A new study finds that underlying chronic conditions and hospital transfers are major indicators of severe disease in pediatric patients with respiratory tract infections.


RT’s Three Key Takeaways:

  1. High Severity Rate: Nearly one-quarter of children hospitalized with acute respiratory tract infections developed severe disease requiring intensive interventions like mechanical ventilation or extracorporeal therapy.
  2. Primary Risk Factors: Having two or more chronic conditions or being transferred from a referring hospital were the strongest predictors for developing severe respiratory illness.
  3. Viral Pathogens: While respiratory syncytial virus and enterovirus-rhinovirus were the most common pathogens, the presence of multiple viruses was not associated with increased disease severity.


Hospitalized children with acute respiratory tract infections (RTIs) frequently have underlying chronic conditions and require intensive medical intervention, according to a study published in JAMA Network Open.1

The analysis identified several key factors associated with a higher risk of severe outcomes.1 Children with two or more preexisting chronic conditions had a significantly higher risk compared to those with no comorbidities.1 The most common underlying issues among the cohort were neurologic, developmental, or genetic conditions (25.3%), followed by asthma (16.9%), and other pulmonary diseases (13.9%).1

Transfer status also served as a major marker for severity. Patients transferred from a referring institution were nearly five times more likely to develop severe disease than those admitted directly.1 Additionally, the study noted a bimodal distribution in age-associated risk, with children younger than 1 year and those older than 10 years facing the greatest risk for severe illness.1

Viral testing was performed for 90.2% of the participants, identifying a pathogen in 70.7% of those tested.1 Respiratory syncytial virus (RSV) was the most common virus, detected in 709 children, followed by enterovirus–rhinovirus (EV-RV) in 598 children.1 Other identified pathogens included influenza, parainfluenza, and human metapneumovirus (hMPV).1

The multisite cohort study, which included 2,585 children aged 0 to 18 years, found that 21.3% of patients developed severe disease.1

While viral coinfections—the presence of two or more viruses—were detected in 338 children, the researchers found that these cases were not associated with increased disease severity.1

Respiratory support was a primary component of clinical management, utilized in 75.6% of the cohort.1 Low-flow nasal cannula or mask was used in 73.7% of patients receiving support, while 52.9% required high-flow nasal cannula.1 Noninvasive ventilation was used in 24.4% of cases, and 11.7% required invasive mechanical ventilation.1

The median length of hospital stay was three days, though this increased to six days for children with severe disease. Nearly 25% of the total cohort required admission to a pediatric intensive care unit (PICU).1

Complications occurred in approximately one-quarter of the children.1 Among those with influenza, 25.5% developed ARDS, and 17.7% experienced septic shock. Patients with hMPV had notable rates of extracorporeal support, with 10.6% requiring ECMO and 8.5% requiring KRT.1

Although the mortality rate remained low at 1.4%, the study authors emphasized that the high rate of severe outcomes and complications highlights the substantial healthcare burden posed by pediatric respiratory infections.1


Reference

  1. Mtaweh H, Kaziev CL, Feinstein CA, et al. Acute Respiratory Tract Infections and Severe Disease Among Hospitalized Children. JAMA Netw Open. 2026;9(6):e2617575. doi:10.1001/jamanetworkopen.2026.17575