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. 2023 Jan;17(1):e13038.
doi: 10.1111/irv.13038. Epub 2022 Oct 3.

Severe viral respiratory infections in the pre-COVID era: A 5-year experience in two pediatric intensive care units in Italy

Maia De Luca  1 , Carmen D'Amore  2 , Lorenza Romani  1 , Costanza Tripiciano  3 , Vitangelo Clemente  4 , Stefania Mercadante  3 , Daniela Perrotta  5 , Joseph Nunziata  6 , Corrado Cecchetti  6 , Emanuele Rossetti  7 , Roberto Bianchi  7 , Carlo Federico Perno  8   9 , Paola Bernaschi  8 , Cristina Russo  8 , Laura Lancella  1 , Massimiliano Raponi  10 , Marta Luisa Ciofi Degli Atti  2
Affiliations

Severe viral respiratory infections in the pre-COVID era: A 5-year experience in two pediatric intensive care units in Italy

Maia De Luca et al. Influenza Other Respir Viruses. 2023 Jan.

Abstract

Background: Viral respiratory infections are one of the main causes of hospitalization in children. Even if mortality rate is low, 2% to 3% of the hospitalized children need mechanical ventilation. Risk factors for admission to the pediatric intensive care unit (PICU) are well known, while few studies have described risk factors for invasive ventilator support and prolonged hospitalization.

Methods: A retrospective study including all patients aged between 2 and 18 months with a confirmed viral respiratory infection, requiring admission to PICU from September to March between 2015 and 2019, was conducted at Bambino Gesù Children's Hospital in Rome, Italy.

Results: One hundred ninety patients were enrolled, with a median age of 2.7 months; 32.1% had at least one comorbidity, mainly prematurity. The most frequent isolated viruses were RSV-B, rhinovirus, and RSV-A; 38.4% needed mechanical ventilation. This subgroup of patients had lower median birth weight compared with patients not requiring mechanical ventilation (2800 g vs. 3180 g, p = 0.02); moreover, comorbidities were present in 43.8% of intubated patients and in 24.8% of patients treated with non-invasive ventilation (p = 0.006). Viral coinfection did not result to be a risk factor for mechanical support, while virus-bacteria coinfection was significantly associated with mechanical ventilation (p < 0.001). Similar risk factors were identified for prolonged hospitalization.

Conclusions: Early identification of patients who could have a sudden respiratory deterioration and need of mechanical ventilation is crucial to reduce complications due to orotracheal intubation and prolonged hospitalization in PICU. Further studies are needed to define high-risk group of patients and to design targeted interventions.

Keywords: bronchiolitis; intensive care units, pediatric; respiration, artificial; respiratory insufficiency; risk factors; viruses.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

FIGURE 1
FIGURE 1
Monthly distribution of viral isolates and number of PICU admissions for VRIs
See this image and copyright information in PMC

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