Exploring pneumonia in less than two-year-olds: comparing respiratory syncytial virus and pneumonia due to other pathogens
DOI:
https://doi.org/10.18203/2349-3291.ijcp20250096Keywords:
Continuous positive airway pressure, Intensive care unit, Pneumonia, Respiratory syncytial virusAbstract
Background: The purpose of this study is to compare the clinical characteristics and outcomes of RSV and non-RSV pneumonia in children less than two years weighing less than 10kg admitted to the Pediatric Intensive Care Unit (PICU) and also study the differences in efficacy of bubble Continuous Positive Airway Pressure (bCPAP) between the two groups.
Methods: Children with severe pneumonia (World Health Organization criteria) and moderate to severe distress (PRESS- Pneumonia Risk Emergency Score Severity criteria) were participants of this cross-sectional comparative study. They were tested for RSV and grouped. Both groups received bCPAP. Data collection included demographic details, clinical findings and outcomes.
Results: 70 children had pneumonia 18 had RSV pneumonia and 52 were non-RSV pneumonia cases. Suprasternal (p<0.05) and xiphoid retractions (p=0.034) were more prevalent in RSV pneumonia and it also required longer duration of bCPAP (50 hours versus 28 hours; p=0.023). bCPAP showed improvement in most of the cases in both groups (RSV-88.9%, non-RSV-80.8%). RSV cases demonstrated better improvement in saturation and respiratory rate within the first four hours of administration of bCPAP. Mortality was comparable between the two groups (RSV-5.6%, non-RSV-11.5%, p=0.14).
Conclusions: RSV pneumonia is associated with more severe respiratory distress and longer bCPAP support but final clinical outcomes of bCPAP were similar in both groups. This is the first study to report a higher prevalence of suprasternal and xiphoid retractions in RSV pneumonia and a significantly better initial response to bCPAP.
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References
Matthew S. Kelly, Thomas J. Sandora. Community-Acquired Pneumonia. In: Kliegman, ST Geme, Blum, Shah, Tasker, Wilson, editors. Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier; 2020: 428.
UN Millennium Development Goals Report 2015. Available at: www.un.org/millenniumgoals. Accessed on 10 Jun 2016.
Meissner H, Cody MD. Selected populations at increased risk from respiratory syncytial virus infection. Pediatr. Infect Dis J. 2003;22:40-5. DOI: https://doi.org/10.1097/01.inf.0000053884.21238.13
Gentile A, Lucion MF, Juarez MDV. Burden of respiratory syncytial virus disease and mortality risk factors in Argentina: 18 years of active surveillance in a children's hospital. Pediatr Infect Dis J. 2019;38:589-94. DOI: https://doi.org/10.1097/INF.0000000000002271
Borchers AT, Chang C, Gershwin ME, Gershwin LJ. Respiratory syncytial virus--a comprehensive review. Clin Rev Allergy Immunol. 2013;45:331-79. DOI: https://doi.org/10.1007/s12016-013-8368-9
Johansson C. Respiratory syncytial virus infection: an innate perspective F1000Research. 2016. Available at: https://doi.org. Accessed on 22 August 2024. DOI: https://doi.org/10.12688/f1000research.9637.1
Meissner, H., Groothuis, J. Immunoprophylaxis and the Control of RSV Disease. Pediatrics. 1997;100:260-3. DOI: https://doi.org/10.1542/peds.100.2.260
Meissner HC. Viral Bronchiolitis in Children. N Engl J Med. 2016;374:62-72. DOI: https://doi.org/10.1056/NEJMra1413456
Blanken MO, Rovers MM, Molenaar JM. Dutch RSV Neonatal Network. Respiratory syncytial virus and recurrent wheeze in healthy preterm infants. N Engl J Med. 2013;368:1791-9. DOI: https://doi.org/10.1056/NEJMoa1211917
Sigurs N, Aljassim F, Kjellman B. Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life. Thorax. 2010;65:1045-52. DOI: https://doi.org/10.1136/thx.2009.121582
Huang H, Chen S, Zhang X, et al. Detection and clinical characteristics analysis of respiratory viruses in hospitalized children with acute respiratory tract infections by a GeXP‐based multiplex‐PCR assay. J Clin Lab Anal. 2019;34:293-8. DOI: https://doi.org/10.1002/jcla.23127
Mazur NI, Caballero MT, Nunes MC. Severe respiratory syncytial virus infection in children: burden, management and emerging therapies. Lancet. 2024;404:1143-56. DOI: https://doi.org/10.1016/S0140-6736(24)01716-1
Revised WHO Classification and Treatment of Pneumonia in Children at Health Facilities: Evidence Summaries. Geneva: World Health Organization; 2014. Available at: https://www.ncbi.nlm.nih.gov. Accessed on 21 August 2024.
Miyaji Y, Sugai K, Nozawa A. Pediatric Respiratory Severity Score (PRESS) for Respiratory Tract Infections in Children. Austin Virol and Retrovirology. 2015;2:1009.
Geoghegan S, Erviti A, Caballero MT. Mortality due to Respiratory Syncytial Virus. Burden and Risk Factors. Am J Respir Crit Care Med. 2017;195:96-103. DOI: https://doi.org/10.1164/rccm.201603-0658OC
Bénet T, Picot VS, Awasthi S. For The Gabriel Network. Severity of pneumonia in under 5-year-old children from developing countries: a multicenter, prospective, observational study. Am J Trop Med Hyg. 2017;97:68-76. DOI: https://doi.org/10.4269/ajtmh.16-0733
Divarathne M, Ahamed R, Noordeen F. The impact of RSV-associated respiratory disease on children in Asia. J Pediatr Infect Dis 2018;14:79–88. DOI: https://doi.org/10.1055/s-0038-1637752
Zar HJ, Barnett W, Stadler A, Gardner-Lubbe S, Myer L, Nicol MP. Aetiology of childhood pneumonia in a well vaccinated South African birth cohort: a nested case-control study of the Drakenstein Child Health Study. Lancet Respir Med. 2016;4:463-72. DOI: https://doi.org/10.1016/S2213-2600(16)00096-5
Jain S, Williams DJ, Arnold SR. CDC EPIC Study Team. Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015;372:835-45. DOI: https://doi.org/10.1056/NEJMoa1405870
Pneumonia Etiology Research for Child Health (PERCH) Study Group. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet. 2019;394:757-79.
Lee YI, Peng CC, Chiu NC. Risk factors associated with death in patients with severe respiratory syncytial virus infection. J Microbiol Immunol Infect. 2016;49:737-42. DOI: https://doi.org/10.1016/j.jmii.2014.08.020
Haerskjold A, Kristensen K, Kamper-Jorgensen M. Risk factors for hospitalization for respiratory syncytial virus infection: a population-based cohort study of Danish children. Pediatr Infect Dis J. 2016;35:61-5. DOI: https://doi.org/10.1097/INF.0000000000000924
von Linstow ML, Larsen HH, Eugen-Olsen J. Human metapneumovirus and respiratory syncytial virus in hospitalized danish children with acute respiratory tract infection. Scand J Infect Dis. 2004;36:578-84. DOI: https://doi.org/10.1080/00365540410018166
Bjerg A, Sandstrom T, Lundback B. Time trends in asthma and wheeze in Swedish children 1996-2006: prevalence and risk factors by sex. Allergy. 2010;65:48-55. DOI: https://doi.org/10.1111/j.1398-9995.2009.02105.x
Davy K, Koskinas E, Watson C. Respiratory syncytial virus-associated pneumonia in primary care in Malawi. J Trop Pediatr. 2024;70:56-9. DOI: https://doi.org/10.1093/tropej/fmae013
Richard N, Komurian-Pradel F, Javouhey E. The impact of dual viral infection in infants admitted to a pediatric intensive care unit as-sociated with severe bronchiolitis. Pediatr Infect Dis J. 2008;27:213-7. DOI: https://doi.org/10.1097/INF.0b013e31815b4935
Silva ER, Pitrez MC, Arruda E. Severe lower respiratory tract infection in infants and toddlers from a non-affluent population: viral etiology and co-detection as risk factors. BMC Infect Dis. 2013;13:41. DOI: https://doi.org/10.1186/1471-2334-13-41
Harada Y, Kinoshita F, Yoshida LM. Does respiratory virus coinfection in-creases the clinical severity of acute respiratory infection among children infected with respiratory syncytial virus? Pediatr Infect Dis J. 2013;32:441-5. DOI: https://doi.org/10.1097/INF.0b013e31828ba08c
Martin ET, Kuypers J, Wald A, Englund JA. Multiple ver-sus single virus respiratory infections: viral load and clinical disease severity in hospitalized children. Version 2. Influenza Other Respir Viruses. 2012;6:71-7. DOI: https://doi.org/10.1111/j.1750-2659.2011.00265.x
Papenburg J, Hamelin MÈ, Ouhoummane N. Comparison of risk factors for human metapneumovirus and respiratory syn-cytial virus disease severity in young children. J Infect Dis. 2012;206:178-89. DOI: https://doi.org/10.1093/infdis/jis333