Clinical and viral profile of children admitted in the paediatric intensive care unit due to severe acute respiratory infection during seasonal surge from a tertiary care centre in Eastern India

Abstract

Background: Acute lower respiratory infections (ALRI), such as pneumonia and bronchiolitis are a leading cause of morbidity and mortality in young children worldwide. Aetiology in young children is mostly viral infection or viral and bacterial infection. Objectives: To study various clinical characteristics among different age groups and viral profiling in children requiring intensive care due to ALRI. Method: Children between 1 month to 12 years, who satisfied the case definition of severe acute respiratory infection (SARI) and who were shifted to the paediatric intensive care unit (PICU) for ventilatory support were included in the study. All children were subjected to history taking, detailed examination, required blood investigations, oropharyngeal and nasopharyngeal swab testing. Results: Of the total 46 cases 32 (69.5%) were <1 year of age, 11 (24%) 1 to 5 years of age, and 3 (6.5%) above 5 years of age. There were 17 (36.9%) deaths. There was 2.3 times more risk of death in the absence of exclusive breastfeeding (OR- 2.3, 95% CI= 0.6-7.9) and 2.2 times higher risk of mortality in the absence of immunization (OR- 2.2, 95% CI=0.6-7.9). Mortality was significantly associated with mechanical ventilation (p<0.0001). Mortality was 17 times higher in children with comorbidities (OR-17, 95% CI= 2-146), 4.7 times higher in children with congenital heart disease (CHD) (OR-4.7 95%CI= 1-22) and 1.3 times higher in children with pre-existing central nervous system (CNS) abnormality (OR-1.33, 95% CI=0.3-6.8). From the respiratory viral panel, 18 (41%) samples were positive for virus detection. Conclusions: In this study 69.5% children with SARI were infants. Mortality was 36.9%. There was a statistically significant increased risk of death in the absence of exclusive breastfeeding, absence of immunization, use of mechanical ventilation, presence of comorbidities, presence of CHD and presence of pre-existing CNS abnormality. Sri Lanka Journal of Child Health, 2023: 52(2): 175-181