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Published on: April 4, 2019
Characteristics of Young Children Hospitalized With Acute Respiratory Failure From Infection With Respiratory
Regina M Simeone1, Margaret M Newhams2, Laura D Zambrano1
1Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Insights
Children infected with SARS-CoV-2 experienced more severe respiratory illness and worse outcomes compared to those with respiratory syncytial virus (RSV). This highlights the need for prevention strategies against both viruses in young children.
Area of Science:
- Pediatric infectious diseases
- Virology
- Critical care medicine
Background:
- Respiratory syncytial virus (RSV) and SARS-CoV-2 are significant causes of acute respiratory failure in children.
- Understanding the comparative impact of these viruses on pediatric critical illness is crucial.
Purpose of the Study:
- To compare the characteristics and outcomes of children under 2 years old experiencing respiratory failure due to RSV, SARS-CoV-2, or co-infection.
- To identify risk factors and clinical trajectories associated with each viral infection.
Main Methods:
- Utilized data from a US pediatric respiratory virus hospitalization surveillance network (November 2023-March 2024).
- Included children aged <2 years admitted to the ICU for acute respiratory failure.
- Compared demographic and clinical characteristics, and hospitalization outcomes stratified by RSV, SARS-CoV-2, or co-detection using statistical tests and multivariable analyses.
Main Results:
- 1406 children were analyzed: 1253 (89.1%) with RSV, 105 (7.5%) with COVID-19, and 48 (3.4%) with RSV + SARS-CoV-2.
- Children with SARS-CoV-2 were older (median 8.8 months) than those with RSV (3.9 months) or co-infection (5.4 months).
- SARS-CoV-2 infection was associated with higher rates of invasive mechanical ventilation, vasoactive infusions, and mortality compared to RSV.
Conclusions:
- Critically ill children under 2 with SARS-CoV-2 presented with more severe illness and poorer outcomes than those with RSV or co-infection.
- A significant proportion of affected children were previously healthy, underscoring the importance of preventative measures against both viruses.
Background:
Respiratory syncytial virus (RSV) and SARS-CoV-2 can cause acute respiratory failure in children. We compared characteristics and outcomes of children aged <2 years with respiratory failure from infection with RSV, SARS-CoV-2, or both viruses.
Methods:
We used data from a US pediatric respiratory virus hospitalization surveillance network including children with ICU admission for acute respiratory failure (receiving high-flow oxygen or mechanical ventilation) with RSV and/or SARS-CoV-2 during November 2023-March 2024. Demographic, clinical characteristics, and hospitalization outcomes were stratified by a positive test for RSV, SARS-CoV-2, or both viruses, and compared using chi-squared or Kruskal-Wallis tests. Multivariable analyses assessed independent associations between outcomes and infection.
Results:
Overall, 1406 children were included: 1253 (89.1%) for RSV, 105 (7.5%) for COVID-19, and 48 (3.4%) with RSV + SARS-CoV-2 detected. Children with RSV or RSV + SARS-CoV-2 had lower median ages (3.9 and 5.4 months, respectively) compared with those with SARS-CoV-2 (8.8 months; P < .001). Twenty percent of children with RSV and 43.8% with COVID-19 had an underlying medical condition. Among infants aged <1 year for whom preterm status was available, 31.5% with RSV and 50% with COVID-19 had either prematurity or a comorbidity. Children with SARS-CoV-2 were more likely to require invasive mechanical ventilation, receive vasoactive infusions, and die compared with RSV with and without SARS-CoV-2.
Conclusions:
Critically ill children <2 years of age infected with SARS-CoV-2 had more severe illness presentation and outcomes and were older compared with those with RSV and RSV + SARS-CoV-2 codetection. Most children were previously healthy, highlighting the need for prevention measures.
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