Clinical outcomes and healthcare utilization of
hospitalized children with influenza versus COVID-19

Ng, David Chun-Ern; Liew, Chuin-Hen; Tan, Kah Kee; Pereira, Joanne; Roslan, Muhammad Ihsan; Cheng, Xiang Lin; Lim, Hui Yi; A.Nazri, Farah Nuruliayana; Maran, Asuwani; Wong, Wan Fei; Chandran, Yasothai; Shaharudin, Syaniza; Lau, Pon Ling; Gangadaran, Naveen Nair; Mohd Ali, Marlindawati

doi:.0.0.0

Clin Exp Pediatr > Accepted Articles

Original Article

DOI: https://doi.org/10.3345/cep.2025.00759 [Accepted]
Published online October 2, 2025.

Clinical outcomes and healthcare utilization of hospitalized children with influenza versus COVID-19

David Chun-Ern Ng¹

, Chuin-Hen Liew²

, Kah Kee Tan³

, Joanne Pereira¹

, Muhammad Ihsan Roslan¹

, Xiang Lin Cheng¹

, Hui Yi Lim¹

, Farah Nuruliayana A.Nazri¹

, Asuwani Maran¹

, Wan Fei Wong¹

, Yasothai Chandran¹

, Syaniza Shaharudin¹

, Pon Ling Lau¹

, Naveen Nair Gangadaran¹

, Marlindawati Mohd Ali¹

¹Hospital Tuanku Ja'afar, Seremban, Malaysia
²Hospital Tuanku Ampuan Najihah, Kuala Pilah, Malaysia
³Faculty of Medicine & Health Sciences, UCSI University Springhill, Port Dickson, Malaysia

Correspondence:
David Chun-Ern Ng, Email: davidngce@gmail.com

Received: 1 April 2025 • Revised: 30 June 2025 • Accepted: 23 July 2025

Abstract

Background
Influenza and coronavirus disease 2019 (COVID-19) are major causes of pediatric respiratory illness with overlapping clinical features but potentially differing impacts on healthcare utilization and outcomes.
Purpose
To compare the clinical presentations, healthcare resource utilization, and outcomes of children hospitalized with influenza and COVID-19 and address the gaps in pediatric data from Southeast Asia.
Methods
This retrospective observational study included children aged ≤12 years hospitalized with laboratoryconfirmed influenza or COVID-19 at a tertiary hospital in Malaysia between May 1, 2022, and May 1, 2023. Patients with viral or bacterial coinfections were excluded. Influenza A and B cases were collectively analyzed. The patients' demographic data, clinical presentation, resource utilization, and outcomes were also evaluated. Propensity score matching (PSM) was performed to balance the cohorts for age, sex, ethnicity, and comorbidities. Outcomes were compared using standardized mean differences (SMDs).
Results
A total of 299 patients were included (influenza, n=177; COVID-19, n=122). Patients with influenza were older (median, 3.6 years vs. 1.8 years; P<0.001) and more likely to have fever, cough, and rhinorrhea. COVID-19 patients presented earlier in the illness (median, 2 days vs. 4 days; P<0.001). After PSM, 102 patients were included in each group. Patients with influenza required greater healthcare resource use, including intravenous fluids (60.8% vs. 43.1%; SMD=0.36), empirical antibiotics (40.2% vs. 12.7%; SMD=0.66), respiratory support (40.2% vs. 26.5%, SMD= 0.29), pediatric intensive care unit admission (10.8% vs. 2.9%; SMD=0.32), and longer duration of oxygen therapy (SMD=0.93).
Conclusion
Children hospitalized for influenza demonstrated higher clinical severity and greater healthcare resource utilization than those hospitalized for COVID-19. These findings highlight the burden of influenza and inform hospital resource planning during periods of viral circulation.

Key Words: Influenza, COVID-19, Child, Health resources, Treatment outcome