Multiple Chronic Conditions Raise Risk of Severe Respiratory Infections in Children: JAMA

A new study published in the Journal American Medical Association showed that children who are moved from another hospital or who have two or more chronic medical disorders are more likely to experience severe disease from acute respiratory tract infections.

Due to seasonality, immunity, transmission, and disruptive events like pandemics, the epidemiology of viral respiratory tract infections (RTIs) in children is always shifting. Thus, the purpose of this study was to investigate risk factors for severe illness and to characterize the clinical features and outcomes of children hospitalized with acute RTIs.

Two children's hospitals in Canada participated in this multisite, retrospective cohort research. Children between the ages of 0 and 18 who were hospitalized for acute RTIs between July 1, 2022, and June 30, 2023, were included in the study. 30 days following release, a readmission follow-up was conducted.

The main outcome was the percentage of patients who experienced severe illness, which was characterized by the requirement for renal replacement treatment, extracorporeal membrane oxygenation therapy, noninvasive or invasive mechanical ventilation, cardiac arrest, or death. Clinical features and demographics were also discussed.

The median (IQR) age of the 2585 children who were admitted to the hospital due to acute RTIs was 2.5 (0.9-5.0) years. 1307 patients (50.6%) and 1542 male children (59.7%) had at least one chronic disease; the most prevalent conditions were neurologic, developmental, or genetic.

879 children [34.0%], or more than one-third, were moved from a referral facility.

A viral pathogen was found in 1828 (70.7%) of the 2332 patients (90.2%) who underwent viral testing. In 338 youngsters, viral co-infections were found.

Enterovirus-rhinovirus (598 children) and respiratory syncytial virus (709 children) were the most prevalent viruses.

Three (2–6) days was the median (IQR) duration of hospital stay. 551 children [21.3%], or nearly 25% of the total, experienced serious illness.

Individuals who were moved from a referring hospital (aRR, 4.73; 95% CI, 4.01-5.59) or had two or more comorbidities (aRR, 1.62; 95% CI, 1.36-1.93) were more likely to experience severe illness.

Overall, many of the hospitalized children in this cohort study who had acute RTI became really unwell and needed intensive care. While viral co-infections were widespread but unrelated to the severity of the disease, chronic diseases were linked to higher risk.

Source:

Mtaweh, H., Kaziev, C. L., Feinstein, C. A., Seaton, C., Farrar, D. S., Datta, R. R., Mahant, S., Campigotto, A., Freire, G., Yeung, R. S. M., Bone, J. N., Buchanan, F., Morris, S. K., Gill, P. J., & READAPT-Kids Study Group. (2026). Acute respiratory tract infections and severe disease among hospitalized children. JAMA Network Open, 9(6), e2617575. https://doi.org/10.1001/jamanetworkopen.2026.17575