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Characteristics of young children hospitalized with acute respiratory failure from infection with RSV, SARS-CoV-2, or both, November 2023–March 2024
Journal article   Open access   Peer reviewed

Characteristics of young children hospitalized with acute respiratory failure from infection with RSV, SARS-CoV-2, or both, November 2023–March 2024

Samina S Bhumbra, Janet R Hume, Michele Kong, Mia Maamari, Bria M Coates, Judith A Guzman-Cottrill, Mary Allen Staat, Thomas J Connors, Matt S Zinter, Jigar C Chauhan, …
Open forum infectious diseases, Vol.13(3), ofag088
03/2026
DOI: 10.1093/ofid/ofag088
PMCID: PMC12978529
PMID: 41822373
url
https://doi.org/10.1093/ofid/ofag088View
Published (Version of record) Open Access

Abstract

Background Respiratory syncytial virus (RSV) and SARS-CoV-2 can cause acute respiratory failure in children. We compared characteristics and outcomes of children aged <2 years with respiratory failure from infection with RSV, SARS-CoV-2, or both viruses. Methods We used data from a U.S. pediatric respiratory virus hospitalization surveillance network including children with ICU admission for acute respiratory failure (receiving high-flow oxygen or mechanical ventilation) with RSV and/or SARS-CoV-2 during November 2023–March 2024. Demographic, clinical characteristics, and hospitalization outcomes were stratified by a positive test for RSV, SARS-CoV-2, or both viruses, and compared using chi-squared or Kruskal-Wallis tests. Multivariable analyses assessed independent associations between outcomes and infection. Results Overall, 1,406 children were included: 1,253 (89.1%) for RSV, 105 (7.5%) for COVID-19, and 48 (3.4%) with RSV+SARS-CoV-2 detected. Children with RSV or RSV+SARS-CoV-2 had lower median ages (3.9 vs. 5.4 months, respectively) compared to those with SARS-CoV-2 (8.8 months; p<0.001). Twenty percent of children with RSV and 43.8% with COVID-19 had an underlying medical condition. Among infants aged <1 year for whom preterm status was available, 31.5% with RSV and 50% with COVID-19 had either prematurity or a comorbidity. Children with SARS-CoV-2 were more likely to require invasive mechanical ventilation, receive vasoactive infusions, and die compared to RSV with and without SARS-CoV-2. Conclusions Critically ill children <2 years of age infected with SARS-CoV-2 had more severe illness presentation and outcomes and were older compared to those with RSV and RSV+SARS-CoV-2 codetection. Most children were previously healthy, highlighting the need for prevention measures
 COVID-19 pediatric respiratory failure respiratory syncytial virus

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