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Risk Factors for Virus-induced Acute Respiratory Tract Infections in Children Younger Than 3 Years and Recurrent Wheezing at 36 Months Follow-Up After Discharge

Nicolai, Ambra MD; Frassanito, Antonella MD; Nenna, Raffaella MD, PhD; Cangiano, Giulia MD; Petrarca, Laura MD; Papoff, Paola MD, PhD; Pierangeli, Alessandra MD, PhD; Scagnolari, Carolina MD, PhD; Moretti, Corrado MD; Midulla, Fabio MD, PhD

The Pediatric Infectious Disease Journal: February 2017 - Volume 36 - Issue 2 - p 179–183
doi: 10.1097/INF.0000000000001385
Original Studies

Background: We sought to know more about how 14 common respiratory viruses manifest clinically, and to identify risk factors for specific virus-induced acute respiratory tract infections (ARTIs) in children younger than 3 years old and for wheezing at 36-month follow-up.

Methods: We retrospectively studied the clinical records for 273 full-term children (median age, 2.9 months; range, 0.26–39; boys, 61.2%) hospitalized for ARTIs, whose nasopharyngeal specimen tested positive for a respiratory virus and 101 children with no history of respiratory diseases (median age, 8 months; range, 0.5–36.5; boys, 58.4%). At 12, 24 and 36 months after children’s discharge, all parents were interviewed by telephone with a structured questionnaire on wheezing episodes.

Results: The most frequently detected viruses were respiratory syncytial virus in bronchiolitis, human rhinovirus in pneumonia and human bocavirus in wheezing. Multivariate analysis identified, as risk factors for virus-induced ARTIs, the presence of siblings [odds ratio (OR): 3.0 (95% confidence interval [CI]: 1.8–5.2)], smoking cohabitants (OR: 2.3 (95% CI: 2–4.2)] and breastfeeding lasting less than 3 months [OR: 0.5 (95% CI: 0.3–0.9)]. The major risk factor for respiratory syncytial virus–induced ARTIs was exposure to tobacco smoke [OR: 1.8 (95% CI: 1.1–3.2)]. Risk factors for human rhinovirus–induced ARTIs were attending day-care [OR: 5.0 (95% CI: 2.3–10.6)] and high eosinophil blood counts [OR: 2.6 (95% CI: 1.2–5.7)]. The leading risk factor for recurrent wheezing was exposure to tobacco smoke [OR: 2.5 (95% CI: 1.1–15.6)].

Conclusions: Each respiratory virus leads to a specific clinical manifestation. Avoiding exposing children to tobacco smoke might restrict viral spread from sick parents and siblings to younger children, prevent severe respiratory diseases, and possibly limit sequelae.

From the *Department of Pediatrics and Infantile Neuropsychiatry, and Department of Molecular Medicine, “Sapienza” University Rome, Rome, Italy.

Accepted for publication July 14, 2016.

A.N. and R.N. interpreted data for the work and drafted the work; A.F., G.C. and L.P. acquired the data; A.P. and C.S. performed and interpreted analysis; P.P. and C.M. revised the work critically for important intellectual content and F.M. conceived and designed the work.

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: Fabio Midulla, MD, PhD, Department of Paediatrics, “Sapienza” University Rome, V.le Regina Elena 324, 00161, Rome, Italy. E-mail:

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