(27) Pediatric COVID-19 Hospitalizations During the Omicron Surge

Jacqueline Lee, Medical College of Wisconsin, United States; Alexandra Bryant, Medical College of Wisconsin, United States; Rosellen Choi, Medical College of Wisconsin, United States; Melodee Liegl, Medical College of Wisconsin, WI, United States; Amy Pan, Medical College of Wisconsin, United States; Svetlana Melamed, Medical College of Wisconsin, Franklin, WI, United States

Background: National Institute of Health treatment recommendations for children hospitalized with COVID-19 currently include remdesivir and dexamethasone for hypoxia and remdesivir for patients at risk of severe illness, including those with comorbidities. The omicron variant, which peaked in winter 2021-22, caused many otherwise-healthy children without hypoxia to be hospitalized for common viral syndromes like croup.

Objectives: This study aimed to characterize children hospitalized with COVID-19 during the omicron surge and describe their management and clinical trajectory.

Design/Methods: This retrospective study at an academic children’s hospital included patients ≤18 years old with a COVID-19 discharge diagnosis on the Hospital Medicine service January-February 2022. Patients were excluded if COVID-19 diagnosis was incidental (unrelated to the reason for hospitalization). Hypoxia was defined by sustained oxygen saturation < 90%. Primary outcome was return to emergency department (ED) or readmission within 14 days. Secondary outcomes were length of stay (LOS), multisystem inflammatory syndrome within 6 weeks, and death.

Results: Of 111 children hospitalized with COVID-19 during the study timeframe, 35 were excluded due to incidental COVID-19 diagnosis. 76 patients with median age 11.5 months were included (Figure 1). 61% were previously healthy (Table 2). Only 3% of patients were fully vaccinated for COVID-19; 79% were ineligible for vaccination due to age. All hypoxic patients received corticosteroids and remdesivir. 20% of patients were not hypoxic but received corticosteroids for asthma or croup. In addition to hypoxia, reasons for prescribing remdesivir included severity of illness (33%) and patient with complex medical history (24%). Two patients receiving remdesivir developed transaminitis. Eight patients (11%) returned to the ED or were readmitted within 14 days of discharge; 3 of the ED visits were related to ongoing COVID-19 infection (Table 3). Of the 9 patients with croup, 1 received remdesivir due to prolonged illness, and none returned to the ED or were re-admitted (Table 4).

Conclusion: Most children hospitalized with COVID-19 were young, previously healthy and unvaccinated for COVID-19 due to age-based ineligibility. Sustained hypoxia, patient comorbidities and illness severity guided use of COVID-19-specific treatments. Reutilization rates for ongoing COVID-19 infection were low. Patients with croup, a presentation seen more commonly with the omicron variant than previously, appear to do well without COVID-19-specific treatment.