Hospitalizations for COVID-19-related croup increase during omicron wave

The proportion of children with COVID-19-related croup increased during the period in which omicron was the predominant variant in the United States, according to a research letter published in JAMA Network Open.

These data come over a month after a study in Pediatrics found “compelling evidence” that the omicron variant of SARS-CoV-2 may cause croup in children. In that vein, researchers from the Children’s Hospital of Minnesota wrote that they sought to find “whether SARS-CoV-2 variants were associated with the proportion of children with croup, as well as hospital and intensive care unit (ICU) admissions and racemic epinephrine (RE) treatment.”

Using data from children aged 3 months to 8 years admitted to 43 U.S. children’s hospitals between Jan. 1, 2021, and March 26, 2022, the researchers identified 5,152 children diagnosed with COVID-19-related croup. Further, they found that the proportion of children with COVID-19-related croup significantly increased during the omicron wave (10.9%) compared with alpha or other variant (4.1%) and delta (3.6%) periods (P < .001).

The authors noted that the evidence supporting the association between specific variants and COVID-19-related croup severity “were mixed in our study.”

“We noted a significant increase in the proportion of children requiring RE during alpha or other variant and omicron periods compared with the period of delta predominance,” they wrote. “However, we also observed no difference in the median number of RE doses, which was comparable to an estimate prior to COVID-19. The overall ICU admission rate in our sample was lower than a rate described prior to COVID-19, which may be associated with constraints on ICU capacity or, alternatively, less severe illness.”

Because COVID-19 is likely to become endemic, “our findings suggest that pediatric health systems should consider variation in SARS-CoV-2 phenotypes and their association with patient care,” they continued. “This may be especially true when other viral infections lead to surges in patient volume.”