RESUMO
OBJECTIVES: To classify COVID-19 pediatric hospitalizations based on reason for admission ("for COVID" or "with COVID") and to compare disease severity and age between the delta and omicron variant predominant time frames. METHODS: This was a retrospective study in patients aged ≤18 years who were hospitalized at a large, tertiary care pediatric hospital for COVID-19 from July 2021 to February 2022. Disease severity was determined based on length of stay, PICU admission, and Remdesivir receipt. A χ2 analysis and a Cochran-Mantel-Haenszel test were used to analyze relationships between presumed variant type with admission reason, disease severity, and age. RESULTS: There were 492 patients included with more admissions during the omicron variant predominant time frame (n = 307). More patients were admitted "for COVID" during the delta variant predominant time frame compared with the omicron variant predominant time frame (P < .001) with interrater reliability testing indicating substantial agreement between reviewers. PICU admissions (P < .001), receipt of remdesivir (P < .001), and length of stay (P < .001) were greater during the delta variant predominant time frame. Hospitalizations "for COVID" were more common in patients aged <5 years during both the delta (odds ratio, 2.6; 95% confidence interval, 1.2-5.7) and omicron (odds ratio, 5.7; 95% confidence interval, 3.4-9.4) predominant time frames compared with older patients. CONCLUSIONS: There was a higher proportion of symptomatic COVID-19 hospitalizations with higher disease severity during the delta variant predominance, indicating greater disease severity during earlier periods of the pandemic despite lower hospitalization rates.