The Impact of Viral Co-Infection in Children Treated With Respiratory Support Due to Lower Respiratory Tract Infections. An Observational Study.

Objective: To investigate the effect of viral co-infections on treatment length and treatment failure in children with lower respiratory tract infections (LRTI) supported with continuous positive airway pressure (CPAP) or high-flow nasal cannula oxygenation therapy (HFNC).

Methods: Patients aged 0-5 years hospitalized with viral LRTI and in need of respiratory support between August 1 and December 31, 2021, were retrospectively evaluated by patient chart audits.

Results: A total of 148 children (median age 10.1 [IQR 2.2-17.6] months) were included. Of this, 98 children were treated with HFNC and 50 with CPAP. Five children were transferred to the pediatric intensive care unit. In 17 children, HFNC treatment failed, leading to a shift to CPAP. The median treatment length was 90.6 (IQR 61-136) h. A total of 93 children were mono-infected: 66 with respiratory syncytial virus (RSV), 14 with rhino/enterovirus (REV), 11 with metapneumovirus (MPV), 1 with adenovirus (AV), and 1 with coronavirus. Fourteen children were co-infected with either RSV, REV or MPV and AV or parainfluenza virus (PIV). A total of 41 children were infected with both RSV and REV, RSV and MPV, MPV and REV, or all three viruses. Co-infections with RSV, MPV, and/or REV were independent predictors of treatment failure with HFNC (p < 0.05) and length of treatment (p < 0.01), whereas co-infections with AV or PIV had no effect.

Conclusion: In children with viral LRTI, the combination of RSV/REV/MPV had an impact on treatment length and failure with HFNC, whereas co-infections with either RSV, REV or MPV, and AV or PIV had not.