The characteristics of SARS‐CoV‐2‐positive children in Australian hospitals: a PREDICT network study

Abstract

Objectives To examine the clinical characteristics and short term outcomes for children with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections who presented to Australian hospitals during 2020 and 2021. Design, setting Retrospective case review study in nineteen hospitals of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network from all Australian states and territories, including seven major paediatric tertiary centres and eight Victorian hospitals. Participants SARS‐CoV‐2‐positive people under 18 years of age who attended emergency departments or were admitted to hospital during 1 February 2020 – 31 December 2021. Main outcome measures Epidemiological and clinical characteristics, by hospital care type (emergency department [ED] or inpatient care). Results A total of 1193 SARS‐CoV‐2‐positive children and adolescents (527 girls, 44%) attended the participating hospitals (107 in 2020, 1086 in 2021). Their median age was 3.8 years (interquartile range [IQR], 0.8–11.4 years); 63 were Aboriginal or Torres Strait Islander people (5%). Other medical conditions were recorded for 293 children (25%), including asthma (86, 7%) and premature birth (68, 6%). Medical interventions were not required during 795 of 1181 ED presentations (67%); children were discharged directly home in 764 cases (65%) and admitted to hospital in 282 (24%; sixteen to intensive care units). The 384 admissions to hospital (including 102 direct admissions) of 341 children (25 infants under one month of age) included 23 to intensive care (6%); the median length of stay was three days (IQR, 1–9 days). Medical interventions were not required during 261 admissions (68%); 44 children received respiratory support (11%) and 21 COVID‐19‐specific treatments, including antiviral and biologic agents (5%). Being under three months of age (v one year to less than six years: odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7–4.0) and pre‐existing medical conditions (OR, 2.5; 95% CI, 1.9–3.2) were the major predictors of hospital admission. Two children died, including one without a known pre‐existing medical condition. Conclusion During 2020 and 2021, most SARS‐CoV‐2‐positive children and adolescents who presented to participating hospitals could be managed as outpatients. Outcomes were generally good, including for those admitted to hospital.

COVID-19 among infants: key clinical features and remaining controversies

“…Regardless of the limitations of existing analyses, several themes have emerged. Among children with COVID-19, some 20%–35% are <1 year of age [ 10 , 12 , 78 , 111 , 128 , 129 ]. The rate of hospital admission may be higher for younger infected patients [ 11 , 128 , 130 ].…”

“…Among children with COVID-19, some 20%–35% are <1 year of age [ 10 , 12 , 78 , 111 , 128 , 129 ]. The rate of hospital admission may be higher for younger infected patients [ 11 , 128 , 130 ]. Admission, however, may also occur commonly for reasons other than the infection proper [ 12 ].…”

“…Another study suggested that the latter risk was more so for those <1 month of age [ 78 ]. Whereas younger age may be at higher risk of hospital admission, those infants may not necessarily require more hospital interventions [ 128 ].…”