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. 2025 Jul 1:10:100638.
doi: 10.1016/j.puhip.2025.100638. eCollection 2025 Dec.

In-hospital course of children with COVID-19 infection - Results of the German nationwide inpatient sample

Karsten Keller  1   2   3 , Ingo Sagoschen  1 , Volker H Schmitt  1   4 , Stefano Barco  2   5 , Visvakanth Sivanathan  6 , Omar Hahad  1   4 , Frank P Schmidt  7 , Christine Espinola-Klein  1   2 , Stavros Konstantinides  2   8 , Thomas Münzel  1   4 , Lukas Hobohm  1   2
Affiliations

In-hospital course of children with COVID-19 infection - Results of the German nationwide inpatient sample

Karsten Keller et al. Public Health Pract (Oxf). .

Abstract

Objectives: To date, few large studies of clinical outcomes in pediatric COVID-19 patients have been reported.

Study design: Epidemiological study of the German nationwide inpatient study (GNIS).

Methods: We used the GNIS to analyze all hospitalized children ≤18 years with confirmed COVID-19 diagnosis in Germany between Jan 1st and December 31st, 2020.

Results: Overall, 3360 children aged ≤18 years were hospitalized with COVID-19 infection in Germany in 2020 (49.8 % females). Among these, 1640 (48.8 %) were aged ≤6 years, 504 (15.0 %) 7 - ≤12 years and 1216 (36.2 %) were aged 13 - ≤18 years. Among these 3360 patients, 3.3 % were treated with mechanical ventilation and 0.23 % died in the hospital. The frequency of venous thromboembolism (0.18 %), vasculopathy (0.68 %), multisystem inflammatory syndrome caused by COVID-19 (0.65 %), and diagnosis of myocarditis (0.60 %) were low. Besides pneumonia and acute respiratory distress syndrome, obesity (OR 6.1 [95 %CI 2.1-18.2], P = 0.001), heart failure (OR 17.0 [95 %CI 6.8-42.1], P < 0.001) and acute/chronic kidney failure (OR 9.5 [95 %CI 4.0-22.2], P < 0.001) were independently associated with mechanical ventilation. Acute or chronic kidney failure (OR 41.4 [95 %CI 7.8-218.6], P < 0.001), liver disease (OR 18.8 [95 %CI 2.5-143.3], P = 0.005), and necessity of mechanical ventilation (OR 7.6 [95 %CI 1.2-47.4], P = 0.031) were independent risk factors for case-fatality.

Conclusions: In Germany in 2020, hospitalized children aged ≤18 years with COVID-19 infection had a low case-fatality. Heart, liver and renal failure were associated with adverse COVID-19 complications, such as the need for mechanical ventilation or death. Myocarditis, vasculopathy and venous thromboembolism were rare complications in this patient group.

Keywords: COVID-19; Case-fatality; Childhood; Mortality; Ventilation.

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Conflict of interest statement

KK, VHS, ISa, VS, OH, FPS report no conflict of interests. SB received lecture/consultant fees from Bayer HealthCare, Concept Medical, BTG Pharmaceuticals, INARI, Boston Scientific, and LeoPharma; institutional grants from Boston Scientific, Bentley, Bayer HealthCare, INARI, Medtronic, Concept Medical, Bard, and Sanofi; and economical support for travel/congress costs from Daiichi Sankyo, BTG Pharmaceuticals, and Bayer HealthCare, outside the submitted work. CEK reports having from Amarin Germany, Amgen GmbH, Bayer Vital, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, MSD Sharp & Dohme, Novartis Pharma, Pfizer Pharma GmbH, Sanofi-Aventis GmbH. SK reports institutional grants and personal lecture/advisory fees from Bayer AG, Daiichi Sankyo, and Boston Scientific; institutional grants from Inari Medical; and personal lecture/advisory fees from MSD and Bristol Myers Squibb/Pfizer. TM reports no conflict of interests. TM is PI of the DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany. LH received lecture/consultant fees from MSD, Boston Scientific, INARI Medical and Johnson&Johnson, outside the submitted work.

Figures

Fig. 1
Fig. 1
Temporal trends regarding total numbers of hospitalized childhood patients with COVID-19-infection stratified by age classes Panel A – Temporal trends regarding absolute numbers of hospitalized childhood patients with COVID-19-infection stratified by age classes Panel B – Temporal trends regarding relative numbers of hospitalized childhood patients with COVID-19-infection stratified by age classes Panel C – Temporal trends regarding absolute numbers of hospitalized childhood patients with COVID-19-infection stratified by age and proportion regarding necessity of mechanical ventilation (dark blue line).
Fig. 2
Fig. 2
Regional differences regarding total numbers, incidence and outcomes of hospitalized childhood patients with COVID-19-infection Panel A – Incidence of hospitalized childhood patients with COVID-19-infection related to the general population Panel B – Incidence of hospitalized childhood patients with COVID-19-infection related to the population aged ≤18 years Panel C – Regional trends regarding rates of pneumonia, ARDS and mechanical ventilation of hospitalized childhood patients with COVID-19-infection (comparison of hospitals in urban vs. suburban vs. rural areas).
Fig. 3
Fig. 3
Length of in-hospital stay.
See this image and copyright information in PMC

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