Objectives: This study sought to determine the epidemiology, seasonal variations, morbidity, and mortality of respiratory syncytial virus (RSV) infection among hospitalized children with lower respiratory tract infection in Thailand. In addition, we assessed the risk factors associated with severe RSV lower respiratory tract infection (LRTI)-related morbidity and mortality. Methods: The data were reviewed retrospectively from the National Health Security Office for hospitalized children younger than 18 years old diagnosed with RSV-related LRTI in Thailand, between the fiscal years of 2015 to 2020. The RSV-related LRTIs were identified using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification. ICD-10-TM codes J12.1, J20.5, and J21.0, which represent respiratory syncytial virus pneumonia, acute bronchitis due to respiratory syncytial virus, and acute bronchiolitis due to respiratory syncytial virus, respectively, were studied. Results: During the study period, RSV-related LRTI accounted for 19,340 of the 1,610,160 hospital admissions due to LRTI. RSV pneumonia was the leading cause of hospitalization (13,684/19,340; 70.76%), followed by bronchiolitis (2849/19,340; 14.73%) and bronchitis (2807/19,340; 14.51%), respectively. The highest peak incidence of 73.55 percent occurred during Thailand’s rainy season, from August to October. The mortality rate of RSV-related LRTI in infants younger than 1 year of age was 1.75 per 100,000 person years, which was significantly higher than that of children 1 to younger than 5 years old and children 5 to younger than 18 years old (0.21 per 100,000 person years and 0.01 per 100,000 person years, respectively, p-value < 0.001). Factors associated with mortality were congenital heart disease, hematologic malignancy, malnutrition, and neurological disease. Conclusions: In children with RSV LRTI, pneumonia was the leading cause of hospitalization. The admission rate was highest during the rainy season. Mortality from RSV-related LRTI was higher in children under 1 year old and in children with underlying illnesses; future preventive interventions should target these groups of patients.

Background: The COVID-19 outbreak emerged in January 2020 and remains present in 2022. During this period, nonpharmaceutical interventions (NPIs) have been used to reduce the spread of COVID-19 infection. Nationwide data analysis should be pushed as the new standard to demonstrate the impact of COVID-19 infection on other respiratory illnesses and the reliability of NPIs during treatment. Objective: This study aims to identify and compare the incidence of lower respiratory tract infections (LRTIs) among children in Thailand before and after the emergence of COVID-19. Methods: A retrospective study was carried out in hospitalized children under the age of 18 in Thailand from October 2015 to September 2020. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification, was used to identify patient diagnoses (ICD-10-TM). The data were extracted from the Universal Coverage Health Security Scheme Database. Results: A total of 1,610,160 admissions were attributed to LRTIs. The most common diagnosis was pneumonia (61.9%). Compared to the 2019 fiscal year, the number of hospitalizations due to LRTIs decreased by 33.9% in the 2020 fiscal year (COVID-19 period) (282,590 vs. 186,651). The incidence of all three diagnostic groupings was substantially lower in the pre- and post-COVID-19 eras, with a decrease of 28% in the pneumonia group (incidence rate ratio (IRR) = 0.72; 95% confidence interval (CI): 0.71 to 0.72), 44% in the bronchiolitis group (IRR = 0.56; 95% CI: 0.55 to 0.57), and 34% in the bronchitis group (IRR = 0.66; 95% CI: 0.65 to 0.67). Between fiscal years 2019 and 2020, the overall monthly cost of all hospitalizations for LRTIs decreased considerably (p value < 0.001). Conclusions: NPIs may decrease the number of pediatric hospitalizations related to LRTIs. All policies designed to prevent the spread of COVID-19 must be continually utilized to maintain the prevention of LRTIs.

Background: Sepsis remains one of the leading causes of morbidity and mortality in critically ill children worldwide. Identifying reliable prognostic markers is essential for improving risk stratification and guiding targeted therapies. While some studies in adults suggest that procalcitonin (PCT) clearance may better predict sepsis outcomes, there is limited information regarding pediatric sepsis. This study aimed to evaluate whether PCT clearance is associated with mortality among children with severe sepsis and septic shock. Methods: We retrospectively reviewed medical records of children aged 1 month to 18 years admitted to the PICU who were diagnosed with severe sepsis and septic shock at Srinagarind Hospital, Thailand, between January 2016 and October 2021. Serum PCT was measured at 0, 24, and 48 hours after the initial diagnosis. PCT clearance was calculated using the relative change from baseline. The primary outcome was in-hospital mortality. Results: A total of 242 children were included, with a median age of 8 years (interquartile range [IQR]: 3–14). Most participants (62.8%) had no underlying conditions. The overall mortality rate was 26.5%. An initial PCT level > 2 ng/mL was not significantly associated with mortality (adjusted odds ratio [aOR] = 1.17; 95% confidence interval [CI]: 0.44–3.16, p = 0.8). However, decreased PCT clearance at 24 hours was strongly associated with mortality (aOR = 2.79; 95% CI: 1.11–7.01, p = 0.029). The area under the receiver operating characteristic curve for 24-hour PCT clearance to predict mortality was 0.71 (95% CI: 0.63–0.80). Conclusions: Lower PCT clearance in the first 24 hours was significantly associated with higher mortality in pediatric patients with sepsis. Serial PCT measurements and PCT clearance monitoring may offer valuable prognostic information and could be considered as part of routine clinical evaluations in pediatric sepsis management.

Background and objective: Lower respiratory tract infection (LRTI) is a leading cause of childhood hospitalization worldwide, with high-flow nasal cannula (HFNC) therapy commonly employed as a non-invasive respiratory support method. Determining early predictors of HFNC failure is crucial for timely intervention and reducing associated morbidity and mortality. Methods: We retrospectively reviewed the medical records of hospitalized children aged 1 month to 18 years with LRTI who received HFNC from January 2016 to December 2021. We aimed to evaluate predictive factors for HFNC failure and identify optimal cutoffs from the AUROC (AUROC). Results: One hundred and sixteen children with LRTI applied to HFNC were included in this study. Most of them (90.5%) were diagnosed with pneumonia as a principal diagnosis, and 68.9% had co-morbidities. Of those, 18 patients (15.5%) needed escalation to intubation and were defined as HFNC failure. The early predictive parameters associated with HFNC failure were pulse rate at 2 hours and SpO₂/FiO₂ ratio at 4 hours. AUROC analysis for the predictive parameter of HFNC failure showed cut-off values of S/F ratio at 4 hours after HFNC therapy was lower than 238 (AUC 0.89, 95%CI: 0.78–0.99). Conclusion: SpO2/FiO2 at 4 hours after initiating HFNC appeared to be a predicting value for early detected failure for HFNC therapy in children with LRTI. Close monitoring and swift management adjustments are recommended for children exhibiting these risk factors to enhance outcomes.

The COVID-19 pandemic, caused by SARS-CoV-2, has posed significant health challenges worldwide. While children generally experience less severe illness compared to adults, pneumonia remains a substantial risk, particularly for those under five years old. This study examines the clinical characteristics and treatment outcomes of pediatric COVID-19 pneumonia patients treated with favipiravir in Thailand, aiming to identify associated factors for pneumonia. A retrospective review was performed on pediatric patients aged 1 month to 18 years hospitalized with COVID-19 at Srinagarind Hospital, Khon Kaen University, from 13 January 2020 to 15 November 2021. Data on demographics, clinical symptoms, treatment, and outcomes were collected, and logistic regression analysis was used to identify factors associated with pneumonia. Among 349 hospitalized children, the median age was 8 years, with 51.9% being male. Symptoms included a fever (100%), a cough (74.2%), and a rash (24.9%). COVID-19 pneumonia was diagnosed in 54.7% of the children. Favipiravir was administered as the standard treatment, showing mild adverse effects, including a rash (4.3%) and nausea (2.8%). Monocytosis was significantly associated with COVID-19 pneumonia (aOR 30.85, 95% CI: 9.03–105.41, p < 0.001), with an ROC curve area of 0.77 (95% CI: 0.71–0.83). Pediatric COVID-19 patients typically exhibit mild-to-moderate symptoms, with pneumonia being common in the early pandemic phase. Monocytosis is a significant factor associated with COVID-19 pneumonia. Favipiravir demonstrated mild adverse effects. Further studies are needed to validate these findings across different settings and phases of the pandemic.

Pediatric acute respiratory distress syndrome (PARDS) causes significant morbidity and mortality, especially in resource-limited settings. This study assessed national hospital and PICU admission rates, regional disparities, and factors associated with mortality in Thai children with PARDS. A nationwide retrospective study was conducted using National Health Security Office (NHSO) data from 2015 to 2022. Children aged 1 month to < 18 years with a diagnosis of PARDS (ICD-10-TM code J80) were included. Multivariable logistic regression was used to identify factors associated with mortality, reported as adjusted relative risk (ARR) with 95% confidence intervals (CI). Among 4,241 patients, the prevalence of PARDS ranged from 29.8 to 37.2 per 100,000 hospital admissions, while PICU admission rates ranged from 13.5 to 18.6 per 1,000. Bangkok had the highest rate in 2022 (27.0 per 1,000) but the lowest mortality at 25.6%. The overall mortality rate declined from 53.7% in 2015 to 37.7% in 2022 but remained high in resource-limited regions. Malignancy (ARR 1.29, 95% CI 1.17–1.43 p < 0.001), drowning (ARR 1.43, 95% CI 1.29–1.60, p < 0.001), sepsis and septic shock (ARR 1.19, 95% CI 1.12–1.27, p < 0.001), non-major pulmonary trauma (ARR 1.43, 95% CI 1.16–1.77, p = 0.001), and cardiovascular dysfunction (ARR 1.41, 95% CI 1.32–1.51, p < 0.001) were strongly associated with mortality. Intubation was significantly associated with increased mortality (ARR 2.52, 95% CI 2.12–3.00, p < 0.001), whereas extracorporeal life support was associated with lower mortality (ARR 0.46, 95% CI 0.35–0.61, p < 0.001). PARDS remains a substantial burden in Thailand, with marked regional differences in access to critical care. Efforts to strengthen healthcare infrastructure and early respiratory support are needed to reduce preventable deaths.