Exploring pneumonia in less than two-year-olds: comparing respiratory syncytial virus and pneumonia due to other pathogens

Background: The purpose of this study is to compare the clinical characteristics and outcomes of RSV and non-RSV pneumonia in children less than two years weighing less than 10kg admitted to the Pediatric Intensive Care Unit (PICU) and also study the differences in efficacy of bubble Continuous Positive Airway Pressure (bCPAP) between the two groups. Methods: Children with severe pneumonia (World Health Organization criteria) and moderate to severe distress (PRESS- Pneumonia Risk Emergency Score Severity criteria) were participants of this cross-sectional comparative study. They were tested for RSV and grouped. Both groups received bCPAP. Data collection included demographic details, clinical findings and outcomes. Results: 70 children had pneumonia 18 had RSV pneumonia and 52 were non-RSV pneumonia cases. Suprasternal (p<0.05) and xiphoid retractions (p=0.034) were more prevalent in RSV pneumonia and it also required longer duration of bCPAP (50 hours versus 28 hours; p=0.023). bCPAP showed improvement in most of the cases in both groups (RSV-88.9%, non-RSV-80.8%). RSV cases demonstrated better improvement in saturation and respiratory rate within the first four hours of administration of bCPAP. Mortality was comparable between the two groups (RSV-5.6%, non-RSV-11.5%, p=0.14). Conclusions: RSV pneumonia is associated with more severe respiratory distress and longer bCPAP support but final clinical outcomes of bCPAP were similar in both groups. This is the first study to report a higher prevalence of suprasternal and xiphoid retractions in RSV pneumonia and a significantly better initial response to bCPAP.