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Infection-related mortality in hospitalized children: A multi-center study in China from 2016 to 2021
Jiao Tian1, Qi Li2, Shiqi Cai3
1Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; Beijing Key Laboratory of Core Technologies for the Prevention and Treatment of Emerging Infectious Diseases in Children, Beijing, China; Research Unit of Critical Infection in Children, 2019RU016, Chinese Academy of Medical Sciences, Beijing, China; Department of Respiratory, Tianjin Children's Hospital, Tianjin, China.
Insights
Infections caused significant mortality in hospitalized children in China. The COVID-19 pandemic period saw fewer infection-related deaths compared to pre-pandemic times, with sepsis being the leading cause.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Hospitalized children face mortality risks from infections.
- China's strict COVID-19 measures impacted pathogen transmission and infection epidemiology.
- The Futang Research Center collected pediatric discharge medical record data since 2016.
Purpose of the Study:
- To investigate infection-related mortality among hospitalized children in China.
- To analyze trends in pediatric deaths from infections before and during the COVID-19 pandemic.
- To identify common causes of death and pathogens in pediatric infections.
Main Methods:
- Analysis of face sheets of discharge medical records (FSMRs) from 27 tertiary children's hospitals in China (2016-2021).
- Inclusion of hospitalized children aged 18 years or younger who died from infections.
- Data collected included demographics, region, admission year, causes of death, pathogens, and length of stay.
Main Results:
- 1130 children died from infections, representing 18.8% of all deaths.
- Boys had higher fatality rates than girls across various demographics.
- The COVID-19 period (2020-2021) showed a decrease in infection-related deaths compared to the pre-COVID-19 era.
- Sepsis was the most frequent cause of death, followed by pneumonia and central nervous system infections.
- Pathogens were identified in 30.6% of cases, including bacteria, viruses, and fungi.
Conclusions:
- Infections remain a significant cause of mortality in hospitalized children in China.
- The study highlights the impact of the COVID-19 pandemic on pediatric infection-related deaths.
- Sepsis and pneumonia are critical areas for intervention in pediatric critical care.
Background:
Hospitalized children experience mortality as a result of infections. Since the COVID-19 outbreak in early 2020, China's strict prevention measures have curbed pathogen transmission, altering infection-related epidemiology. The Futang Research Center of Pediatric Development has collected the face sheet of discharge medical records (FSMRs) data from 27 tertiary children's hospitals since January 2016, which facilitate us to investigate this issue. Moreover, this study focuses on hospitalized children aged 18 years old or younger.
Methods:
This study analyzed data from the FSMRs of children who died from infections at 27 tertiary children's hospitals across China between January 2016 and December 2021. Of these hospitals, 21 are located in provincial capitals. The data included gender, age, region, residence, year of admission, infections-associated causes of death, pathogens, length of stay, and expense.
Results:
A total of 1130 hospitalized children died from infections, accounting for 18.8 % of all deaths and 0.015 % of the total hospitalizations in the database during the period. Boys had a higher fatality than girls across different regions, age groups, years. Among all age groups, 0-28 days and 29 days-1 year group (≤365 days) had a higher number and proportion of deaths than other age groups. In terms of year of admission, the COVID-19 period (2020-2021) had a lower number of infections related death cases than pre-COVID-19 period. Further analysis of infection-related causes indicated that sepsis was the most common cause of death, followed by pneumonia, central nervous system infection, shock, enteritis, and myocarditis. The pathogens (bacterium, virus, fungus) were identified in 30.6 % of children.
Conclusions:
Infections are the significant cause of death among hospitalized children in China.
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