P-530. Mortality among U.S. Children <18 Years Old Hospitalized with Laboratory-Confirmed COVID-19 Infection, 12 States, March 2020–September 2023

Abstract Background Pediatric COVID-19 hospitalizations have been well-described, but pediatric COVID-19-associated mortality data are limited. Methods COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) conducts population-based surveillance for laboratory-confirmed COVID-19 hospitalizations in 12 states. After excluding trauma-related admissions, medical charts among children aged < 18 years hospitalized during March 2020–September 2023 were abstracted. Children who died in-hospital or within 30 days of discharge were identified by matching cases with death certificates to describe pediatric COVID-19-associated mortality. Results Among 12,779 hospitalized children with complete chart abstraction, 88 (0.7%) died, including 66 (75.0%) in-hospital deaths and 22 (25.0%) deaths that occurred ≤30 days post-discharge (Figure). Thirty-two percent of children who died were < 1 year old and 23% were < 6 months old. Comparing children who died and those who survived, there were no significant differences in age or sex. A higher proportion of children who died than those who survived were Hispanic (37.5% vs 28.5%), while a lower proportion of children who died were non-Hispanic White (22.7% vs 33.1%) (p< 0.001 for overall racial differences) (Table 1). Compared with children who survived, children who died were more likely to have ≥1 (81.8% vs 51.1%) or ≥2 (52.3% vs 23.3%) underlying medical conditions, including neurological (37.5% vs 15.5%), chronic lung (27.3% vs 19.8%), and cardiovascular diseases (17.0% vs 7.0%) (p< 0.001 for all). Among COVID-19 vaccine-eligible children, 93.8% of those who died and 91.6% of those who survived were not up-to-date with COVID-19 vaccine recommendations (Table 2). Conclusion While COVID-19-associated pediatric hospitalizations resulting in death were rare, most were among children with comorbidities and COVID-19 vaccine-eligible children who were not up-to-date with vaccination, indicating missed opportunities to prevent severe illness and death through COVID-19 vaccination. One-quarter of deaths occurred within 30 days of discharge, highlighting the need for post-hospitalization surveillance for pediatric COVID-19 mortality estimates. Disclosures Melissa Sutton, MD, MPH, Centers for Disease Control and Prevention Emerging Infections Program: Grant/Research Support