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Human Metapneumovirus Infection in Hospitalized Children
Nicholas F Holzemer1, Jennifer J Hasvold2, Kyle J Pohl3
1Department of Internal Medicine - Pediatrics, University of Michigan, Ann Arbor, Michigan.
Insights
Human metapneumovirus (HMPV) infections in children can lead to acute kidney injury (AKI). The risk of developing HMPV-associated AKI increases with age, even in those without other health conditions.
Area of Science:
- Pediatric Infectious Diseases
- Viral Respiratory Infections
- Nephrology
Background:
- Human metapneumovirus (HMPV) is a common respiratory virus in children.
- Most children are infected by age five.
- Morbidity associated with HMPV in US children is not well-described.
Purpose of the Study:
- To describe the morbidity associated with HMPV infections in a pediatric cohort in the Midwestern United States.
- To identify risk factors for severe outcomes, including acute kidney injury (AKI).
Main Methods:
- Retrospective 2-center cohort study of children (0-17 years) hospitalized with HMPV infections from 2009-2013.
- Data collected included demographics, comorbidities, viral coinfections, respiratory support needs, pediatric intensive care unit (PICU) admission, AKI, extracorporeal membrane oxygenation (ECMO), and length of stay.
- Statistical analysis was performed to identify factors associated with AKI.
Main Results:
- 131 children were included; 75.6% required respiratory support.
- 38.9% required PICU admission, and 12.2% developed AKI.
- Older age was associated with a higher risk of AKI, with a 16% increase in odds per year of age, independent of comorbidities or respiratory illness severity.
Conclusions:
- Children hospitalized with HMPV are at risk for AKI.
- Age is a significant risk factor for HMPV-associated AKI.
- Further research is needed to understand the mechanisms and long-term implications of HMPV-associated AKI.
Background:
Most children are exposed to human metapneumovirus (HMPV) by the age of 5 y. This study aimed to describe the morbidity associated with HMPV infections in a cohort of children in the Midwest of the United States.
Methods:
This was a retrospective 2-center cohort study including children (0-17 y old) hospitalized with HMPV infections at 2 tertiary care pediatric hospitals from 2009 to 2013. Demographics, chronic medical conditions, viral coinfections, and hospitalization characteristics, including the need for respiratory support, high-flow nasal cannula, CPAP, bi-level positive airway pressure, invasive mechanical ventilation, pediatric ICU admission, acute kidney injury (AKI), use of extracorporeal membrane oxygenation, and length of stay, were collected.
Results:
In total, 131 subjects were included. Those with one or more comorbidities were older than their otherwise healthy counterparts, with a median age of 2.8 y (interquartile range [IQR] 1.1-7.0) compared to 1.3 y (IQR 0.6-2.0, P < .001), respectively. Ninety-nine (75.6%) subjects required respiratory support; 72 (55.0%) subjects required nasal cannula, simple face mask, or tracheostomy mask as their maximum support. Additionally, 1 (0.8%) subject required high-flow nasal cannula, 1 (0.8%) subject required CPAP, 2 (1.5%) subjects required bi-level positive airway pressure, 15 (11.5%) subjects required invasive mechanical ventilation, 4 (3.1%) subjects required high-frequency oscillatory or jet ventilation, and 4 (3.1%) subjects required extracorporeal membrane oxygenation. Fifty-one (38.9%) subjects required pediatric ICU admission, and 16 (12.2%) subjects developed AKI. Subjects with AKI were significantly older than those without AKI at 5.4 y old (IQR 1.6-11.7) versus 1.9 y old (IQR 0.7-3.5, P = .003). After controlling for the presence of at least one comorbidity and cystic fibrosis, each year increase in age led to a 16% increase in the odds of AKI (P = .01). The median length of stay for the entire cohort was 4.0 d (IQR 2.7-7.0).
Conclusions:
Children hospitalized with HMPV may be at risk for AKI. Risk of HMPV-associated AKI appears to increase with age regardless of severity of respiratory illness or presence of comorbidities.
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