Characteristics and Outcomes of 728,047 Children in the National COVID Cohort Collaborative (N3C)
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Worldwide Data, Infection, Pediatrics, 2022
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INTRODUCTION: SARS-CoV-2 can cause severe pediatric disease via acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C). We sought to determine the characteristics, changes over time, outcomes, and severity risk factors of SARS-CoV-2 infected children within the National COVID Cohort Collaborative (N3C). 
METHODS: We performed an analysis of an EHR-based registry of children < 19-years-old at initial SARS-CoV-2 testing at 45 N3C institutions with encounter end dates before 5/27/2021. Outcomes included case incidence and severity over time, risk factors for higher severity disease, vital sign and lab trajectories, clinical outcomes, and acute COVID-19 vs. MIS-C differences for children with SARS-CoV-2.
RESULTS: 728,047 children were tested for SARS-CoV-2 and 91,865 (12.6%) were positive. Of 5,213 (6%) hospitalized children, 685 (13%) met criteria for severe disease: invasive ventilation (7%), vasoactive-inotropic support (7%), ECMO (0.6%), or death/discharge to hospice (1.1%). Male sex, African American race, older age, and most pediatric complex chronic condition (PCCC) categories were associated with higher peak clinical severity (p≤0.05). Vital signs (all p≤0.002) and many lab tests from the day of hospital admission were predictive of peak disease severity. Children with severe (vs. moderate) disease were more likely to be treated with antimicrobial (71% vs. 32%, p < 0.001) and immunomodulatory (53% vs. 16%, p < 0.001) medications. Compared to children with acute COVID-19, those with MIS-C were more likely to be male, African American, 1-to-12-years-old, and less likely to have asthma, diabetes, or a PCCC (p0.04). Children with MIS-C demonstrated a more inflammatory lab profile and severe clinical phenotype with higher rates of invasive ventilation (12% vs. 6%) and vasoactive-inotropic support (31% vs. 6%) compared to those with acute COVID-19, respectively (p < 0.03).
CONCLUSIONS: In the largest U.S. SARS-CoV-2-positive pediatric cohort to date, we identified differences in demographics, comorbidities, and initial vital sign and laboratory values between severity subgroups, indicating that early identification of children likely to progress to severe disease might be feasible using readily available data from the day of admission. Further work is needed to translate this knowledge into improved outcomes.
Meta Tag
Content Type Presentation
Knowledge Area Infection
Knowledge Area Pediatrics
Knowledge Area Worldwide Data
Knowledge Level Advanced
Membership Level Select
Tag Epidemiology Outcomes
Tag Pediatrics
Tag COVID-19
Tag Infectious Diseases
Year 2022
National COVID Cohort Collaborative
severe disease
risk factors


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