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Clinical profile, intensive care needs, and outcome of children with adenoviral pneumonia: a retrospective study from a tertiary care hospital in north India��Siva Vyasam*, Jyothi Jayaram, Subhabrata Sarkar1, Suresh Kumar Angurana, Shubham Raj, Ishani Bora1, �Karthi Nallasamy, Arun Bansal, Jayashree Muralidharan, Radha Kanta Ratho1�Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatric Centre, 1Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

Introduction:

  • Adenovirus is a leading cause of respiratory illnesses in children, accounting for 5-10% childhood pneumonia
  • Higher prevalence in under five years of age
  • Adenovirus is a significant pathogen in PICUs
  • Clinical presentations: mild upper respiratory tract infections to severe pneumonia, acute respiratory distress syndrome (ARDS), encephalopathy, and multi-organ dysfunction syndrome (MODS)
  • Most of studies are from developed countries, and their findings may not be directly applicable to resource-limited settings

Methodology

  • Study design: Retrospective study
  • Study setting: Pediatric emergency room and PICU of a tertiary care hospital in North India
  • Study duration: 2 years (July 2022 to June 2024)
  • Inclusion: Children aged 1 month to 12 years with adenovirus pneumonia
  • Approvals: Institute Ethics Committee
  • Data collection: Case record files and electronic database

Conclusions

  • Infants constituted largest group
  • Complications: ARDS (47%), MODS (26%), shock (25%), liver dysfunction (22%), and AKI (20%)
  • Nearly half of children required PICU admission
  • Mortality predictors: Lower admission pH, myocardial dysfunction, AKI, ARDS, shock, MODS, HCAIs

References

  • Varadarajan P. Clinical Profile of Children with Adenovirus Infection - A Hospital-based Observational Study. Indian Pediatr. 2024
  • Beura S. Adenovirus respiratory infection with severe pneumonia in hospitalized children: a case series. J Trop Pediatr. 2024;

Results

Multivariate logistic regression: lower admission pH; and presence of myocardial dysfunction, AKI, ARDS, shock, MODS, and HCAIs were independent predictors of mortality

Characteristics

n=85

Male, n (%)

61 (71.7)

Age groups (years), n (%)

​

<1

61 (71.7)

1-5

17 (20)

6-10

4 (4.7)

>10

3 (3.5)

Fever

85 (100)

Respiratory symptoms

85 (100)

Neurological symptoms

27 (31.8)

Gastrointestinal symptoms

27 (31.8)

Renal Symptoms

3 (3.5)

Presented in respiratory failure, n (%)

46 (54.1)

Underlying Co-morbidities, n (%)

19 (22.4)

Congenital cardiac disease

5 (5.9)

Neurological/neuromuscular disease

5 (5.9)

Suspected immunodeficiency

3 (3.5)

Acute leukemia

3 (3.5)

Chronic lung disease

2 (2.4)

Elevated CRP

48 (56.5)

Anemia

24 (28.2)

Transaminitis

19 (22.3)

Thrombocytopenia

16 (18.8)

Characteristics

n=85

ARDS

40 (47.1)

MODS

22 (25.9)

Shock

21 (24.7)

Encephalopathy

21 (24.7)

Liver dysfunction

19 (22.3)

AKI

17 (20)

Thrombocytopenia

16 (18.9)

Myocardial dysfunction

13 (15.3)

Coagulopathy

5 (5.9)

Oseltamivir

5 (5.9)

Cidofovir

4 (4.7)

IVIG, n (%)

7 (8.2)

Organ supportive therapy, n (%)

 

PICU admission

39 (45.9)

Invasive mechanical ventilation

41 (48.2)

CPAP

33 (38.8)

HFNC

8 (9.4)

NIV

3 (3.5)

Central venous catheter

35 (41.2)

Vasoactive drugs

21 (24.7)

RRT

5 (5.9)

HCAIs

12 (14.1)

Duration of ER stay (hours)

48 (24-96)

Duration of PICU stay (days)

7 (4-14)

Duration of hospital stay (days)

9 (5-18)

Deaths

19 (22.3)