If a child is infected with the new coronavirus, having obesity appears to greatly raise the odds for developing a severe form of COVID-19, according to a report was based on 50 cases of paediatric COVID-19 severe enough to require admission to a New York City hospital.
Obesity has long been noted as a risk factor for adults with COVID-19, "so it was interesting that many of the hospitalized patients in this study had obesity and/or overweight," said researchers led by Dr Philip Zachariah, a paediatrician at Columbia University Irving Medical Center in New York City. They published their findings, ‘Multisystem Inflammatory Syndrome Related to COVID-19 in Previously Healthy Children and Adolescents in New York City’, in the journal JAMA Pediatrics.
In the study, Zachariah's group looked at the medical records of 50 children and adolescents who were first tested for COVID-19 in March and the first two weeks of April. Of the 50 children (under the age of 21), eleven (22%) of the 50 children had obesity and six of the nine children who required a ventilator also had obesity, the study found. None of the 50 children developed a dangerous inflammatory illness, similar to Kawasaki disease, which has been seen in rare cases among other children infected with the new coronavirus.
"We found even higher rates of obesity in the kids that were really sick," said Dr Charles Schleien, pediatrician-in-chief at Northwell Health in New Hyde Park, N.Y. "This actually is not unlike the adults, where obesity also played a key role in the severity of disease if you contracted the virus."
Older children - averaging 14 years of age - were more likely to develop severe COVID-19, the study found. Among severe cases, cough, shortness of breath and fever were very common, and nearly half (44%) of cases involved gastrointestinal symptoms, as well.
For most of the young patients treated in the hospital, the course of severe illness was not long—76% were discharged within three days of being admitted. But a third required some form of respiratory support, including nine being placed on a ventilator, the Columbia team said.
In two cases, COVID-19 became extremely serious, blood oxygen levels fell and a sudden cardiac arrest occurred. One of these cases proved fatal, and the researchers said they are investigating whether a blood clot might have been involved. COVID-19 is known to boost clotting risks.
Hydroxychloroquine, a malaria drug that's since proven ineffective against COVID-19 in clinical trials, was tried in 15 patients. However, it appeared to be ineffective and was even tied to potentially dangerous side effects, the researchers added. After a mean total length of hospital stay of 7.1 (range, 3-18) days, all patients had been discharged home with no fatalities.
They did stress that "the small sample size of this descriptive study may additionally limit generalisability" to a broader population of children with COVID-19.
Experts believe that in the vast majority of cases of infection with coronavirus, children experience few or no symptoms. But in rare cases, illness can develop, and "this retrospective description … adds important insights to the body of knowledge about the similarities and differences between paediatric and adult infection," said Dr. Michael Grosso, chair of pediatrics at Huntington Hospital in Huntington, NY.
"Much of what the investigators saw confirmed previous experience," added Grosso. "Children are less likely to die, infants do not fare worse - as they do with influenza - nor do the immunocompromised. However, obesity was a risk factor for severe disease and predicted the need for mechanical ventilation."
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