of Neonatology (SIN). Novel coronavirus disease (COVID-19) in newborns and infants: what we know so far. Ital J Pediatr 2020; 46 (01) 56
- 2 Children and COVID-19. State-level data report 2022. Accessed August 08, 2022 at: https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/
- 3 Allotey J, Chatterjee S, Kew T. et al; PregCOV-19 Living Systematic Review Consortium. SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission: living systematic review and meta-analysis. BMJ 2022; 376: e067696
- 4 Blumberg DA, Underwood MA, Hedriana HL, Lakshminrusimha S. Vertical Transmission of SARS-CoV-2: what is the optimal definition?. Am J Perinatol 2020; 37 (08) 769-772
- 5 Kotlyar AM, Grechukhina O, Chen A. et al. Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 224 (01) 35-53.e3
- 6 Rawat M, Chandrasekharan P, Hicar MD, Lakshminrusimha S. COVID-19 in newborns and infants-low risk of severe disease: silver lining or dark cloud?. Am J Perinatol 2020; 37 (08) 845-849
- 7 Pique-Regi R, Romero R, Tarca AL. et al. Does the human placenta express the canonical cell entry mediators for SARS-CoV-2?. eLife 2020; 9: 9
- 8 Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020; 46 (04) 586-590
- 9 Muus C, Luecken MD, Eraslan G. et al; NHLBI LungMap Consortium, Human Cell Atlas Lung Biological Network. Single-cell meta-analysis of SARS-CoV-2 entry genes across tissues and demographics. Nat Med 2021; 27 (03) 546-559
- 10 Patil UP, Krishnan P, Abudinen-Vasquez S, Maru S, Noble L. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive newborns of COVID-19 mothers after dyad-care: a case series. Cureus 2021; 13 (01) e12528
- 11 Patil UP, Maru S, Krishnan P. et al. Newborns of COVID-19 mothers: short-term outcomes of colocating and breastfeeding from the pandemic's epicenter. J Perinatol 2020; 40 (10) 1455-1458
- 12 Smith V, Seo D, Warty R. et al. Maternal and neonatal outcomes associated with COVID-19 infection: a systematic review. PLoS One 2020; 15 (06) e0234187
- 13 Villar J, Ariff S, Gunier RB. et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study. JAMA Pediatr 2021; 175 (08) 817-826
- 14 Hudak ML, Flannery DD, Barnette K. et al; AMERICAN ACADEMY OF PEDIATRICS NPC-19 REGISTRY INVESTIGATORS. Maternal and newborn hospital outcomes of perinatal SARS-CoV-2 infection: a national registry. Pediatrics 2023; 151 (02) e2022059595
- 15 Zeng LK, Zhu HP, Xiao TT. et al. Short-term developmental outcomes in neonates born to mothers with COVID-19 from Wuhan, China. World J Pediatr 2021; 17 (03) 253-262
- 16 Lim KH, Soong FSJ, Low YF, Goh XL, Amin Z, Ng YPM. Clinical features and outcomes of neonatal COVID-19: a systematic review. J Clin Virol 2021; 139: 104819
- 17 Trevisanuto D, Cavallin F, Cavicchiolo ME, Borellini M, Calgaro S, Baraldi E. Coronavirus infection in neonates: a systematic review. Arch Dis Child Fetal Neonatal Ed 2021; 106 (03) 330-335
- 18 Hajra A, Malik A, Bandyopadhyay D. et al. Impact of COVID-19 in patients hospitalized with stress cardiomyopathy: a nationwide analysis. Prog Cardiovasc Dis 2023; 76: 25-30
- 19 Kadri SS, Gundrum J, Warner S. et al. Uptake and accuracy of the diagnosis code for COVID-19 among US hospitalizations. JAMA 2020; 324 (24) 2553-2554
- 20 Isath A, Malik AH, Goel A, Gupta R, Shrivastav R, Bandyopadhyay D. Nationwide analysis of the outcomes and mortality of hospitalized COVID-19 patients. Curr Probl Cardiol 2023; 48 (02) 101440
- 21 Isath A, Malik A, Bandyopadhyay D. et al. COVID-19, heart failure hospitalizations, and outcomes: a nationwide analysis. Curr Probl Cardiol 2023; 48 (04) 101541
- 22 Goel A, Malik AH, Bandyopadhyay D. et al. Impact of COVID-19 on outcomes of patients hospitalized with STEMI: a nationwide propensity-matched analysis. Curr Probl Cardiol 2023; 48 (04) 101547
- 23 HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality. Accessed February 3, 2023 at: https://hcup-us.ahrq.gov/nisoverview.jsp
- 24 Devin J, Marano R, Mikhael M, Feaster W, Sanger T, Ehwerhemuepha L. Epidemiology of neonatal COVID-19 in the United States. Pediatrics 2022; 150 (04) e2022056297
- 25 Mullins E, Hudak ML, Banerjee J. et al; PAN-COVID investigators and the National Perinatal COVID-19 Registry Study Group. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol 2021; 57 (04) 573-581
- 26 Lakshminrusimha S, Hudak ML, Dimitriades VR, Higgins RD. Multisystem inflammatory syndrome in neonates following maternal SARS-CoV-2 COVID-19 infection. Am J Perinatol 2022; 39 (11) 1166-1171
- 27 García-Salido A, de Carlos Vicente JC, Belda Hofheinz S. et al; Spanish Pediatric Intensive Care Society working group on SARS-CoV-2 infection. Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain. Crit Care 2020; 24 (01) 666
- 28 Lu X, Zhang L, Du H. et al; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 infection in children. N Engl J Med 2020; 382 (17) 1663-1665
- 29 Boyce TG, Mellen BG, Mitchel Jr EF, Wright PF, Griffin MR. Rates of hospitalization for respiratory syncytial virus infection among children in Medicaid. J Pediatr 2000; 137 (06) 865-870
- 30 Prochaska E, Jang M, Burd I. COVID-19 in pregnancy: placental and neonatal involvement. Am J Reprod Immunol 2020; 84 (05) e13306
- 31 Abedi V, Olulana O, Avula V. et al. Racial, economic, and health inequality and COVID-19 infection in the United States. J Racial Ethn Health Disparities 2021; 8 (03) 732-742
- 32 Williamson EJ, Walker AJ, Bhaskaran K. et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020; 584 (7821) 430-436
- 33 Bailey LC, Razzaghi H, Burrows EK. et al. Assessment of 135 794 pediatric patients tested for severe acute respiratory syndrome coronavirus 2 across the United States. JAMA Pediatr 2021; 175 (02) 176-184
- 34 Saatci D, Ranger TA, Garriga C. et al. Association between race and COVID-19 outcomes among 2.6 million children in England. JAMA Pediatr 2021; 175 (09) 928-938
- 35 Park S, Lee Y, Michelow IC, Choe YJ. Global seasonality of human coronaviruses: a systematic review. Open Forum Infect Dis 2020; 7 (11) ofaa443
- 36 Dowell SF. Seasonal variation in host susceptibility and cycles of certain infectious diseases. Emerg Infect Dis 2001; 7 (03) 369-374