Severe Acute Respiratory Tract Infections in Hospitalized Children: Study Sheds Light on Burden and Risk Factors
Canada: A recent cohort study found that children hospitalized with acute respiratory tract infections frequently have underlying chronic medical conditions and often require intensive care interventions.
The findings highlight the significant burden of severe respiratory illness in pediatric patients and highlight the importance of understanding epidemiologic patterns and risk factors for severe disease. Such insights can help guide healthcare resource allocation, improve preparedness, and optimize clinical outcomes for hospitalized children.
Published in JAMA Network Open, the study by Haifa Mtaweh and colleagues at The Hospital for Sick Children in Toronto examined the clinical characteristics of children hospitalized with acute respiratory tract infections (RTIs) and identified factors associated with severe disease.
Acute RTIs are a major cause of pediatric hospitalization, with disease patterns influenced by changing viral circulation, seasonality, population immunity, and events such as the COVID-19 pandemic. Identifying children at higher risk of severe illness is important for improving clinical care and healthcare planning.
The retrospective cohort study included 2,585 children aged 0 to 18 years who were hospitalized with acute RTIs at two Canadian pediatric hospitals between July 2022 and June 2023. The median age was 2.5 years, and 59.7% of participants were boys.
The study revealed the following findings:
- Among the 2,585 hospitalized children with acute respiratory tract infections, 50.6% had at least one chronic medical condition.
- Neurologic, developmental, and genetic disorders were the most common underlying chronic conditions.
- More than one-third of patients (34.0%) were transferred from another healthcare facility before admission.
- Viral testing was performed in 90.2% of children, and a respiratory virus was identified in 70.7% of those tested.
- The most frequently detected viruses were respiratory syncytial virus (RSV) and enterovirus-rhinovirus.
- Viral coinfections were identified in 338 children.
- Severe disease developed in 551 children, accounting for 21.3% of the study population.
- Severe illness was defined by the need for noninvasive or invasive mechanical ventilation, extracorporeal membrane oxygenation (ECMO), kidney replacement therapy, cardiac arrest, or death.
- Children with two or more chronic conditions had a 62% higher risk of developing severe disease (adjusted risk ratio [aRR] 1.62).
- Children transferred from a referring hospital were nearly five times more likely to experience severe disease (aRR 4.73).
- The median length of hospital stay was 3 days.
- Although viral coinfections were common, they were not associated with an increased risk of severe disease.
The authors acknowledged several limitations, including the study's retrospective design, potential diagnostic misclassification, and the lack of direct comparison with community hospitals. They also noted that viral circulation patterns may change over time, highlighting the importance of continued surveillance.
Overall, the findings indicate that severe respiratory illness remains a considerable burden among hospitalized children. The researchers concluded that recognizing high-risk patients, particularly those with multiple chronic conditions, can help clinicians prioritize care, allocate resources effectively, and improve outcomes for children admitted with acute respiratory tract infections.
Reference:
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
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