Clinical characteristics and factors associated with severe COVID-19 among hospitalized pediatric patients: a retrospective cohort study in the Chaoshan region of China
BackgroundSince 2019, COVID-19 has substantially impacted global public health. Although pediatric cases generally manifest with mild symptoms, severe and even fatal outcomes have occurred. Despite the decreased viral transmissibility and pathogenicity observed in the post-pandemic era, identifying...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2025.1627428/full |
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| author | Xianyao Wang Ruiling Ma Ruiling Ma Wenshan Zhong Haipeng Lin Hachao Zhou Zhiwei Xiao Shaofen Lin Yutao Guo Xufeng Zheng Mingxiang Lin |
| author_facet | Xianyao Wang Ruiling Ma Ruiling Ma Wenshan Zhong Haipeng Lin Hachao Zhou Zhiwei Xiao Shaofen Lin Yutao Guo Xufeng Zheng Mingxiang Lin |
| author_sort | Xianyao Wang |
| collection | DOAJ |
| description | BackgroundSince 2019, COVID-19 has substantially impacted global public health. Although pediatric cases generally manifest with mild symptoms, severe and even fatal outcomes have occurred. Despite the decreased viral transmissibility and pathogenicity observed in the post-pandemic era, identifying early clinical indicators for severe pediatric COVID-19 remains crucial.MethodA retrospective cohort study analyzed 287 hospitalized pediatric COVID-19 patients admitted from December 2022 to August 2023. Clinical and laboratory data were compared between severe/critical and mild/moderate groups using univariable and multivariable analyses.ResultsAmong hospitalized patients, 82.2% were under 3 years, and severe or critical illness occurred in 32.8%. Fatigue (OR = 2.505, 95% CI: 1.359–4.615, P = 0.003) and hoarseness (OR = 2.781, 95% CI: 1.188–6.510, P = 0.018) were independent predictors of severity in multivariable analysis. In univariable analysis, elevated white blood cell counts, neutrophil percentage, procalcitonin (PCT), and reduced bicarbonate (CO₂) levels were also significantly associated with severe disease. All deaths (n = 3) involved children aged 1–1.5 years with acute necrotizing encephalopathy (ANE), two of whom also met diagnostic criteria for multisystem inflammatory syndrome in children (MIS-C).ConclusionPediatric COVID-19 hospitalizations predominantly involved children under 3 years of age. Fatigue was independently associated with severe or critical illness, potentially indicating early neurological involvement. Hoarseness was frequently observed in severe cases. Based on our cohort, particular attention may be warranted for children aged 1–1.5 years presenting with neurological symptoms, as all fatal cases (n = 3) in this age group were associated with acute necrotizing encephalopathy (ANE), and two were additionally complicated by multisystem inflammatory syndrome in children (MIS-C). |
| format | Article |
| id | doaj-art-376f672ed8bb47f9bbb5d9882dde5001 |
| institution | Kabale University |
| issn | 2296-2360 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj-art-376f672ed8bb47f9bbb5d9882dde50012025-08-21T05:27:21ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602025-08-011310.3389/fped.2025.16274281627428Clinical characteristics and factors associated with severe COVID-19 among hospitalized pediatric patients: a retrospective cohort study in the Chaoshan region of ChinaXianyao Wang0Ruiling Ma1Ruiling Ma2Wenshan Zhong3Haipeng Lin4Hachao Zhou5Zhiwei Xiao6Shaofen Lin7Yutao Guo8Xufeng Zheng9Mingxiang Lin10Department of Pediatrics, Shantou Central Hospital, Shantou, Guangdong, ChinaDepartment of Pediatrics, Shantou Central Hospital, Shantou, Guangdong, ChinaShantou University Medical College, Shantou, Guangdong, ChinaDepartment of Pediatrics, Shantou Central Hospital, Shantou, Guangdong, ChinaDepartment of Pediatrics, Shantou Central Hospital, Shantou, Guangdong, ChinaDepartment of Pediatrics, Shantou Central Hospital, Shantou, Guangdong, ChinaDepartment of Pediatrics, Shantou Central Hospital, Shantou, Guangdong, ChinaDepartment of Pediatrics, Shantou Central Hospital, Shantou, Guangdong, ChinaDepartment of Pediatrics, Shantou Central Hospital, Shantou, Guangdong, ChinaDepartment of Radiology, Shantou Central Hospital, Shantou, Guangdong, ChinaDepartment of Pediatrics, Shantou Central Hospital, Shantou, Guangdong, ChinaBackgroundSince 2019, COVID-19 has substantially impacted global public health. Although pediatric cases generally manifest with mild symptoms, severe and even fatal outcomes have occurred. Despite the decreased viral transmissibility and pathogenicity observed in the post-pandemic era, identifying early clinical indicators for severe pediatric COVID-19 remains crucial.MethodA retrospective cohort study analyzed 287 hospitalized pediatric COVID-19 patients admitted from December 2022 to August 2023. Clinical and laboratory data were compared between severe/critical and mild/moderate groups using univariable and multivariable analyses.ResultsAmong hospitalized patients, 82.2% were under 3 years, and severe or critical illness occurred in 32.8%. Fatigue (OR = 2.505, 95% CI: 1.359–4.615, P = 0.003) and hoarseness (OR = 2.781, 95% CI: 1.188–6.510, P = 0.018) were independent predictors of severity in multivariable analysis. In univariable analysis, elevated white blood cell counts, neutrophil percentage, procalcitonin (PCT), and reduced bicarbonate (CO₂) levels were also significantly associated with severe disease. All deaths (n = 3) involved children aged 1–1.5 years with acute necrotizing encephalopathy (ANE), two of whom also met diagnostic criteria for multisystem inflammatory syndrome in children (MIS-C).ConclusionPediatric COVID-19 hospitalizations predominantly involved children under 3 years of age. Fatigue was independently associated with severe or critical illness, potentially indicating early neurological involvement. Hoarseness was frequently observed in severe cases. Based on our cohort, particular attention may be warranted for children aged 1–1.5 years presenting with neurological symptoms, as all fatal cases (n = 3) in this age group were associated with acute necrotizing encephalopathy (ANE), and two were additionally complicated by multisystem inflammatory syndrome in children (MIS-C).https://www.frontiersin.org/articles/10.3389/fped.2025.1627428/fullSARS-CoV-2COVID-19hospitalized childrensevere diseaseneurological involvementacute necrotizing encephalitis (ANE) |
| spellingShingle | Xianyao Wang Ruiling Ma Ruiling Ma Wenshan Zhong Haipeng Lin Hachao Zhou Zhiwei Xiao Shaofen Lin Yutao Guo Xufeng Zheng Mingxiang Lin Clinical characteristics and factors associated with severe COVID-19 among hospitalized pediatric patients: a retrospective cohort study in the Chaoshan region of China Frontiers in Pediatrics SARS-CoV-2 COVID-19 hospitalized children severe disease neurological involvement acute necrotizing encephalitis (ANE) |
| title | Clinical characteristics and factors associated with severe COVID-19 among hospitalized pediatric patients: a retrospective cohort study in the Chaoshan region of China |
| title_full | Clinical characteristics and factors associated with severe COVID-19 among hospitalized pediatric patients: a retrospective cohort study in the Chaoshan region of China |
| title_fullStr | Clinical characteristics and factors associated with severe COVID-19 among hospitalized pediatric patients: a retrospective cohort study in the Chaoshan region of China |
| title_full_unstemmed | Clinical characteristics and factors associated with severe COVID-19 among hospitalized pediatric patients: a retrospective cohort study in the Chaoshan region of China |
| title_short | Clinical characteristics and factors associated with severe COVID-19 among hospitalized pediatric patients: a retrospective cohort study in the Chaoshan region of China |
| title_sort | clinical characteristics and factors associated with severe covid 19 among hospitalized pediatric patients a retrospective cohort study in the chaoshan region of china |
| topic | SARS-CoV-2 COVID-19 hospitalized children severe disease neurological involvement acute necrotizing encephalitis (ANE) |
| url | https://www.frontiersin.org/articles/10.3389/fped.2025.1627428/full |
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