{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T22:42:49Z","timestamp":1783723369454,"version":"3.55.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000038","name":"U.S. Food and Drug Administration","doi-asserted-by":"publisher","award":["75F40119D10037"],"award-info":[{"award-number":["75F40119D10037"]}],"id":[{"id":"10.13039\/100000038","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>We described care received by hospitalized children with COVID-19 or multi-system inflammatory syndrome (MIS-C) prior to the 2021 COVID-19 Omicron variant surge in the US. We identified hospitalized children &lt;18 years of age with a COVID-19 or MIS-C diagnosis (COVID-19 not required), separately, from February 2020-September 2021 (n = 126 hospitals). We described high-risk conditions, inpatient treatments, and complications among these groups. Among 383,083 pediatric hospitalizations, 2,186 had COVID-19 and 395 had MIS-C diagnosis. Less than 1% had both COVID-19 and MIS-C diagnosis (n = 154). Over half were &gt;6 years old (54% COVID-19, 70% MIS-C). High-risk conditions included asthma (14% COVID-19, 11% MIS-C), and obesity (9% COVID-19, 10% MIS-C). Pulmonary complications in children with COVID-19 included viral pneumonia (24%) and acute respiratory failure (11%). In reference to children with COVID-19, those with MIS-C had more hematological disorders (62% vs 34%), sepsis (16% vs 6%), pericarditis (13% vs 2%), myocarditis (8% vs 1%). Few were ventilated or died, but some required oxygen support (38% COVID-19, 45% MIS-C) or intensive care (42% COVID-19, 69% MIS-C). Treatments included: methylprednisolone (34% COVID-19, 75% MIS-C), dexamethasone (25% COVID-19, 15% MIS-C), remdesivir (13% COVID-19, 5% MIS-C). Antibiotics (50% COVID-19, 68% MIS-C) and low-molecular weight heparin (17% COVID-19, 34% MIS-C) were frequently administered. Markers of illness severity among hospitalized children with COVID-19 prior to the 2021 Omicron surge are consistent with previous studies. We report important trends on treatments in hospitalized children with COVID-19 to improve the understanding of real-world treatment patterns in this population.<\/jats:p>","DOI":"10.1371\/journal.pone.0288284","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T17:23:52Z","timestamp":1689096232000},"page":"e0288284","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Treatment and care received by children hospitalized with COVID-19 in a large hospital network in the United States, February 2020 to September 2021"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8902-1435","authenticated-orcid":true,"given":"Candace C.","family":"Fuller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin","family":"Cosgrove","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayura","family":"Shinde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Rosen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Haffenreffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hague","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3866-8554","authenticated-orcid":true,"given":"Laura E.","family":"McLean","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Perlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell E.","family":"Poland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth E.","family":"Sands","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Pratt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Bright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Platt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noelle M.","family":"Cocoros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah K.","family":"Dutcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,7,11]]},"reference":[{"key":"pone.0288284.ref001","article-title":"Hospitalization Rates and Characteristics of Children Aged 18 Years Hospitalized with Laboratory-Confirmed COVID-19\u2014COVID-NET, 14 States, March 1\u2013July 25, 2020","volume":"69","author":"L. Kim","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0288284.ref002","unstructured":"Delahoy MJ. Hospitalizations Associated with COVID-19 Among Children and Adolescents\u2014COVID-NET, 14 States, March 1, 2020\u2013August 14, 2021. MMWR Morb Mortal Wkly Rep [Internet]. 2021 [cited 2021 Sep 21];70. Available from: https:\/\/www.cdc.gov\/mmwr\/volumes\/70\/wr\/mm7036e2.htm"},{"key":"pone.0288284.ref003","article-title":"COVID-19 in Children\u2014Not Just Little Adults","author":"JE Schuster","year":"2021","journal-title":"JAMA Netw Open"},{"key":"pone.0288284.ref004","article-title":"Trends in Disease Severity and Health Care Utilization During the Early Omicron Variant Period Compared with Previous SARS-CoV-2 High Transmission Periods\u2014United States, December 2020\u2013January 2022","author":"AD Iuliano","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0288284.ref005","volume-title":"FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine","author":"U.S. Food and Drug Administration","year":"2020"},{"key":"pone.0288284.ref006","volume-title":"Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic","author":"U.S. Food and Drug Administration","year":"2021"},{"key":"pone.0288284.ref007","volume-title":"FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Children 5 through 11 Years of Age","author":"U.S. Food and Drug Administration","year":"2021"},{"key":"pone.0288284.ref008","author":"U.S. Food and Drug Administration","year":"2022","journal-title":"Coronavirus (COVID-19) Update: FDA Authorizes Moderna and Pfizer-BioNTech COVID-19 Vaccines for Children Down to 6 Months of Age"},{"issue":"4","key":"pone.0288284.ref009","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1056\/NEJMoa2021756","article-title":"Multisystem Inflammatory Syndrome in Children in New York State","volume":"383","author":"EM Dufort","year":"2020","journal-title":"N Engl J Med"},{"key":"pone.0288284.ref010","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jpeds.2020.05.006","article-title":"Clinical Characteristics and Outcomes of Hospitalized and Critically Ill Children and Adolescents with Coronavirus Disease 2019 at a Tertiary Care Medical Center in New York City","volume":"223","author":"JY Chao","year":"2020","journal-title":"J Pediatr"},{"issue":"6","key":"pone.0288284.ref011","doi-asserted-by":"crossref","first-page":"e2111182","DOI":"10.1001\/jamanetworkopen.2021.11182","article-title":"Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children","volume":"4","author":"L Kompaniyets","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"3","key":"pone.0288284.ref012","doi-asserted-by":"crossref","first-page":"e2022057798","DOI":"10.1542\/peds.2022-057798","article-title":"Health Impairments in Children and Adolescents After Hospitalization for Acute COVID-19 or MIS-C","volume":"150","author":"AB Maddux","year":"2022","journal-title":"Pediatrics"},{"issue":"E10","key":"pone.0288284.ref013","first-page":"P23","article-title":"Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth","volume":"230","author":"D. Fernandes","journal-title":"Journal of Pediatrics"},{"issue":"10","key":"pone.0288284.ref014","doi-asserted-by":"crossref","first-page":"e202430","DOI":"10.1001\/jamapediatrics.2020.2430","article-title":"Epidemiology, Clinical Features, and Disease Severity in Patients With Coronavirus Disease 2019 (COVID-19) in a Children\u2019s Hospital in New York City, New York","volume":"174","author":"P Zachariah","year":"2020","journal-title":"JAMA Pediatr"},{"key":"pone.0288284.ref015","article-title":"Risk Factors for Severe COVID-19 in Children","author":"RC Woodruff","year":"2021","journal-title":"Pediatrics"},{"key":"pone.0288284.ref016","article-title":"Trends in COVID-19 Cases, Emergency Department Visits, and Hospital Admissions Among Children and Adolescents Aged 0\u201317 Years\u2014United States, August 2020\u2013August 2021","author":"DA Siegel","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"11","key":"pone.0288284.ref017","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1001\/jama.2021.2091","article-title":"Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19","volume":"325","author":"LR Feldstein","year":"2021","journal-title":"JAMA"},{"key":"pone.0288284.ref018","volume-title":"Therapeutic Management of Hospitalized Children With COVID-19","author":"National Institutes of Health"},{"issue":"22","key":"pone.0288284.ref019","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1056\/NEJMp1809643","article-title":"The FDA Sentinel Initiative\u2014An Evolving National Resource","volume":"379","author":"R Platt","year":"2018","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0288284.ref020","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1002\/cpt.320","article-title":"The FDA\u2019s sentinel initiative\u2014A comprehensive approach to medical product surveillance","volume":"99","author":"R Ball","year":"2016","journal-title":"Clin Pharmacol Ther"},{"issue":"2","key":"pone.0288284.ref021","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1111\/irv.12921","article-title":"Using inpatient electronic medical records to study influenza for pandemic preparedness","volume":"16","author":"CC Fuller","year":"2022","journal-title":"Influenza Other Respir Viruses"},{"issue":"7","key":"pone.0288284.ref022","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1002\/pds.5240","article-title":"A COVID-19-ready public health surveillance system: The FDA\u2019s Sentinel System","volume":"30","author":"NM Cocoros","year":"2021","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"pone.0288284.ref023","unstructured":"HCA Healthcare. Who We Are [Internet]. [cited 2020 Sep 7]. Available from: https:\/\/hcahealthcare.com\/about\/"},{"key":"pone.0288284.ref024","unstructured":"Centers for Disease Control and Prevention. ICD-10-CM Official Coding Guidelines\u2014Supplement Coding encounters related to COVID-19 Coronavirus Outbreak [Internet]. [cited 2020 Nov 9]. Available from: https:\/\/www.cdc.gov\/nchs\/data\/icd\/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf"},{"key":"pone.0288284.ref025","unstructured":"Centers for Disease Control and Prevention. COVID-19 and Your Health [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2022 Jan 7]. Available from: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/need-extra-precautions\/people-with-medical-conditions.html"},{"key":"pone.0288284.ref026","unstructured":"Basic HHS Policy for Protection of Human Research Subjects [Internet]. 45 CFR \u00a746.102(l)(2). Available from: https:\/\/www.hhs.gov\/ohrp\/regulations-and-policy\/regulations\/45-cfr-46\/index.html"},{"key":"pone.0288284.ref027","volume":"49","author":"K Rosati","year":"2018","journal-title":"HIPAA and Common Rule Compliance in the Sentinel Initiative"},{"key":"pone.0288284.ref028","volume":"19","year":"2017","journal-title":"Federal Policy for the Protection of Human Subjects, 82 Federal Register"},{"issue":"1","key":"pone.0288284.ref029","doi-asserted-by":"crossref","first-page":"e1165","DOI":"10.1093\/cid\/ciab1007","article-title":"Multisystem Inflammatory Syndrome in Children-United States, February 2020-July 2021","volume":"75","author":"AD Miller","year":"2022","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"key":"pone.0288284.ref030","article-title":"Data-driven clustering identifies features distinguishing multisystem inflammatory syndrome from acute COVID-19 in children and adolescents","author":"A Geva","year":"2021","journal-title":"eClinicalMedicine"},{"issue":"1","key":"pone.0288284.ref031","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1056\/NEJMoa2102605","article-title":"Multisystem Inflammatory Syndrome in Children\u2014Initial Therapy and Outcomes","volume":"385","author":"MBF Son","year":"2021","journal-title":"N Engl J Med"},{"issue":"5","key":"pone.0288284.ref032","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1161\/CIRCULATIONAHA.120.048360","article-title":"Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic","volume":"142","author":"Z Belhadjer","year":"2020","journal-title":"Circulation"},{"issue":"7","key":"pone.0288284.ref033","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1093\/cid\/ciac072","article-title":"Trends in Treatments for Multisystem Inflammatory Syndrome in Children (MIS-C), United States, February 2020\u2014July 2021","volume":"75","author":"JY Abrams","year":"2022","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"key":"pone.0288284.ref034","volume-title":"Special Considerations in Children [Internet]. COVID-19 Treatment Guidelines","author":"National Institutes of Health","year":"2022"},{"key":"pone.0288284.ref035","volume-title":"Hospitalized Pediatric Patients: Therapeutic Management of MIS-C [Internet]. COVID-19 Treatment Guidelines","author":"National Institutes of Health","year":"2022"},{"key":"pone.0288284.ref036","volume-title":"FDA Approves First Treatment for COVID-19Internet]","author":"U.S. Food and Drug Administration","year":"2021"},{"key":"pone.0288284.ref037","volume-title":"Fact sheet for healthcare providers: emergency use authorization (EUA) of baricitinib","author":"U.S. Food and Drug Administration","year":"2021"},{"issue":"1","key":"pone.0288284.ref038","first-page":"133","article-title":"Clinical Outcomes of COVID-19 with Evidence-Based Supportive Care","volume":"74","author":"DT Larson","year":"2020","journal-title":"Clin Infect Dis"},{"key":"pone.0288284.ref039","volume-title":"Guidelines on the Treatment and Management of Patients with COVID-19","author":"Infectious Diseases Society of America","year":"2021"},{"key":"pone.0288284.ref040","unstructured":"National Institute for Health and Care Excellence. COVID-19 rapid guideline: children and young people who are immunocompromised [Internet]. London: National Institute for Health and Care Excellence (UK); 2020 [cited 2021 Feb 4]. (National Institute for Health and Care Excellence: Clinical Guidelines). Available from: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK566164\/"},{"issue":"11","key":"pone.0288284.ref041","doi-asserted-by":"crossref","first-page":"3099","DOI":"10.1111\/jth.15073","article-title":"Consensus-based clinical recommendations and research priorities for anticoagulant thromboprophylaxis in children hospitalized for COVID-19\u2013related illness","volume":"18","author":"NA Goldenberg","year":"2020","journal-title":"J Thromb Haemost"},{"issue":"6","key":"pone.0288284.ref042","doi-asserted-by":"crossref","first-page":"ofab236","DOI":"10.1093\/ofid\/ofab236","article-title":"Trends in Antibiotic Use in United States Hospitals During the Coronavirus Disease 2019 Pandemic","volume":"8","author":"AN Rose","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"pone.0288284.ref043","volume-title":"Coronavirus Disease 2019 (COVID-19) Treatment Guidelines","author":"National Institutes of Health","year":"2021"},{"issue":"8","key":"pone.0288284.ref044","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1002\/pds.5029","article-title":"Considerations for pharmacoepidemiological analyses in the SARS-CoV-2 pandemic","volume":"29","author":"A Potteg\u00e5rd","year":"2020","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"pone.0288284.ref045","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.2147\/CLEP.S335621","article-title":"Positive Predictive Value of COVID-19 ICD-10 Diagnosis Codes Across Calendar Time and Clinical Setting","volume":"13","author":"KE Lynch","year":"2021","journal-title":"Clin Epidemiol"},{"issue":"4","key":"pone.0288284.ref046","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1002\/pds.5401","article-title":"Validation of diagnosis codes to identify hospitalized COVID-19 patients in health care claims data","volume":"31","author":"SA Kluberg","year":"2022","journal-title":"Pharmacoepidemiol Drug Saf"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0288284","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T17:24:20Z","timestamp":1689096260000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0288284"}},"subtitle":[],"editor":[{"given":"Paavani","family":"Atluri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,7,11]]},"references-count":46,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0288284","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,11]]}}}