Management and outcomes of children hospitalised with COVID-19 including incidental and nosocomial infections in Australia 2020-2023: A national surveillance study

Elizabeth White; Mehyar Khair Baik; Syeda Farah Zahir; Christopher C Blyth; Jeremy Carr; Nigel W Crawford; Joshua R Francis; Helen S Marshall; Emma Carey; Kristine Macartney; Brendan McMullan; Nicholas Wood; Philip N Britton; Julia E Clark; PAEDS network

doi:10.1016/j.jcv.2025.105824

Management and outcomes of children hospitalised with COVID-19 including incidental and nosocomial infections in Australia 2020-2023: A national surveillance study

J Clin Virol. 2025 Aug:179:105824. doi: 10.1016/j.jcv.2025.105824. Epub 2025 Jun 11.

Authors

Affiliations

¹ Queensland Children's Hospital, QLD, Australia. Electronic address: elizabeth.white3@health.qld.gov.au.
² National Centre for Immunisation Research and Surveillance, NSW, Australia.
³ Centre for Health Services Research, Faculty of Medicine, University of Queensland, QLD, Australia; QCIF Biostatistics, Brisbane, Queensland, Australia.
⁴ School of Medicine and Wesfarmers Centre of Vaccines & Infectious Diseases, The Kids Research Institute Australia, University of Western Australia, WA, Australia; Department of Infectious Diseases, Perth Children's Hospital, WA, Australia; Department of Microbiology, PathWest Microbiology Laboratory, WA, Australia.
⁵ Department of Infection & Immunity, Monash Children's Hospital, VIC, Australia; Department of Paediatrics, Monash University, VIC, Australia.
⁶ Immunisation Services, Royal Children's Hospital, VIC, Australia; Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC), Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, VIC, Australia.
⁷ Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, NT, Australia; Department of Paediatrics, Royal Darwin Hospital, NT, Australia.
⁸ Women's and Children's Hospital, SA, Australia.
⁹ National Centre for Immunisation Research and Surveillance, NSW, Australia; The Children's Hospital at Westmead, NSW, Australia.
¹⁰ National Centre for Immunisation Research and Surveillance, NSW, Australia; Faculty of Medicine and Health and Sydney ID, University of Sydney, NSW, Australia; The Children's Hospital at Westmead, NSW, Australia.
¹¹ Department of Infectious Diseases, Sydney Children's Hospital Randwick, Sydney, NSW, Australia; Discipline of Pediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
¹² Faculty of Medicine and Health and Sydney ID, University of Sydney, NSW, Australia; The Children's Hospital at Westmead, NSW, Australia.
¹³ Queensland Children's Hospital, QLD, Australia; University of Queensland, QLD, Australia.

PMID: 40554400
DOI: 10.1016/j.jcv.2025.105824

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 6009 children aged 0-16 years between January 2020 and 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 % vs 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.

Keywords: Adolescent; COVID-19; Child; Hospitalisation; Infant; SARS-CoV-2.

Publication types

Multicenter Study

MeSH terms

Adolescent
Anti-Bacterial Agents / therapeutic use
Australia / epidemiology
COVID-19* / epidemiology
COVID-19* / therapy
Child
Child, Preschool
Cross Infection* / epidemiology
Cross Infection* / therapy
Female
Hospitalization* / statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Prospective Studies
SARS-CoV-2
Severity of Illness Index
Treatment Outcome

Substances

Anti-Bacterial Agents