Importance: SARS-CoV-2 Objective: To determine the characteristics, changes over time, outcomes, and severity risk factors of SARS-CoV-2 affected children within the National COVID Cohort Collaborative (N3C) Design: Prospective cohort study of encounters with end dates before May 27th, 2021. Setting: 45 N3C institutions Participants: Children < 19-years-old at initial SARS-CoV-2 testing Main Outcomes and Measures: Case incidence and severity over time, demographic and comorbidity severity risk factors, vital sign and laboratory trajectories, clinical outcomes, and acute COVID-19 vs MIS-C contrasts for children infected with SARS-CoV-2. Results: 728,047 children in the N3C were tested for SARS-CoV-2; of these, 91,865 (12.6%) were positive. Among the 5,213 (6%) hospitalized children, 685 (13%) met criteria for severe disease: mechanical ventilation (7%), vasopressor/inotropic support (7%), ECMO (0.6%), or death/discharge to hospice (1.1%). Male gender, African American race, older age, and several pediatric complex chronic condition (PCCC) subcategories were associated with higher clinical severity (p ≤ 0.05). Vital signs (all p ≤ 0.002) and many laboratory tests from the first day of hospitalization were predictive of peak disease severity. Children with severe (vs moderate) disease were more likely to receive antimicrobials (71% vs 32%, p < 0.001) and immunomodulatory medications (53% vs 16%, p < 0.001). Compared to those with acute COVID-19, children with MIS-C were more likely to be male, Black/African American, 1-to-12-years-old, and less likely to have asthma, diabetes, or a PCCC (p < 0.04). MIS-C cases demonstrated a more inflammatory laboratory profile and more severe clinical phenotype with higher rates of invasive ventilation (12% vs 6%) and need for vasoactive-inotropic support (31% vs 6%) compared to acute COVID-19 cases, respectively (p <0.03). Conclusions: In the largest U.S. SARS-CoV-2-positive pediatric cohort to date, we observed differences in demographics, pre-existing comorbidities, and initial vital sign and laboratory test values between severity subgroups. Taken together, these results suggest that early identification of children likely to progress to severe disease could be achieved using readily available data elements from the day of admission. Further work is needed to translate this knowledge into improved outcomes.

中文翻译：

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国家 COVID 队列协作 (N3C) 中的 SARS-CoV-2 儿童

重要性：SARS-CoV-2 目的：确定国家 COVID 队列协作 (N3C) 设计中受 SARS-CoV-2 影响的儿童的特征、随时间的变化、结果和严重风险因素日期在 2021 年 5 月 27 日之前。 地点：45 家 N3C 机构 参与者：最初 SARS-CoV-2 检测时年龄小于 19 岁的儿童 主要结果和措施：病例发生率和严重程度随时间变化、人口统计和合并症严重性风险因素、生命体征感染 SARS-CoV-2 的儿童的实验室轨迹、临床结果和急性 COVID-19 与 MIS-C 对比。结果：N3C 的 728,047 名儿童接受了 SARS-CoV-2 检测；其中，91,865 (12.6%) 人呈阳性。在 5,213 (6%) 名住院儿童中，685 (13%) 名符合严重疾病标准：机械通气 (7%)、升压药/正性肌力支持 (7%)、ECMO (0.6%) 或死亡/出院到临终关怀 (1.1%)。男性、非洲裔美国人、年龄较大和一些儿科复杂慢性病 (PCCC) 亚类与较高的临床严重程度相关 (p ≤ 0.05)。从住院第一天开始，生命体征（所有 p ≤ 0.002）和许多实验室检查都可以预测疾病的严重程度。患有重度（相对于中度）疾病的儿童更有可能接受抗菌药物治疗（71% vs 32%，p < 0.001）和免疫调节药物（53% vs 16%，p < 0.001）。与患有急性 COVID-19 的儿童相比，患有 MIS-C 的儿童更有可能是 1 至 12 岁的男性、黑人/非裔美国人，并且不太可能患有哮喘、糖尿病或 PCCC（p < 0.04)。与急性 COVID-19 病例相比，MIS-C 病例显示出更多的炎症实验室特征和更严重的临床表型，具有更高的有创通气率（12% 对 6%）和需要血管活性正性肌力支持（31% 对 6%），分别（p <0.03）。结论：在迄今为止最大的美国 SARS-CoV-2 阳性儿科队列中，我们观察到严重程度亚组之间的人口统计学、预先存在的合并症以及初始生命体征和实验室测试值的差异。总之，这些结果表明，使用入院当天现成的数据元素，可以早期识别可能发展为严重疾病的儿童。需要进一步的工作将这些知识转化为改进的结果。