Hospitalization for COVID-19 and Risk Factors for Severe Disease Among Children: 2022-2024

Objectives We assessed characteristics associated with pediatric COVID-19 hospitalizations and risk factors for severe disease among hospitalized children ≥6 months. METHODS Using data from COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) during October 1, 2022-April 30, 2024, we described demographic characteristics, underlying medical conditions, COVID-19 vaccination status, and clinical outcomes, including severe disease (ICU admission, mechanical ventilation, extracorporeal membrane oxygenation, in-hospital death), of hospitalized children 6 months-17 years residing in the COVID-NET catchment area with laboratory-confirmed SARS-CoV-2 infection. Multivariable log-linked Poisson generalized estimating equations were conducted to assess risk factors for severe disease among children 6-23 months and 2-17 years. RESULTS Of 2,490 children hospitalized for COVID-19, 1114 (44.7%) were 6-23 months; 1358 (54.1%) were male. Overall, 1464 (58.9%) had ≥1 underlying conditions: 471 (41.8%) of children 6-23 months, 290 (61.6%) 2-4 years, 383 (79.2%) 5-11 years, and 320 (77.0%) 12-17 years. 100 (3.8%) were up-to-date with recommended COVID-19 vaccination. Among children 6-23 months, severe disease was associated with underlying chronic lung (adjusted risk ratio [aRR] 1.5, 95% CI: 1.2-1.8) and cardiovascular disease (aRR: 1.4, 95% CI: 1.1-1.7). Among children ≥2 years, severity was associated with chronic lung disease (aRR: 1.9, 95% CI: 1.5-2.3), diabetes (aRR: 1.5, 95% CI: 1.2-1.8), and neurologic disorders (aRR: 1.4, 95% CI: 1.2-1.6). CONCLUSION Most hospitalized children ≥6 months had ≥1 underlying conditions and <5% were up-to-date with COVID-19 vaccination. Specific conditions were associated with increased risk of severe illness. Increasing COVID-19 vaccination, particularly among children with high-risk conditions, may reduce pediatric COVID-19 hospitalizations and severe outcomes.