Clinical Outcomes of Acute Viral Lower Respiratory Infections in Hospitalized Children.

BACKGROUND: Viral infections represent a significant global health strain in children who are below the age of five years. Among these, lower respiratory tract infections (LRTIs) pose a higher risk, particularly in children with comorbid conditions. However, less is known about the impact of LRTIs on healthy children. This academic discourse aims to explore this gap by looking into the clinical outcomes of viral LRTIs in hospitalized children without comorbidities. OBJECTIVE: The objective of this study was to investigate whether the clinical outcomes of healthy children below the age of five years hospitalized as a result of viral LRTIs differed depending on the presence of single or multiple viral pathogens. METHODS: We carried out a monocentric retrospective study of 646 children below the age of five years who were admitted for LRTIs at Woodhull Medical and Mental Health Center, New York City, NY, between January 1, 2021, and December 31, 2023. Inclusion and exclusion criteria were applied to select healthy children with no significant medical history. Assessment of statistics was performed using IBM SPSS Statistics software, version 29.0 (IBM Corp., Armonk, NY), to study the clinical outcomes of focus, which included the requirement of a high-flow nasal cannula (HFNC) and other respiratory support, the need for transfer or ICU admission, and the length of hospital stay.  Results: The mean age of children in our study was 19.5 months. There were 293 (45.4%) females and 353 (54.6%) males. Of these, 297 (46%) tested positive for a viral pathogen, with respiratory syncytial virus (RSV) being the most common. Post hoc analysis showed a small effect size, Cohen's d = 0.302, 95% CI (0.645, 0.041), and no statistical significance (p = 0.077) when the mean length of hospital stay in children with multiple viruses was compared to those with a single virus. A total of 105 (16.3%) children required pediatric ICU (PICU) transfer, with a higher proportion having multiple viral infections compared to those with a single virus and no virus (p=0.025), with an effect size of 0.176, 95% CI (0.327, 0.076). Of the 68 (10.5%) children requiring respiratory support on admission, the need for support was significantly associated with the presence of a viral infection (p<0.001), although the effect size was also small (0.229) with a 95% CI (0.415, 0.091). There was no significant difference between the type of virus and the need for respiratory support or PICU transfer. CONCLUSION: In healthy children below the age of five years hospitalized with viral LRTIs, multiple viral infections were associated with more severe outcomes, including longer duration of hospitalization and a higher likelihood of PICU transfer. These findings call attention to the importance of considering viral co-infections in predicting disease severity and guiding clinical management, even in children with no risk factors.