Department of Internal Medicine - Pediatrics, University of Michigan, Ann Arbor, Michigan.
Department of Internal Medicine, University of South Dakota, Rapid City, South Dakota.
Respir Care. 2020 May;65(5):650-657. doi: 10.4187/respcare.07156. Epub 2020 Feb 11.
Most children are exposed to human metapneumovirus (HMPV) by the age of 5 y. This study aimed to describe the morbidity associated with HMPV infections in a cohort of children in the Midwest of the United States.
This was a retrospective 2-center cohort study including children (0-17 y old) hospitalized with HMPV infections at 2 tertiary care pediatric hospitals from 2009 to 2013. Demographics, chronic medical conditions, viral coinfections, and hospitalization characteristics, including the need for respiratory support, high-flow nasal cannula, CPAP, bi-level positive airway pressure, invasive mechanical ventilation, pediatric ICU admission, acute kidney injury (AKI), use of extracorporeal membrane oxygenation, and length of stay, were collected.
In total, 131 subjects were included. Those with one or more comorbidities were older than their otherwise healthy counterparts, with a median age of 2.8 y (interquartile range [IQR] 1.1-7.0) compared to 1.3 y (IQR 0.6-2.0, < .001), respectively. Ninety-nine (75.6%) subjects required respiratory support; 72 (55.0%) subjects required nasal cannula, simple face mask, or tracheostomy mask as their maximum support. Additionally, 1 (0.8%) subject required high-flow nasal cannula, 1 (0.8%) subject required CPAP, 2 (1.5%) subjects required bi-level positive airway pressure, 15 (11.5%) subjects required invasive mechanical ventilation, 4 (3.1%) subjects required high-frequency oscillatory or jet ventilation, and 4 (3.1%) subjects required extracorporeal membrane oxygenation. Fifty-one (38.9%) subjects required pediatric ICU admission, and 16 (12.2%) subjects developed AKI. Subjects with AKI were significantly older than those without AKI at 5.4 y old (IQR 1.6-11.7) versus 1.9 y old (IQR 0.7-3.5, = .003). After controlling for the presence of at least one comorbidity and cystic fibrosis, each year increase in age led to a 16% increase in the odds of AKI ( = .01). The median length of stay for the entire cohort was 4.0 d (IQR 2.7-7.0).
Children hospitalized with HMPV may be at risk for AKI. Risk of HMPV-associated AKI appears to increase with age regardless of severity of respiratory illness or presence of comorbidities.
大多数儿童在 5 岁前就已感染人偏肺病毒（HMPV）。本研究旨在描述美国中西部地区一组儿童的 HMPV 感染发病率。
这是一项回顾性的 2 中心队列研究，包括 2009 年至 2013 年期间在 2 家三级儿科医院因 HMPV 感染住院的儿童（0-17 岁）。收集人口统计学、慢性疾病、病毒合并感染和住院特征，包括呼吸支持、高流量鼻导管、CPAP、双水平气道正压通气、有创机械通气、儿科 ICU 入院、急性肾损伤（AKI）、体外膜氧合使用和住院时间。
共有 131 名受试者纳入研究。有一个或多个合并症的受试者比无合并症的受试者年龄更大，中位数年龄为 2.8 岁（IQR 1.1-7.0），而无合并症的受试者为 1.3 岁（IQR 0.6-2.0，<0.001）。99 名（75.6%）受试者需要呼吸支持；72 名（55.0%）受试者需要鼻导管、简易面罩或气管造口面罩作为最大支持。此外，1 名（0.8%）受试者需要高流量鼻导管，1 名（0.8%）受试者需要 CPAP，2 名（1.5%）受试者需要双水平气道正压通气，15 名（11.5%）受试者需要有创机械通气，4 名（3.1%）受试者需要高频振荡或射流通气，4 名（3.1%）受试者需要体外膜氧合。51 名（38.9%）受试者需要儿科 ICU 入院，16 名（12.2%）受试者发生 AKI。AKI 组的受试者年龄明显大于非 AKI 组，分别为 5.4 岁（IQR 1.6-11.7）和 1.9 岁（IQR 0.7-3.5，=0.003）。在控制至少有一个合并症和囊性纤维化的情况下，年龄每增加 1 岁，AKI 的几率就会增加 16%（=0.01）。整个队列的中位住院时间为 4.0 天（IQR 2.7-7.0）。
因 HMPV 住院的儿童可能有发生 AKI 的风险。无论呼吸道疾病的严重程度或合并症的存在如何，HMPV 相关 AKI 的风险似乎都随年龄的增加而增加。
