Objectives: To investigate whether the three nationwide coronavirus disease 2019 (COVID‐19) lockdowns imposed in Israel during the full first pandemic year altered the traditional seasonality of pediatric respiratory healthcare utilization.Methods: Month by month pediatric emergency department (ED) visits and hospitalizations for respiratory diagnoses during the first full COVID‐19 year were compared to those recorded for the six consecutive years preceding the pandemic. Data were collected from the patients' electronic files by utilizing a data extraction platform (MDClone^©).Results: A significant decline of 40% in respiratory ED visits and 54%–73% in respiratory hospitalizations during the first COVID‐19 year compared with the pre‐COVID‐19 years were observed (p < 0.001 and p < 0.001, respectively). The rate of respiratory ED visits out of the total monthly visits, mostly for asthma, peaked during June 2020, compared with proceeding years (109 [5.9%] versus 88 [3.9%] visits; p < 0.001). This peak occurred 2 weeks after the lifting of the first lockdown, resembling the “back‐to‐school asthma” phenomenon of September.Conclusions: This study demonstrates important changes in the seasonality of pediatric respiratory illnesses during the first COVID‐19 year, including a new “back‐from‐lockdown” asthma peak. These dramatic changes along with the recent resurgence of respiratory diseases may indicate the beginnings of altered seasonality in pediatric pulmonary pathologies as collateral damage of the pandemic.

Background: Admission to a pediatric intensive care unit (PICU) has been associated with respiratory consequences in children with asthma and carries major implications for management control. Whereas respiratory syncytial virus (RSV) bronchiolitis has been associated with increasing intensity of wheezing, the relationship between RSV‐bronchiolitis PICU admission and future asthma is unclear. This retrospective case‐control study evaluated whether hospitalization in the PICU due to RSV bronchiolitis is more likely to be associated with future asthma in early life compared with hospitalization in a general pediatric ward.Methods: Children hospitalized due to RSV bronchiolitis between 2007 and 2019 in the PICU (study group) were compared to those hospitalized in a general pediatric ward (controls). Asthma prevalence was assessed by a follow‐up questionnaire based on The International Study of Asthma and Allergies in Childhood questionnaire.Results: Sixty‐three PICU patients and 66 controls were included. The PICU patients presented with more severe disease during RSV hospitalization. At follow‐up, significantly more PICU patients aged 3–6 years had physician‐diagnosed asthma, respiratory symptoms during the previous 12 months, and underwent respiratory treatment since hospital discharge compared to controls (14 [60.9%] vs. 4 [18.2%] patients; 15 [65.2%] vs. 6 [27.3%]; and 16 [69.6%] vs. 8 [36.4%]; respectively). These differences were no longer observed after 6 years of age.Conclusions: Children admitted to the PICU for RSV bronchiolitis are at higher risk for asthma in subsequent pre‐school years and will require close respiratory follow‐up than those admitted to general pediatric wards. Admission venue should be queried when asthma is suspected.

Purpose The second year of life is gaining increased attention in the era of long-acting RSV immunoprophylaxis. This multicenter study, across pre- and post-COVID seasons, aimed to assess the association between specific key risk-factors and severe RSV-related disease among hospitalized children aged 12–23 months. Methods This retrospective study included children aged 12–23 months hospitalized with RSV across 11 medical-centers (2017–2021). We compared outcomes of prolonged hospitalization (> 3 days) and PICU (Pediatric Intensive Care Unit) admission for children with risk factors (prematurity < 37 weeks, major congenital heart disease (CHD), chronic lung disease of prematurity (CLD) or Down syndrome (DS)) and those without the respective risk factor, adjusting for demographic variables and COVID-19 pandemic admission. Clinical outcomes were also compared between children with ≥ 1 risk factors and those with none. Results Among 1023 children, 228 (22%) had ≥ 1 risk factor: prematurity (n = 183), CLD (n = 28), CHD (n = 45) or DS (n = 20). In multivariable analysis, prematurity with CLD (aOR 4.7,95%CI:1.97–11.22) or without CLD (aOR 2.26, 95%CI:1.54–3.3), CHD (aOR-3.29, 95%CI:1.6–6.77), DS (aOR-4.14, 95%CI:1.26–13.6) and having ≥ 1 risk (aOR-3.55, 95%CI:2.55–4.96) were independently associated with prolonged hospitalization. DS (aOR 6.7, 95%CI:2.1–22.4), CHD (aOR 3.0,95%CI:1.04–8.66) and having ≥ 1 risk factor (aOR-3.58, 95%CI:1.89–6.80) were also associated with PICU admission. Conclusion Children aged 12–23 months with prematurity, CLD, major CHD or DS had significantly higher rates of prolonged RSV hospitalization. Those with ≥ 1 risk factor, and presumably patients with DS and CHD are at highest risk for severe complications. Preventive strategies for these high-risk populations should be considered in their second-year of life. What is Known: • Children with prematurity, congenital heart disease (CHD), chronic lung disease of prematurity (CLD) or Down syndrome (DS) are at increased risk for severe RSV-related illness in the first year of life. • The second year of life is now relevant for long-acting RSV prevention strategies. What is New: • This multicenter study shows that prematurity, CLD, CHD, and DS remain strong predictors of prolonged RSV hospitalization in children aged 12–23 months. • Those with ≥ 1 risk factor, and presumably those with DS and major CHD, faced the highest risk, with increased likelihood of PICU admission.