University of Wisconsin–Madison Medical College of Wisconsin

Pediatric COVID-19 Hospitalizations During the Omicron Surge

Svetlana Melamed, MD; Jacqueline Lee, MD; Alexandra Bryant, MD, MPH; Rosellen Choi, MD; Melodee Liegl, MA; Amy Pan, PhD

WMJ. 2023;122(5):342-345

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Background: Treatment recommendations for children hospitalized with COVID-19 during the winter 2021-2022 omicron variant surge included remdesivir and dexamethasone for hypoxia and remdesivir for patients at risk of severe illness, including those with comorbidities. The omicron variant caused many otherwise-healthy children without hypoxia to be hospitalized for common viral syndromes like croup. This study aimed to characterize children hospitalized with COVID-19 during the omicron surge and describe their management and clinical trajectory.

Methods: This single-center retrospective study included patients under 19 years old with a COVID-19 discharge diagnosis on the Pediatric Hospital Medicine service in January and February 2022. Hypoxia was defined by sustained oxygen saturation greater than 90%. Primary outcome was return to emergency department or readmission within 14 days. Secondary outcomes were length of stay, multisystem inflammatory syndrome within 6 weeks, and death.

Results: During the study time frame, 111 children were hospitalized with COVID-19, including 35 who had an incidental COVID-19 result. In the remaining 76 patients, the median length of stay was 1.9 days (1.0 – 3.3). Eight patients (11%) returned to the emergency department or were readmitted within 14 days of discharge; 3 of the emergency department visits were related to ongoing COVID-19 infection. Of the 10 patients with croup, 1 received remdesivir due to prolonged illness, and none returned to the emergency department or were readmitted.

Discussion: Most children hospitalized with COVID-19 were young, previously healthy and unvaccinated for COVID-19 due to age-based ineligibility. Hypoxia was the most common indication for use of remdesivir/corticosteroids (25%). Return to the emergency department for ongoing COVID-19 symptoms was uncommon (4%). Patients with croup, a presentation seen more commonly with the omicron variant than previously, appeared to do well without remdesivir.

Author Affiliations: Children’s Minnesota, Section of Hospital Medicine, Minneapolis, Minnesota (Melamed); Children’s Health of Orange County, Orange, California (Lee); Medical College of Wisconsin, Milwaukee, Wisconsin (Bryant, Choi, Liegl, Pan).
Corresponding Author: Svetlana Melamed, MD, Children’s Minnesota, Section of Hospital Medicine, 2525 Chicago Ave, Minneapolis, MN 55404; phone 612.813.6000; email; ORCID ID 0009-0006-1660-8426
Funding/Support: None declared.
Financial Disclosures: None declared.
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