Paramyxovirus Infection: Mortality and Morbidity in a Pediatric Intensive Care Unit

Abstract

Objectives: We investigated mortality and morbidity of patients admitted to a pediatric intensive care unit (PICU) with paramyxovirus infection.

Methods: A retrospective study between October 2002 and March 2015 of children with a laboratory-confirmed paramyxovirus infection was included.

Results: In all, 98 (5%) PICU admissions were tested positive to have paramyxovirus infection (respiratory syncytial virus = 66, parainfluenza = 27 and metapneumovirus = 5). The majority of admissions were young patients (median age 1.05 years). Bacteremia and bacterial isolation in any site were present in 10% and 28%, respectively; 41% were mechanically ventilated, and 20% received inotropes. The three respiratory viruses caused similar mortality and morbidity in the PICU. Fatality (seven patients) was associated with malignancy, positive bacterial culture in blood, the use of mechanical ventilation, inotrope use, lower blood white cell count and higher C reactive protein (p = 0.02-0.0005). Backward binary logistic regression for these variables showed bacteremia (odds ratio [OR]: 31.7; 95% CI: 2.3-427.8; p = 0.009), malignancy (OR: 45.5; 95% CI: 1.4-1467.7; p = 0.031) and use of inotropes (OR: 15.0; 95% CI: 1.1-196.1; p = 0.039) were independently associated with non-survival. March and July appeared to be the two peak months for PICU hospitalizations with paramyxovirus infection.

Conclusions: Infections with paramyxoviruses account for 5% of PICU admissions and significant morbidity. Patient with premorbid history of malignancy and co-morbidity of bacteremia are associated with non-survival. March and July appeared to be the two peak months for PICU admissions with paramyxoviruses.

Keywords: PICU; bacterial co-infection; human metapneumovirus (hMPV); parainfluenza virus (PIV); paramyxovirus; pediatric intensive care; respiratory syncytial virus (RSV); seasonality.