Hospitalizations for viral respiratory infections in children under 2 years of age: epidemiology and in-hospital complications

Abstract

Background Viral respiratory infections (VRIs) are a frequent cause of hospitalization in children under 24 months of age. A history of prematurity or heart disease may be a risk factor for complications in patients hospitalized for VRI. The objective was to describe epidemiological data for children hospitalized for IRV and aged 1 to 24 months and to identify risk factors for the presence of in-hospital complications and mortality over a period of 5 years. Methods This was a cross-sectional study. Patients registered with VRI codes B974, J12, J120-J129X, J168, J17, J171, J178, J20, J203-J209, J21, J210, J211, J218, J219 (based on International Classification of Diseases [ICD-10]) from 2013 to 2017 were included. Three subanalyses were performed to compare [1] patients with pathological history (prematurity, bronchopulmonary dysplasia [BPD] and congenital heart disease [CHD]), [2] diagnoses (pneumonia, acute bronchitis, and acute bronchiolitis), and [3] admission to the pediatric intensive care unit. Days of hospital stay, in-hospital complications, invasive medical procedure and mortality were analyzed. Statistical analysis: VRI hospitalization prevalence was described. For comparison between groups, Student’s t-test, ANOVA and the Chi2 test were applied. To identify factors related to days of hospital stay, in-hospital complications and mortality, a linear and logistic regression model was performed. Results A total of 66,304 hospitalizations were reported. The average age was 14.7 weeks; hospitalization events were higher in winter (39%), followed by autumn (27.3%). A total of 371 (0.56%) patients died. A total of 7068 (10.6%) hospitalized patients with pathological histories were identified. The presence of BPD (coefficient = 1.6), CHD (coefficient = 1.2), diagnosis of pneumonia (coefficient = 1.2), in-hospital complications (coefficient = 2.1) and invasive medical procedures (coefficient = 15.7) were the most common factors that increased the length of hospital stay. Risk factors for in-hospital complications and mortality were invasive medical procedure (OR = 3.3 & 11.7), BPD (OR = 1.8 & 1.6), CHD (OR = 4.6 & 3.4) and diagnosis of pneumonia (OR = 1.8 & 4.2). Conclusions Risk factors for morbidity and mortality in patients hospitalized for VRIs are BPD and CHD, diagnosis of pneumonia and invasive medical procedure.

Respiratory viral infections are prevalent but uncomplicated in single ventricle CHD

“…9 In a large population study of 66,304 hospital admissions of children 1-24 months old, Zuritz-Cruz et al reported a mean length of stay of 4.1 ± 4.4 days for a respiratory viral infection. 8 Thus, hospital length of stay, a surrogate for illness severity, in our single ventricle cohort is comparable to previous studies and relatively brief during the periods of Glenn circulation and Fontan circulation.…”

“…5,6 Simple and complex forms of CHD are risk factors for viral-related hospital admissions and increased hospital length of stay for viral-related admissions. 7,8 Focusing on patients with single ventricle CHD, one recent study showed that upper and lower respiratory infections are the most common causes of non-cardiac hospital admissions. 9 However, few data exist on how respiratory viruses influence clinical presentations, hospital admissions, and hospital length of stay for patients with single ventricle CHD.…”

Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study

“…The rates of these complications and mortality are much higher than reported in the literature. 38 , 39 …”

Age and respiratory syncytial virus etiology in bronchiolitis clinical outcomes

“…This is consistent with the findings of other studies in which younger infants were at higher risk of need for supplemental O 2 administration and PICU admission. 11 , 21 , 22 , 23 , 24 , 25 , 26 These clinical data are correlated quite precisely with improved understanding of the infant's immune system, in which the innate immune response against RSV, especially the interferon response, does not appear to be protective until after 6 months of age. 27 , 28 …”