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#Management and #outcomes of #children hospitalised with #COVID19 including Incidental and Nosocomial infections in #Australia 2020-2023: a national surveillance study

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By G.M.

Highlights

• Acute COVID-19 usually causes mild illness even in young and immunosuppressed children

• Nosocomial SARS-CoV-2 infection is associated with more severe disease

• Concurrent serious bacterial infection is rare in children admitted with acute COVID-19.


ABSTRACT

Background

Management and outcomes of children hospitalised with acute SARS-CoV-2 infection may differ throughout the pandemic or with admission type (clinical COVID-19, incidental COVID-19 or nosocomial infection).

Objectives

Describe the severity, management and outcomes of hospitalised children with acute SARS-CoV-2 infection in Australia across the first 4 years of the pandemic and compare between admission types, SARS-CoV-2 variants, age groups and immune status.

Study design

A multi-centre prospective cohort study of 6,009 children aged 0-16 years between January 2020 to June 2023.

Results

Most children (84.3%) did not receive respiratory support, 33.4% received antibiotics and 8% were admitted to intensive care unit (ICU). Infants <6 months old were more likely to be admitted with clinical COVID than older children (12-16 years). Older children were more likely to receive antibiotics (27.8% vs 43.9%), corticosteroids (11.3% vs 34.1) or ICU admission (5.2% vs 13.5%). Compared to immunocompetent children, the immunosuppressed (7.7%) were more likely to have nosocomial infection (9.5% v 3.9%), receive antibiotics (57% vs 25%) or antivirals (18% vs 4.4%), but less likely to require respiratory support (93.4% vs 83.8%) or ICU admission (3.5% vs 8%). Children with nosocomial SARS-CoV-2 infection had higher rates of invasive ventilation (8%) and ICU admission (21%) compared to those with clinical (2.1% and 7.1% respectively) or incidental COVID-19 (4.8% and 9.1% respectively).

Conclusions

Acute COVID-19 generally caused mild disease in hospitalised children, with management and outcomes differing by age and admission type. Similar outcomes were observed across the pandemic. Nosocomial SARS-CoV-2 infection was associated with more severe disease.

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