Life-Threatening Complications of Influenza vs Coronavirus Disease 2019 (COVID-19) in US Children
Authors: Halasa Natasha B , Spieker Andrew J , Young Cameron C , Olson Samantha M , Newhams Margaret M , Amarin Justin Z , Moffitt Kristin L , Nakamura Mari M , Levy Emily R , Soma Vijaya L , Talj Rana , Weiss Scott L , Fitzgerald Julie C , Mack Elizabeth H , Maddux Aline B , Schuster Jennifer E , Coates Bria M , Hall Mark W , Schwartz Stephanie P , Schwarz Adam J , Kong Michele , Spinella Philip C , Loftis Laura L , McLaughlin Gwenn E , Hobbs Charlotte V , Rowan Courtney M , Bembea Melania M , Nofziger Ryan A , Babbitt Christopher J , Bowens Cindy , Flori Heidi R , Gertz Shira J , Zinter Matt S , Giuliano John S , Hume Janet R , Cvijanovich Natalie Z , Singh Aalok R , Crandall Hillary A , Thomas Neal J , Cullimore Melissa L , Patel Manish M , Randolph Adrienne G ,   for the Pediatric Intensive Care Influenza,   Overcoming COVID-19 Investigators, Kong Michele , Gaspers Mary Glas , Typpo Katri V , Sanders Ronald C , Katherine Irby , Peter Mourani , Schwarz Adam J , Babbitt Christopher J , Helen Harvey , Cvijanovich Natalie Z , Zinter Matt S , Maddux Aline B , Osborne Christina M , Sara Shankman , Mourani Peter M , Emily Port , Van Kevin A , Carroll Christopher L , Giuliano John S , McLaughlin Gwenn E , Tarquinio Keiko M , Michelson Kelly N , Coates Bria M , Rowan Courtney M , Wellnitz Kari , Bhoojhawon Guru , Sullivan Janice E , Montgomery Vicki L , Havlin Kevin M , Bradford Tamara T , Riggs Becky J , Bembea Melania M , Randolph Adrienne G , Newhams Margaret M , Chen Sabrina R , Young Cameron C , Moffitt Kristin L , Nakamura Mari M , Carroll Ryan W , Yager Phoebe H , Fernandes Neil D , Flori Heidi R , Heidemann Sabrina M , Hume Janet R , Levy Emily R , Hobbs Charlotte V , Martin Lora , Malloch Lacy , Inagaki Kengo , Dhanrajani Anita , Schuster Jennifer E , Kietzman Abigail , Hill Shannon , Spinella Philip C , Cullimore Melissa L , McCulloh Russell J , Clouser Katharine N , Gertz Shira J , Kleinman Lawrence C , Li Simon , Horwitz Steven M , Ratner Adam J , Dapul Heda , Soma Vijaya L , Keenaghan Michael A , Singh Aalok R , Harwayne-Gidansky Ilana , Hymes Saul R , Doymaz Sule , Schwartz Stephanie P , Walker Tracie C , Hall Mark W , Shein Steven L , Lansell Amanda N , Nofziger Ryan A , Staat Mary A , Fitzgerald Julie C , Weiss Scott , Thomas Neal J , Fink Ericka L , Carcillo Joseph A , Mack Elizabeth H , Smallcomb Laura S , Halasa Natasha B , Stewart Laura , Romero Yesenia , Hayek Haya , Loftis Laura L , Munoz Alvaro Coronado , Bowens Cindy , Maamari Mia , Crandall Hillary , Smith Lincoln S , McGuire John K 
Published: June 2022

Abstract

Background
Clinical differences between critical illness from influenza infection vs coronavirus disease 2019 (COVID-19) have not been well characterized in pediatric patients.

Methods
We compared demographics, clinical characteristics, and outcomes of US children (aged 8 months to 17 years) admitted to the intensive care or high-acuity unit with influenza or COVID-19. Using mixed-effects models, we assessed the odds of death or requiring life support for influenza vs COVID-19 after adjustment for age, sex, race and Hispanic origin, and underlying conditions including obesity.

Results
Children with influenza (n = 179) were younger than those with COVID-19 (n = 381; median, 5.2 years vs 13.8 years), less likely to be non-Hispanic Black (14.5% vs 27.6%) or Hispanic (24.0% vs 36.2%), and less likely to have ≥1 underlying condition (66.4% vs 78.5%) or be obese (21.4% vs 42.2%), and a shorter hospital stay (median, 5 days vs 7 days). They were similarly likely to require invasive mechanical ventilation (both 30.2%), vasopressor support (19.6% and 19.9%), or extracorporeal membrane oxygenation (2.2% and 2.9%). Four children with influenza (2.2%) and 11 children with COVID-19 (2.9%) died. The odds of death or requiring life support in children with influenza vs COVID-19 were similar (adjusted odds ratio, 1.30; 95% confidence interval, .78–2.15; P = .32).

Conclusions
Despite differences in demographics and clinical characteristics of children with influenza or COVID-19, the frequency of life-threatening complications was similar. Our findings highlight the importance of implementing prevention measures to reduce transmission and disease severity of influenza and COVID-19.