Adenoviral Respiratory Infection-Associated Mortality in Children: A Retrospective Case Series

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Virology

Background:

• Viral respiratory infections are a major cause of pediatric illness and hospitalization globally.
• Adenoviral lower respiratory tract infections carry significant mortality risk in critically ill children.

Purpose of the Study:

• To investigate the demographics and clinical features of pediatric fatalities due to adenoviral respiratory infections.
• To compare clinical characteristics and treatment between immunocompromised and immunocompetent children who died from adenovirus infection.

Main Methods:

• Retrospective analysis of 107 pediatric mortality cases across 12 US academic children's hospitals.
• Data collected on demographics, chronic medical conditions, and clinical course, including organ dysfunction and treatments.

Main Results:

• 73% of pediatric fatalities had a chronic medical condition, most commonly an immunocompromised state (35%).
• High rates of pediatric acute respiratory distress syndrome (78%) and multiple organ dysfunction syndrome (94%) were observed.
• Immunocompromised cases showed higher rates of bacteremia, adenoviremia, and antiviral treatment, while immunocompetent cases received more mechanical ventilation and ECMO early in ICU admission.

Conclusions:

• Chronic medical conditions, particularly immunocompromised states, are associated with increased risk and complications in pediatric adenovirus respiratory fatalities.
• Significant differences in clinical presentation, organ dysfunction, and treatment strategies exist between immunocompromised and immunocompetent pediatric patients with fatal adenoviral respiratory infections.