Alarming pediatric hospital admissions linked to COVID-19 in England

In a recent study published in BMJresearchers describe hospitalizations associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric patients.

Examination: Hospital admissions associated with SARS-CoV-2 infection in children and adolescents: cohort study of 3.2 million first-identified infections in England. Image credit: Ermolaev Alexander / Shutterstock.com

How does COVID-19 affect children?

Pediatric hospitalization with SARS-CoV-2 has been rare; However, infection rates have been high, and patients with underlying comorbidities are more susceptible to severe outcomes from coronavirus disease 2019 (COVID-19). At the same time, the SARS-CoV-2 vaccination rate has remained low in the pediatric population.

Between September 2021 and April 2022, the Office for National Statistics (ONS) reported the highest incidences of COVID-19 among children and young people, with an increase in pediatric hospitalizations reported during the second wave of COVID-19 compared to the first wave. Nevertheless, the health consequences of COVID-19-related hospitalizations remain unclear.

About the study

In the current nationwide retrospective cohort study, researchers comprehensively analyzed all COVID-19-related hospital admissions among 12 million pediatric residents in England.

The study included three million initially ascertained COVID-19 cases among 12 million individuals under the age of 18 living in England using data obtained from electronic health records between July 2020 and February 2022. The study outcomes were initial COVID-19-related admissions, with SARS-CoV-2 as a contributing factor, as a result of COVID-19, and hospital-acquired or nosocomial COVID-19.

National Health Service (NHS) England research settings, accessed through the British Heart Foundation (BHF) COVID-IMPACT/CVD-COVID-UK consortium, were used to form a linked group comprising different data sets. These included nationwide laboratory-based SARS-CoV-2 testing information from the United Kingdom Health Security Agency (UKHSA) Second Generation Surveillance System (SGSS), primary care information provided by the General Practice Extraction Service (GPES) information for COVID-19 research and planning, and Hospital Episode Statistics (HES), including hospital unit, intensive care unit, and outpatient care.

The results were stratified by dominant periods of the SARS-CoV-2 ancestral Wuhan-Hu-1 strain between July 1, 2020 and December 5, 2020, as well as other viral variants of concern (VOCs). These included the Alpha-dominant period between January 3, 2021 and May 1, 2021, the Delta-dominant period between May 30, 2021 and December 11, 2021, and the Omicron-dominant period between December 26 and February 17, 2022 for originally determined COVID -19 cases and March 31, 2022 for hospitalizations for those that occurred before February 17, 2022.

The first confirmed SARS-CoV-2 infection was identified based on the first SARS-CoV-2 positive test reports in the SGSS or an initial COVID-19-related hospitalization. A six-week follow-up period was included for SARS-CoV-2 positive cases to record COVID-19-related hospitalizations until March 31, 2022 and calculate COVID-19-associated hospitalization rates. Reinfections and the second SARS-CoV-2-associated hospitalizations were excluded from the analysis.

Survey results

A total of 3,226,535 pediatric patients had initial SARS-CoV-2 infections during the study period, of which 0.9% required hospitalization. The median length of stay was two days, with 6% of COVID-19-related admissions requiring admission to critical care units and 4.3% admitted for multisystem inflammatory syndrome in children (MIS-C) not receiving critical care . In total, 70 deaths were reported in which SARS-CoV-2 infection or MIS-C were listed as causes, with 79% of cases reported in individuals with COVID-19-related hospitalization.

SARS-CoV-2 was either the cause or a contributing factor among 72% of hospitalized individuals, of whom 1.3% acquired COVID-19 in an inpatient setting, whereas 27% were hospitalized with accidental COVID-19. Male participants, younger children under five, those from ethnic minorities and those living in areas of high deprivation were more likely to be hospitalized.

The COVID-19 vaccination program in England identified certain conditions with a greater risk of SARS-CoV-2-associated hospitalization. About 38% of inpatients had documentation of these medical conditions, and 16% of inpatients had developmental or medical health conditions not listed in the program.

The percentage of pediatric patients with severe infection decreased under SARS-CoV-2 Omicron VOC dominance to 0.9% from 2% under Wuhan-Hu-1 and Alpha dominance and 0.7% under Delta dominance. Importantly, a reduced frequency of MIS-C diagnoses contributed to this decrease.

In contrast, the number of pediatric hospitalizations under Wuhan-Hu-1 and Alpha dominance, at 2,445 and 3,300, respectively, was much lower than under Delta and Omicron dominance, at 11,185 and 9,240, respectively.

The most severe COVID-19 cases were reported among people admitted with MIS-C, with 30% of them admitted to the intensive care unit (ICU) or high dependency unit (HDU) with an average length of stay of six days. Additionally, 28% of ICU or HCU admitted patients had nosocomial infections and a median length of stay of 93 days.

Among hospitalized individuals, 75% were unvaccinated, with an even higher proportion of 80% among individuals requiring HDU or ICU care.

Conclusions

Most COVID-19-related admissions among pediatric residents in England were either primarily due to COVID-19 or SARS-CoV-2 infection contributing to the medical condition requiring admission.