Background: Respiratory syncytial virus (RSV) infection is a significant burden for children under 5 years of age. While RSV is a common cause of acute lower respiratory tract infection (ALRTI), routine confirmatory testing is not widely practiced. Identifying risk factors for RSV infection can help inform clinical decision-making and guide appropriate management in emergency departments. The objective of this study is to determine the risk factors associated with RSV infection in children hospitalized with ALRTI. Methods: A retrospective case-control study was conducted among pediatric patients under 5 years of age diagnosed with ALRTI at Naresuan University Hospital between January 2018 and December 2020. Data were extracted from electronic medical records. RSV diagnoses were confirmed using a rapid RSV antigen test. Potential risk factors—including prematurity, family history of atopic disease, past respiratory illness, history of ALRTI contact, and underlying disease—were analyzed using a multivariable logistic model in Stata version 17.0. Results: Among 3,579 children hospitalized with ALRTI, 459 (13%) were diagnosed with RSV infection. Peaks in RSV-ALRTI were observed in September, October, and November across 2018–2020. Significant risk factors identified through multivariable logistic regression analysis included the rainy season [odds ratio (OR) =15.51; 95% confidence interval (CI): 1.74–138.42; P=0.01], daycare attendance (OR =3.00; 95% CI: 1.27–7.10; P=0.01), lung crepitations (OR =2.60; 95% CI: 1.23–5.50; P=0.01), and oxygen supplementation (OR =2.38; 95% CI: 1.07–5.30; P=0.03). Conclusions: This study highlights the significant clinical burden of RSV in ALRTI, with RSV-ALRTI accounting for 13% of all ALRTI cases. Notably, RSV-ALRTI cases peaked during the rainy season, specifically in September, October, and November. The identified risk factors for RSV-ALRTI include the rainy season, daycare attendance, lung crepitations, and the need for oxygen supplementation. These findings underscore the importance of early identification and management of high-risk patients, particularly during peak seasonal periods. Clinically, these risk factors can help guide targeted prevention and treatment strategies, improving patient outcomes and optimizing resource allocation in healthcare settings.

BACKGROUND Recurrent wheezing following acute lower respiratory tract infection (ALRTI) in early childhood is a common clinical problem and may be an early indicator of chronic respiratory diseases. Early identification of associated risk factors is essential for early intervention and prevention. AIM To investigate the risk factors and timing of recurrent wheezing episodes following ALRTI in children. METHODS A retrospective cohort study was conducted among pediatric patients ≤ 5 years old admitted with ALRTI and wheezing at Naresuan University Hospital between July 1, 2020 and June 30, 2023. Participants were followed for 12 months. Data from electronic and paper records were analyzed using STATA 18.0. Multivariable logistic regression identified independent risk factors. Kaplan-Meier analysis and log-rank tests compared recurrence and non-recurrence groups through survival curves. RESULTS Significant predictors of recurrent wheezing included age 12-24 months [odds ratio (OR): 2.38; 95%CI: 1.50-3.78, P < 0.001], prematurity (OR: 1.66; 95%CI: 1.07-2.58, P = 0.024), allergic rhinitis (OR: 1.50; 95%CI: 1.04-2.17, P = 0.031), urban residency (OR: 1.68; 95%CI: 1.19-2.38, P = 0.003), eosinophilia (absolute eosinophil count > 500 cells/μL) (OR: 3.29; 95%CI: 1.57-6.91, P = 0.002), and prior lower respiratory tract infection (OR: 1.82; 95%CI: 1.20-2.76, P = 0.005). The median time to recurrence was 100 days (interquartile range: 43-125), varying across clinical and environmental subgroups. CONCLUSION Children with certain demographic and clinical features have higher recurrent wheezing risk after ALRTI, highlighting the need for closer monitoring and early preventive care.

The role of vitamin C in children with community-acquired pneumonia (CAP) in children is controversial; moreover, a standard dose is lacking. This study aimed to evaluate the ability of vitamin C to reduce symptom severity and length of hospital stay among children with CAP as well as determine its optimal dose. This randomized controlled clinical trial was conducted between July 2020 and October 2023. The participating patients were aged 6 months to 15 years, had CAP, and required hospitalization at Naresuan University Hospital. The patients were randomly assigned to placebo, low-dose vitamin C (15 mg/kg/dose every 6 h), and high-dose vitamin C (30 mg/kg/dose every 6 h) groups. Treatment was provided until discharge and doses maximized after 3 days. The patients' clinical symptoms and side effects were recorded every 12 h. This study included 143 patients (median age, 3 years). The clinical severity score improved significantly in the low- and high-dose vitamin C versus placebo groups at 48-72 h. Vitamin C supplementation did not reduce the length of hospital stay in any group. Vitamin C supplementation did not reduce the length of hospital stay among patients with CAP who required hospitalization. However, it improved the mean clinical severity score, with the greatest reduction observed at 48 h post-treatment. A dose of 15 mg/kg was demonstrated effective with minimal side effects.

Background: Sisunatovir is an investigational respiratory syncytial virus (RSV) antiviral that was effective in an adult human viral challenge study. Methods: In 2 multicenter studies, safety and pharmacokinetics of sisunatovir were evaluated in hospitalized individuals 1 month to 36 months of age (Study 1) and outpatient and hospitalized individuals 1 day to 60 months of age (Study 2) with RSV lower respiratory tract infection (RSV-LRTI). In Study 1 Part A, participants received single sisunatovir doses; in Part B, participants received placebo or multiple ascending sisunatovir doses every 12 hours for 5 days. In Study 2, participants received weight-based sisunatovir dosing or placebo every 12 hours for 5 days. Results: In Study 1 Part A, 19 participants received sisunatovir; 31 in Part B received sisunatovir (n = 22) or placebo (n = 9). Adverse events (AEs) were reported by 11 (57.9%) and 12 (38.7%) participants in Parts A and B, respectively. In Study 2, 10 participants received sisunatovir (n = 6) or placebo (n = 4). No treatment-related serious AEs were reported; all AEs were mild or moderate. In Study 1 Part A 12 hours post-dose, mean sisunatovir concentrations were within safety margins. In Part B, at the highest dose assessed for each group, steady-state trough concentrations surpassed those effective in the adult challenge study. Conclusions: In children with RSV-LRTI, sisunatovir was safe and well tolerated. The pediatric multiple-dose regimen achieved plasma concentrations effective at reducing viral load and symptoms in an adult challenge study; however, further studies are needed to identify doses providing comparable exposure across pediatric populations. ClinicalTrials.gov registration number: NCT04225897 (registered December 11, 2019); NCT06102174 (registered October 6, 2023)

Introduction: Hospital-acquired malnutrition (HAM) is increasingly recognised as an important yet underdiagnosed problem in paediatric inpatient care. Nutritional status can decline quickly during hospitalisation due to illness severity and inadequate intake. However, data on the burden and determinants of HAM in children remain limited particularly in resource-limited settings. Objective: This study aimed to determine the prevalence and identify factors associated with malnutrition among hospitalised children. Methods: Medical records of children aged 1 month to 15 years admitted to Naresuan University Hospital between 1 January 2019 and 31 December 2020 were reviewed. A total of 368 children met the inclusion criteria. Anthropometric data were collected at admission, 48 hours after admission and discharge. HAM was defined as a decrease in body mass index z-score during hospitalisation. Data were analysed using Stata V.18. Univariate and multivariate logistic regression analyses were performed to identify risk factors, with results expressed as adjusted ORs (aORs) and 95% CIs. A p value 12–36 months (OR 0.27; 95% CI 0.09 to 0.81), age >36 months (OR 0.24; 95% CI 0.09 to 0.65), length of hospital stay (LOS) 4–7 days (OR 14.21; 95% CI 3.21 to 62.95), LOS >7 days (OR 14.63; 95% CI 2.73 to 78.49), fever (OR 6.87; 95% CI 2.00 to 23.52) and nosocomial infection (OR 10.86; 95% CI 1.72 to 68.54). Multivariate analysis identified LOS 4–7 days (aOR 8.72; 95% CI 1.77 to 43.09) and LOS >7 days (aOR 9.52; 95% CI 1.46 to 63.13) were independently associated with HAM. Discussion: HAM occurred in 6.3% of hospitalised children. Prolonged hospitalisation was the factor most strongly associated with HAM, highlighting the importance of continuous nutritional monitoring and early intervention during inpatient care.

Introduction: Severe lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) is a major cause of respiratory morbidity in children. Nutritional status is hypothesised to influence the severity of RSV infection, affecting clinical outcomes. Objective: To evaluate the association between malnutrition and the severity of RSV-related LRTI in children. Methods: A retrospective study was conducted at Naresuan University Hospital, including children under 5 years of age diagnosed with RSV LRTI between January 2014 and December 2018. Nutritional status was assessed using Z-scores for wasting (weight-for-height), underweight (weight-for-age), stunting (height-for-age) and both undernutrition and overnutrition (body mass index). Data were analysed using STATA V.18. Univariate analysis used t-test and χ ² test. Variables with p<0.2 entered multivariate logistic regression to identify risk factors. Adjusted ORs (aORs) with 95% CI were reported; p<0.05 was significant. Results: A total of 250 children met the inclusion criteria, with 36 (14.4%) classified as having severe RSV LRTI and 214 (85.6%) as non-severe cases. Among those with severe RSV-related LRTI, 16 (44.4%) were male and 20 (55.6%) were female, whereas in the non-severe group, 119 (55.6%) were male and 95 (44.4%) were female. Multivariable analysis revealed that severe wasting (aOR=3.70; 95% CI 1.01 to 13.55; p=0.048) and severe underweight (aOR=9.09; 95% CI 2.62 to 31.50; p=0.001) were strongly correlated with severe RSV LRTI. Discussion: Severe wasting and severe underweight are significant risk factors for severe RSV LRTI in children. These findings suggest that improving nutritional status may help reduce the severity of RSV LRTI.