Methods: Children <2 years of age were identified from a larger cohort of patients aged 0-17 years hospitalized from August 1- September 15, 2014 with positive multiplex-PCR testing for enterovirus/rhinovirus (EV/RV). Specimens were retrospectively tested for EV-D68 by sequencing or PCR; results were unavailable to providers. Clinical features, management, and outcome data were obtained from medical record review using a standardized data collection form.
Results: Of 542 children hospitalized due to EV/RV with specimens available for further testing, 182 (33%) were <2 years. 86 (46%) were EV-D68 positive and 96 (53%) were EV-D68 negative. Compared to hospitalized children with other EV/RV, EV-D68 infected children were older (13 vs 10 months, P=0.03) and more likely to have a history of cough (84% vs 68%, P=0.01) and increased work of breathing (80% vs 60%, P=0.004). They were more likely to be hypoxic (48% vs 26%, P= 0.002), wheeze (52% vs 33%, P=0.01), and have retractions (71% vs 46%, P=0.001). More EV-D68 infected children received oxygen supplementation (74% vs 48%, P<0.001), albuterol (78% vs 48%, P<0.001), and corticosteroids (61% vs 37%, P=0.001). They were more likely to be discharged with albuterol (70% vs 38%, P<0.001) and corticosteroids (40% vs 24%, P=0.02) despite no difference in history of asthma or wheeze (30% vs 23%, P=0.26). Need for intensive care management was not more common in children with EV-D68 infection (15% vs 12%, P=0.47).
Conclusion: EV-D68 is a cause of ARI in young children. Despite no difference in history of bronchospasm, EV-D68 hospitalized children <2 years of age were more likely to receive asthma directed therapies, despite providers being unaware of the diagnosis. Without an EV-D68 specific therapy, future trials should consider evaluation of the utility of bronchospasm directed therapies in young children with EV-D68 infection.
F. Hassan, None
M. A. Jackson, None
J. Schuster, None