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J Pediatr Intensive Care 2022; 11(01): 013-018
DOI: 10.1055/s-0040-1718868
Original Article

Adenoviral Respiratory Infection-Associated Mortality in Children: A Retrospective Case Series

Michael C. Spaeder 
1   Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
Claire Stewart
2   Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Matthew P. Sharron
3   Division of Critical Care Medicine, Children's National Hospital, Washington, District of Columbia, United States
,
Julia R. Noether 
4   Division of Pediatric Critical Care, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, United States
,
Natalia Martinez-Schlurman 
5   Division of Pediatric Critical Care, University of Florida School of Medicine, Gainesville, Florida, United States
,
Robert P. Kavanagh
6   Division of Pediatric Critical Care, Pennsylvania State University School of Medicine, Hershey, Pennsylvania, United States
,
Jessica K. Signoff 
7   Division of Pediatric Critical Care, University of California at Davis School of Medicine, Sacramento, California, United States
,
Michael C. McCrory
8   Pediatric Critical Care, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
,
Daniel B. Eidman 
9   Pediatric Critical Care, Yale University School of Medicine, New Haven, Connecticut, United States
,
Anjali V. Subbaswamy
10   Division of Pediatric Critical Care, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
,
Paul L. Shea
11   Division of Pediatric Critical Care, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
,
Ilana Harwayne-Gidansky
12   Division of Pediatric Critical Care, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, United States
,
Emily K. Ninmer
1   Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States
,
Mary Lynn Sheram
13   Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
,
Christopher M. Watson
13   Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, Georgia, United States
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Abstract

Viral respiratory infections are a leading cause of illness and hospitalization in young children worldwide. Case fatality rates in pediatric patients with adenoviral lower respiratory tract infection requiring intensive care unit (ICU) admission have been reported between 7 and 22%. We investigated the demographics and clinical characteristics in pediatric mortalities associated with adenoviral respiratory infection at 12 academic children's hospitals in the United States. There were 107 mortality cases included in our study, 73% of which had a chronic medical condition. The most common chronic medical condition was immunocompromised state in 37 cases (35%). The incidences of pediatric acute respiratory distress syndrome (78%) and multiple organ dysfunction syndrome (94%) were profound. Immunocompetent cases were more likely to receive mechanical ventilation within the first hour of ICU admission (60 vs. 14%, p < 0.001) and extracorporeal membrane oxygenation (27 vs. 5%, p = 0.009), and less likely to receive continuous renal replacement therapy (20 vs. 49%, p = 0.002) or have renal dysfunction (54 vs. 78%, p = 0.014) as compared with immunocompromised cases. Immunocompromised cases were more likely to have bacteremia (57 vs. 16%, p < 0.001) and adenoviremia (51 vs. 17%, p < 0.001) and be treated with antiviral medications (81 vs. 26%, p < 0.001). We observed a high burden of nonrespiratory organ system dysfunction in a cohort of pediatric case fatalities with adenoviral respiratory infection. The majority of cases had a chronic medical condition associated with an increased risk of complications from viral respiratory illness, most notably immunocompromised state. Important treatment differences were noted between immunocompromised and immunocompetent cases.

Keywords

respiratory tract infections - adenovirus - intensive care - children - pediatric


Publication History

Received: 01 August 2020

Accepted: 19 September 2020

Article published online:
26 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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