A single-center retrospective study analyzed 192 children with Epstein-Barr virus (EBV) infection hospitalized from January 2022 to October 2025. Patients were divided into a group with high EBV DNA viral load (n=99) and low (n=93). The high-load group had significantly higher peak ALT (p<0.001) and AST (p=0.036), received glucocorticoids more often (p=0.002) and longer hospitalization (p<0.001). Virologically, she had higher EBV DNA levels on admission (p<0.001), which decreased in both groups until discharge (p<0.001). Complications were more frequent (p<0.001), including splenomegaly (p=0.001). Multivariate Cox regression confirmed high viral load (HR=0.528, p<0.001) and splenomegaly (HR=0.665, p=0.016) as independent predictors of prolonged hospitalization. A high EBV DNA load is associated with the need for immunomodulatory treatment and prolonged liver complications. Viral load monitoring helps identify children at high risk for adverse outcomes.