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The Impact of Viral Co-Infection in Children Treated With Respiratory Support Due to Lower Respiratory Tract

Signe Vahlkvist1, Arman Mohammad1, Poul-Erik Kofoed1

  • 1Department of Pediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark.

Pediatric Pulmonology
|January 6, 2025
PubMed

Insights

Viral co-infections involving respiratory syncytial virus (RSV), rhino/enterovirus (REV), or metapneumovirus (MPV) significantly impact treatment length and failure in children with lower respiratory tract infections (LRTI) receiving high-flow nasal cannula (HFNC) therapy.

Area of Science:

  • Pediatric Respiratory Medicine
  • Infectious Diseases
  • Critical Care

Background:

  • Lower respiratory tract infections (LRTI) are common in young children, often requiring respiratory support.
  • Viral co-infections can complicate LRTI management and outcomes.
  • High-flow nasal cannula (HFNC) and continuous positive airway pressure (CPAP) are key respiratory support modalities.

Purpose of the Study:

  • To determine the influence of viral co-infections on treatment duration and failure rates in pediatric LRTI patients.
  • To compare outcomes between HFNC and CPAP therapies in the context of viral co-infections.

Main Methods:

  • Retrospective chart audit of 148 children (0-5 years) hospitalized with viral LRTI requiring respiratory support.
  • Analysis of treatment length and failure rates based on viral pathogen and respiratory support type (HFNC vs. CPAP).

Main Results:

  • Co-infections with respiratory syncytial virus (RSV), rhino/enterovirus (REV), and/or metapneumovirus (MPV) were independent predictors of HFNC treatment failure (p<0.05) and increased treatment length (p<0.01).
  • Co-infections involving adenovirus (AV) or parainfluenza virus (PIV) did not significantly affect treatment outcomes.
  • HFNC treatment failed in 17 children, necessitating a switch to CPAP.

Conclusions:

  • Combinations of RSV, REV, and/or MPV infections significantly impact treatment outcomes in children with LRTI managed with HFNC.
  • Co-infections with AV or PIV do not appear to influence treatment length or failure in this patient population.
  • Understanding specific viral co-infection patterns is crucial for optimizing respiratory support strategies in pediatric LRTI.
Abstract

Keywords:
CPAPHFNCbronchiolitischildrenlower respiratory tract infectionsviral co‐infection

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