Reductions in hospital care among clinically vulnerable children aged 0-4 years during the COVID-19 pandemic

Objective To quantify reductions in hospital care for clinically vulnerable children during the COVID-19 pandemic. Design Birth cohort. Setting National Health Service hospitals in England. Study population All children aged <5 years with a birth recorded in hospital administrative data (January 2010-March 2021). Main exposure Clinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks' gestation) or low birth weight (<2500 g). Main outcomes Reductions in care defined by predicted hospital contact rates for 2020, estimated from 2015 to 2019, minus observed rates per 1000 child years during the first year of the pandemic (March 2020-2021). Results Of 3 813 465 children, 17.7% (one in six) were clinically vulnerable (9.5% born preterm or low birth weight, 10.3% had a chronic condition). Reductions in hospital care during the pandemic were much higher for clinically vulnerable children than peers: respectively, outpatient attendances (314 vs 73 per 1000 child years), planned admissions (55 vs 10) and unplanned admissions (105 vs 79). Clinically vulnerable children accounted for 50.1% of the reduction in outpatient attendances, 55.0% in planned admissions and 32.8% in unplanned hospital admissions. During the pandemic, weekly rates of planned care returned to prepandemic levels for infants with chronic conditions but not older children. Reductions in care differed by ethnic group and level of deprivation. Virtual outpatient attendances increased from 3.2% to 24.8% during the pandemic. Conclusion One in six clinically vulnerable children accounted for one-third to one half of the reduction in hospital care during the pandemic. While children with chronic conditions, prematurity or were born with low birthweight make up a sixth of children aged 0-4 years in England, they account of up to half of COVID-21 pandemic-related reductions in hospital contact (from Jan 2020 to March 2021).