Impact of congenital heart disease on outcomes among pediatric patients hospitalized for COVID-19 infection (preprint)

ABSTRACT

Background COVID-19 infection is generally regarded as an acute self-limiting illness in children, but it can cause significant morbidity and mortality in both healthy and high-risk children. There are limited data on the outcomes of children with congenital heart disease (CHD) and COVID-19. This study aimed to examine the risks of mortality, in-hospital cardiovascular and non-cardiovascular complications in this patient population.Methods We analyzed data from hospitalized pediatric patients from 2020 using the nationally representative National Inpatient Sample (NIS). Children hospitalized for COVID-19 were included, and weighted data were used to compare in-hospital mortality and morbidities between children with and without CHD.Results Out of 33,220 children admitted with a diagnosis of COVID-19 infection(ICD-10 codeU07.1) during calendar year 2020, 875 (2.6%) had CHD. Compared to children without CHD, children with CHD had similar in-hospital mortality (1.2% vs 0.8%, p = 0.63), with adjusted OR (aOR) of 2.0 (95% CI 0.5–8.3). Tachyarrhythmias and heart block were more likely in CHD children with an aOR of 4.9 (95% CI 1.9–12.4) and aOR of 4.4 (95% CI 2.0-9.7), respectively. Similarly, respiratory failure [aOR = 1.8 (1.2–2.9)], respiratory failure requiring non-invasive mechanical ventilation [aOR = 3.1 (1.5–6.2)] and invasive mechanical ventilation [aOR = 2.2 (1.2-4.0)], and acute kidney injury [aOR = 3.0 (1.8–4.9)] were all significantly higher among patients with CHD. Median length of hospital stay in children with CHD was longer than those without CHD [5 days (IQR 2-9.3) vs. 3 days (IQR 2–5), p = < 0.001].Conclusions Children with CHD hospitalized with COVID-19 infection were at increased risk of serious cardiovascular and non-cardiovascular adverse clinical outcomes. They were not at increased risk for death when compared to children without CHD but had increased length of hospital stay and utilization of healthcare resources.