What are the risk factors for severe coronavirus disease 2019 (COVID-19) in children?

Updated: Oct 10, 2021
  • Author: Ayesha Mirza, MD; Chief Editor: David J Cennimo, MD, FAAP, FACP, FIDSA, AAHIVS  more...
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According to Shen et al, children with SARS-CoV-2 infection who are at risk for severe disease include those with underlying conditions (eg, congenital heart disease, bronchial pulmonary hypoplasia, respiratory tract anomaly, abnormal hemoglobin level, or severe malnutrition) and those with immune deficiency or immunocompromised status (eg, as a result of long-term immunosuppressant use). [50]  The following conditions indicate a greater likelihood of severe disease:

  • Dyspnea: Respiration rate of >50 breaths/min in children aged 2-12 months; >40 breaths/min in children aged 1-5 years; >30 breaths/min in patients older than 5 years old (after excluding the effects of fever and crying).
  • Persistent high fever for 3-5 days.
  • Poor mental response, lethargy, disturbance of consciousness, and other changes of consciousness.
  • Abnormally increased levels of enzymes, such as myocardial and liver enzymes and lactate dehydrogenase.
  • Unexplained metabolic acidosis.
  • Chest imaging findings indicating bilateral or multi-lobe infiltration, pleural effusion, or rapid progression of conditions during a very brief period.
  • Age younger than 3 months.
  • Extrapulmonary complications.
  • Coinfection with other viruses or bacteria.

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