PREVALENCE RATE AND CLINICAL RISK FACTORS FOR ADVERSE OUTCOMES OF ACUTE LOWER RESPIRATORY TRACT INFECTION IN CHILDREN UNDER 5

The aim is to systematize clinical studies to identify the most significant predictors of adverse outcomes in acute lower respiratory tract infections in children caused by common pathogens. Analytical review of scientific literature is carried out in PubMed, Global Health and RINC databases examining the past 10 years (2014–2024). The analysis considers cohort studies, systematic reviews, and meta-analyses, as well as clinical reports. Adverse outcomes include: the need for oxygen therapy, mechanical ventilation, hospitalization with a stay in intensive care units, long-term inpatient treatment (over 5 days) and mortality. Key findings:
1. The underlying conditions that predispose to a complicated course of respiratory syncytial virus infection, Influenza, metapneumovirus and COVID-19 have been established. These conditions include chronic comorbidities (bronchopulmonary dysplasia, cardiovascular and neurological disorders, nutritional deficiencies, anaemia); congenital malformations of the heart; prematurity; Down syndrome; being under 1 year of age, as well as mucoviscidosis, vitamin D deficiency as significant risk factors for children under 5 years with severe respiratory syncytial virus infection.
2. Analysis by age group reveals high-risk groups, particularly vulnerable to the development of severe infections. This highlights the need for priority prevention (including vaccination against respiratory syncytial virus infection and influenza) and early diagnosis to minimise negative outcomes. The analysis highlights the importance of a comprehensive approach to prevent serious complications in acute respiratory infections in children.

1. World Health Organization. Pneumonia in children. URL: https://www.who.int/en/news-room/fact-sheets/detail/pneumonia (дата обращения: 06.12.2024).

2. Tsou P., Vadivelan A., Kovvuri M. et al. Association between multiple respiratory viral infections and pediatric intensive care unit admission among infants with bronchiolitis // Archives de Pédiatrie. 2020. Vol. 27, no. 1. P. 39–44. https://doi.org/10.1016/j.arcped.2019.11.006.

3. GBD 2017 Causes of Death Collaborators. Global, regional and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017 // The Lancet. 2018. Vol. 392, no. 10159. P. 1736–1788. https://doi.org/10.1016/S0140-6736(18)32203-7.

4. GBD 2019 LRI Collaborators. Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019 // The Lancet. Infectious Diseases. 2022. Vol. 22, no. 11. P. 1626–1647. https://doi.org/10.1016/S1473-3099(22)00510-2.

5. Wang X., Li Y., O’Brien K. L. et al. Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study // The Lancet. Global Health. 2020. Vol. 8, no. 4. P. E497–E510. https://doi.org/10.1016/s2214-109x(19)30545-5.

6. McAllister D. A., Liu L., Shi T. et al. Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis // The Lancet. Global Health. 2019. Vol. 7, no. 1. P. E47–E57. https:// doi.org/10.1016/s2214-109x(18)30408-x.

7. Pneumonia Etiology Research for Child Health (PERCH) Study Group. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study // The Lancet. 2019. Vol. 394, no. 10200. P. 757–779. https://doi.org/10.1016/S0140-6736(19)30721-4.

8. Aneja S., Singh V., Narayan V. V. et al. Respiratory viruses associated with severe acute respiratory infection in children aged <5 years at a tertiary care hospital in Delhi, India during 2013–15 // Journal of Global Health. 2024. Vol. 14. 13 p. https://doi.org/10.7189/jogh.14.04230.

9. Olsen S. J., Winn A. K., Budd A. P. et al. Changes in influenza and other respiratory virus activity during the COVID–19 pandemic–United States, 2020-2021 // American Journal of Transplantation. 2021. Vol. 21, no. 10. P. 3481–3486. https://doi.org/10.1111/ajt.16049.

10. Li Y., Wang X., Blau D. M. et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis // The Lancet. 2022. Vol. 399, no. 10340. P. 2047–2064. https://doi.org/10.1016/S0140-6736(22)00478-0.

11. Sitthikarnkha P., Uppala R., Niamsanit S. et al. Burden of respiratory syncytial virus related acute lower respiratory tract infection in hospitalized Thai children: a 6-year national data analysis // Children. 2022. Vol. 9, no. 12. 10 p. https://doi.org/10.3390/children9121990.

12. Lafond K. E., Nair H., Rasooly M. H. et al. Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982–2012: A Systematic Analysis // PLoS Medicine. 2016. Vol. 13, no. 3. 19 p. https://doi.org/10.1371/journal.pmed.1001977.

13. Углева Т. Н., Пахотина В. А. Этиологическая структура и характеристика клинических проявлений гриппа в Ханты-Мансийском автономном округе – Югре. Журнал инфектологии. 2018. Т. 10, № 2. С. 62–67. https://doi.org/10.2262/2072-6732-2018-10-2-62-67.

14. Wang X., Li Y., Deloria-Knoll M. et al. Global burden of acute lower respiratory infection associated with human metapneumovirus in children under 5 years in 2018: a systematic review and modelling study // The Lancet. Global Health. 2021. Vol. 9, no. 1. P. E33–E43. https://doi.org/10.1016/s2214-109x(20)30393-4.

15. Bennett M. V., McLaurin K., Ambrose C. et al. Population-based trends and underlying risk factors for infant respiratory syncytial virus and bronchiolitis hospitalizations // PLoS ONE. 2018. Vol. 13, no. 10. 11 p. https://doi.org/10.1371/journal.pone.0205399.

16. Shi T., Vennard S., Mahdy S. et al. Risk Factors for Poor Outcome or Death in Young Children With Respiratory Syncytial Virus–Associated Acute Lower Respiratory Tract Infection: A Systematic Review and Meta-Analysis // The Journal of Infectious Diseases. 2021. Vol. 226. P. S10–S16. https://doi.org/10.1093/infdis/jiaa751.

17. Cai W., Buda S., Schuler E. et al. Risk factors for hospitalized respiratory syncytial virus disease and its severe outcomes // Influenza and Other Respiratory Viruses. 2020. Vol. 14, no. 6. P. 658–670. https://doi.org/10.1111/irv.12729.

18. Sanchez-Luna M., Elola F. J., Fernandez-Perez C. et al. Trends in respiratory syncytial virus bronchiolitis hospitalizations in children less than 1 year: 2004-2012 // Current Medical Research and Opinion. 2016. Vol. 32, no. 4. P. 693–698. https://doi.org/10.1185/03007995.2015.1136606.

19. Havdal L. B., Bøås H., Bekkevold T. et al. Risk factors associated with severe disease in respiratory syncytial virus infected children under 5 years of age // Frontiers in Pediatrics. 2022. Vol. 10. 11 p. https://doi.org/10.3389/fped.2022.1004739.

20. Deng S., Cong B., Edgoose M. et al. Risk factors for respiratory syncytial virus-associated acute lower respiratory infection in children under 5 years: An updated systematic review and meta-analysis // International Journal of Infectious Diseases. 2024. Vol. 146.8 p. https://doi.org/10.1016/j.ijid.2024.107125.

21. Doucette A., Jiang X., Fryzek J. et al. Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997–2012 // PLoS ONE. 2016. Vol. 11, no. 4. 15 p. https://doi.org/10.1371/journal.pone.0152208.

22. Kobiałka M., Jackowska T., Wrotek A. Risk Factors for Severe Respiratory Syncytial Virus Infection in Hospitalized Children // Viruses. 2023. Vol. 15, no. 8. 24 p. https://doi.org/10.3390/v15081713.

23. Chan M., Park J. J., Shi T. et al. The burden of respiratory syncytial virus (RSV) associated acute lower respiratory infections in children with Down syndrome: A systematic review and meta-analysis // Journal of Global Health. 2017. Vol. 7, no. 2. 10 p. https://doi.org/10.7189/jogh.07.020413.

24. Beckhaus A. A., Castro-Rodriguez J. A. Down Syndrome and the Risk of Severe RSV Infection: A Meta-analysis // Pediatrics. 2018. Vol. 142, no. 3. 10 p. https://doi.org/10.1542/peds.2018-0225.

25. Ghezzi M., Garancini N., De Santis R. et al. Recurrent Respiratory Infections in Children with Down Syndrome: A Review // Children. 2024. Vol. 11, no. 2. 11 p. https://doi.org/10.3390/children11020246.

26. Dimopoulos K., Constantine A., Clift P. et al. Cardiovascular Complications of Down Syndrome: Scoping Review and Expert Consensus // Circulation. 2023. Vol. 147, no. 5. P. 425–441. https://doi.org/10.1161/circulationaha.122.059706.

27. Bush D., Galambos C., Ivy D. D. et al. Clinical Characteristics andRisk Factors for Developing Pulmonary Hypertension in Children with Down Syndrome // The Journal of Pediatrics. 2018. Vol. 202. P. 212–219.e2. https://doi.org/10.1016/j.jpeds.2018.06.031.

28. Fockens M. M., Hölscher M., Limpens J. et al. Tracheal anomalies associated with Down syndrome: A systematic review // Pediatric Pulmonology. 2021. Vol. 56, no. 5. P. 814–822. https://doi.org/10.1002/ppul.25203.

29. De Lausnay M., Verhulst S., Boel L. et al. The prevalence of lower airway anomalies in children with Down syndrome compared to controls // Pediatric Pulmonology. 2020. Vol. 55, no. 5. P. 1259–1263. https://doi.org/10.1002/ppul.24741.

30. Chaw P. S., Wong S. W. L., Cunningham S. et al. Acute Lower Respiratory Infections Associated With Respiratory Syncytial Virus in Children With Underlying Congenital Heart Disease: Systematic Review and Meta-analysis // The Journal of Infectious Diseases. 2020. Vol. 222. P. S613-S619. https://doi.org/10.1093/infdis/jiz150.

31. Friedman D., Fryzek J., Jiang X. et al. Respiratory syncytial virus hospitalization risk in the second year of life by specific congenital heart disease diagnoses // PLoS ONE. 2017. Vol. 12, no. 3. 16 p. https://doi.org/10.1371/journal.pone.0172512.

32. Checchia P. A., Paes B., Bont L. et al. Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Infants with Congenital Heart Disease // Infectious Diseases and Therapy. 2017. Vol. 6. P. 37–56. https://doi.org/10.1007/s40121-016-0142-x.

33. Chaw P. S., Hua L., Cunningham S. et al. Respiratory Syncytial Virus-Associated Acute Lower Respiratory Infections in Children With Bronchopulmonary Dysplasia: Systematic Review and Meta-Analysis // The Journal of Infectious Diseases. 2020. Vol. 222. P. S620–S627. https://doi.org/10.1093/infdis/jiz492.

34. Trusinska D., Zin S. T., Sandoval E. et al. Risk Factors for Poor Outcomes in Children Hospitalized With Virus-associated Acute Lower Respiratory Infections: A Systematic Review and Meta-analysis // The Pediatric Infectious Disease Journal. 2024. Vol. 43, no. 5. P. 467–476. https://doi.org/10.1097/inf.0000000000004258.

35. Bunjoungmanee P., Sompoch S., Tangsathapornpong A. et al. Factors associated with severe respiratory syncytial virus infection among hospitalized children in Thammasat University Hospital // F1000Research. 2024. Vol. 13. 22 p. https://doi.org/10.12688/f1000research.146540.2.

36. Rodriguez-Martinez C. E., Barbosa-Ramirez J., Acuña-Cordero R. Predictors of poor outcomes of respiratory syncytial virus acute lower respiratory infections in children under 5 years of age in a middle-income tropical country based on the National Public Health Surveillance System // Pediatric Pulmonology. 2022. Vol. 57, no. 5. P. 1188–1195. https://doi.org/10.1002/ppul.25866.

37. Wilkes C., Bava M., Graham H. R. et al. What are the risk factors for death among children with pneumonia in low- and middle-income countries? A systematic review // Journal of Global Health. 2023. Vol. 13. 27 p. https://doi.org/10.7189/jogh.13.05003.

38. Sonego M., Pellegrin M. C., Becker G. et al. Risk Factors for Mortality from Acute Lower Respiratory Infections (ALRI) in Children under Five Years of Age in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis of Observational Studies // PLoS ONE. 2015. Vol. 10, no. 1. 17 p. https://doi.org/10.1371/journal.pone.0116380.

39. Kamidani S., Garg S., Rolfes M. A. et al. Epidemiology, Clinical Characteristics, and Outcomes of Influenza-Associated Hospitalizations in US Children Over 9 Seasons Following the 2009 H1N1 Pandemic // Clinical Infectious Diseases. 2022. Vol. 75, no. 11. P. 1930–1939. https://doi.org/10.1093/cid/ciac296.

40. UNICEF. UNICEF Data. COVID-19 confirmed cases and deaths. URL: https://data.unicef.org/resources/covid-19-confirmed-cases-anddeaths-dashboard/ (дата обращения: 31.10.2024).

41. Martínez-Valdez L., Richardson López Collada V., Castro-Ceronio L. E. et al. Risk factors for COVID-19 hospitalisations and deaths in Mexican children and adolescents: retrospective cross-sectional study // BMJ Open. 2022. Vol. 12. 10 p. https://doi.org/10.1136/bmjopen-2021-055074.

42. Sarfo J. O., Amoadu M., Gyan T. B. et al. Acute lower respiratory infections among children under five in Sub-Saharan Africa: a scoping review of prevalence and risk factors // BMC Pediatrics. 2023. Vol. 23. 19 p. https://doi.org/10.1186/s12887-023-04033-x.