![]() Severity of clinical outcomes in the propensity-score matched Omicron and Delta cohorts was assessed based on the number of ED visits, hospitalizations, ICU admissions and need for mechanical ventilation in the 3-day time-window that followed from the first day of SARS-CoV-2 infection. ![]() The two cohorts were propensity-score matched (1:1 using a nearest neighbor greedy matching with a caliper of 0.25 times the standard deviation) for demographics (age, gender, race/ethnicity) adverse socioeconomic determinants of health (assessed by ICD-10 codes “Z55-Z65” for “Persons with potential health hazards related to socioeconomic and psychosocial circumstances”) that include employment, housing, education, and economic circumstances common medical conditions in children including cancer, congenital heart diseases, asthma, influenza and pneumonia, common cold, asthma, type 1 diabetes, type 2 diabetes, anemia and other blood-related disorders, autistic disorders, overweight (BMI ≥ 85th Percentile for Age), underweight (BMI < 5th Percentile for Age) and COVID-19-related medications 8 including remdesivir, dexamethasone, hydrocortisone, and tocilizumab (assessed by RxNorm codes). We tested whether severe clinical outcomes in children in the Omicron cohort differed from those in the Delta cohort. ![]() The status of adverse clinical outcomes was based on the Current Procedural Terminology (CPT) relevant codes for ED visits (“Emergency Department Visits”, code 1013711), hospitalizations (“hospital inpatient services”, code: 013659), ICU admissions (“Critical Care Services”, code: 1013729), and mechanical ventilation use (“Respiratory ventilation”, codes: 5A1935Z, 5A1945Z, 5A1955Z, 5A09357, 5A09457, 5A09557). The status of SARS-CoV-2 infection was based on the ICD-10 diagnosis code of “COVID-19” (U07.1) or lab-test confirmed presence of “SARS coronavirus 2 and related RNA” (9088). This second Delta cohort was created to control for later time periods and shorter window of infection. The CDC’s national genomic surveillance program reports that Omicron accounted over 92% of all circulating virus variants in the US during the two week period of – 7 (b) the Delta cohort (n = 63,203) – contracted first SARS-CoV-2 infection between – when Delta was the predominant variant (99.0%) 7 (c) the Delta-2 cohort (n = 9,188) – contracted first SARS-CoV-2 infection between –, immediately before the Omicron variant was detected in the US and when Delta was the predominant variant (99.0%) 7. The study population comprised of three cohorts of children under age 5 with first time SARS-CoV-2 infections: (a) the Omicron cohort (n = 7,201) – contracted first SARS-CoV-2 infection between –. Because this study only queried statistics of de-identified patient records through web-applications and did not involve retrieval, storage, collection, use, or transmittal of individually identifiable data, Institutional Review Board approval and informed consent was not needed or sought. ![]() Although the data are fully de-identified, end-users can use built-in statistical functions to perform patient-level data analysis, including cohort selection, propensity-score matching, time trend analysis, outcome research, among others. TriNetX Analytics provides web-based secure access to patient EHR data from hospitals, primary care, and specialty treatment providers, covering diverse geographic locations, age groups, racial and ethnic groups, income levels, and insurance types. This study used the TriNetX Analytics network platform that contains de-identified EHR data of 90 million unique patients from 63 health care organizations in both inpatient and outpatient settings across the US 6. Here we compared severe clinical outcomes including ED visits, hospitalizations, ICU admissions, and mechanical ventilation use in children under age 5 who contracted SARS-CoV-2 infection for the first time during the period when the Omicron predominated in the US and compared them to those in similar children who first infected when the Delta variant predominated through a retrospective study of a large, geographically diverse database of patient electronic health record (EHR) data in the US. However, the data on disease severity from Omicron in children under 5 is lacking. Reports from South Africa 3, Scotland 4, and England 5 showed lower rates of hospitalization following Omicron infection compared with the Delta variant infection. This is especially concerning for children under 5 years old since they are not eligible for COVID-19 vaccines and their low rates of previous SARS-CoV-2 infection also limits their pre-existing immunity 2. Pediatric SARS-CoV-2 infections and hospitalizations are rising in the US and other countries after the emergence of Omicron variant 1. ![]()
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