Respiratory tract infections in children often lead to a visit with a pediatrician and can even require a trip to the emergency department or hospitalization. 

A study published in JAMA Network Open looked at why some children with acute respiratory infections experience severe complications and found that that children who had two or more chronic conditions or who had been transferred from another hospital tend to be sicker. 

“Understanding the epidemiologic profile and factors associated with risk of severe disease in this population can inform resource allocation to optimize outcomes for pediatric patients,” wrote the authors, who were led by researchers at the University of Toronto. 

Scientists evaluated data on 2,585 children with respiratory tract infections who were admitted to one of two Canadian medical centers, the Hospital for Sick Children in Toronto and BC Children’s Hospital in Vancouver, from July 1, 2022, to June 30, 2023. 

Over half (50.6%) had at least one chronic condition, the most common of which were neurologic, developmental, or genetic, and a third (34%) had been moved from another hospital. 

Understanding the epidemiologic profile and factors associated with risk of severe disease in this population can inform resource allocation to optimize outcomes for pediatric patients.

Children who had two or more conditions or who were transferred were at increased risk for severe illness. The researchers considered serious illness to include needing non-invasive breathing assistance such as a bilevel positive airway pressure (BiPAP), invasive breathing support, or extra-corporeal membrane oxygenation or experiencing cardiac arrest or dying. The risk of death remained low, at less than 2%.  

“Children with 2 or more chronic conditions faced a substantially increased risk of severe outcomes,” the authors wrote. “These findings suggest that children with chronic health conditions represent a high-risk group who should be prioritized for preventive strategies and emerging prophylactic [preventive] treatments.” 

The researchers also found that 15% of children had viral co-infections, although they did not worsen their illness. “In this cohort, the proportion of severe and non-severe outcomes was similar among children with multiple viruses,” the authors concluded.