Children hospitalised with acute respiratory tract infections (RTIs) are significantly more likely to develop severe disease if they have multiple chronic health conditions or require transfer from another hospital, according to a large cohort study.
The findings provide an updated overview of the characteristics and outcomes of pediatric RTIs in the post-pandemic era and may help clinicians identify children at greatest risk of deterioration while supporting healthcare planning during periods of high respiratory virus circulation.
Large Multicentre Study Evaluates Pediatric RTIs
Researchers conducted a retrospective cohort study across two Canadian children’s hospitals, including 2,585 patients aged 0–18 years who were hospitalized with acute RTIs between July 2022 and June 2023.
The primary outcome was severe disease, defined as requiring non-invasive or invasive mechanical ventilation, extracorporeal membrane oxygenation (ECMO), kidney replacement therapy, cardiac arrest, or death.
The investigators also assessed demographic characteristics, viral pathogens, underlying medical conditions, and factors associated with severe outcomes.
One in Five Children Developed Severe Disease
The median age of hospitalized children was 2.5 years, and almost 60% were male. More than half of patients (50.6%) had at least one chronic medical condition, with neurologic, developmental, and genetic disorders representing the most common comorbidities.
Overall, 21.3% of children developed severe disease during their hospitalization, highlighting the substantial burden of serious respiratory illness in pediatric inpatient care.
Hospital stays lasted a median of three days, although illness severity varied considerably across the cohort.
Chronic Conditions Increased Risk
Multivariable analysis identified several factors independently associated with severe disease.
Children with two or more chronic conditions had a 62% higher risk of developing severe illness compared with those without multiple comorbidities (adjusted risk ratio [aRR] 1.62).
An even stronger association was observed among children transferred from another hospital, who were nearly five times more likely to experience severe outcomes (aRR 4.73). The authors suggest this likely reflects greater illness severity at presentation and the need for higher levels of specialist care.
RSV and Rhinovirus Were the Most Common Viruses
Viral testing was performed in more than 90% of patients, with a respiratory virus identified in over 70% of those tested.
The most frequently detected pathogens were respiratory syncytial virus (RSV), identified in 709 children, and enterovirus-rhinovirus, detected in 598 children. Viral coinfections were found in 338 patients.
Despite changes in respiratory virus circulation following the COVID-19 pandemic, the study demonstrates that RSV and rhinovirus continue to account for a substantial proportion of pediatric respiratory hospitalizations.
Supporting Clinical Decision-Making
The authors conclude that children hospitalized with acute RTIs frequently have underlying chronic illnesses and often require intensive medical support. Recognizing patients at highest risk of severe disease could help clinicians prioritize monitoring, guide resource allocation, and improve preparedness during seasonal respiratory virus surges.
The researchers suggest that incorporating risk factors such as multiple comorbidities and transfer status into clinical assessment may help optimize care for children hospitalized with respiratory infections.
Reference
Mtaweh H et al. Acute Respiratory Tract Infections and Severe Disease Among Hospitalized Children. JAMA Netw Open. 2026;9(6):e2617575.
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