The impact of influenza B (FLUB) was relatively less researched than influenza A (FLUA), because of its lower pandemic potential. We aimed to compare the clinical presentations and disease severity between FLUA and B. This study involved children hospitalized with virologically-confirmed influenza between 2010-2020. The disease severity was assessed according to admission to the intensive care unit (ICU), mechanical ventilation requirement, length of hospital, and ICU stay and death. FLUA and B were compared within predefined age groups (0-2, 3-9, and 10-18 years) and in all age groups. Of 343 patients, FLUA and B were detected in 260 (75.8%) and 83 (24.2%) children, respectively. Headache and abdominal pain were more common in FLUB (P<0.05). Children with FLUA were prescribed antibiotics and antivirals 1.6 and 2.3-fold more than those with FLUB. From subgroup analysis by age, patients between 3-9 with FLUB had a higher rate of headache and abdominal pain; additionally, headache occurred in 5 (100%) children aged 10-18 years with FLUB and 10 (38.5%) with FLUA (P<0.05). Children between 0-2 with FLUA were more often admitted to ICU than those with FLUB (22.9% vs. 6.0%; P<0.05). Eight patients with FLUA died, and one with FLUB (P>0.05). The clinical presentation was similar between FLUA and B, except for headache and abdominal pain, which were notably more common in older patients with FLUB. Children aged 0-2 years with FLUA had a significant risk for ICU admission. Higher levels of awareness and attention should be paid to children under two years with FLUA.

Objective: To determine whether high-flow nasal cannula oxygen (HFNCO) provided enhanced respiratory support in bronchiolitis than low-flow oxygen (LFO). Methods: We conducted a prospective, randomized controlled trial in children between 1-24 months diagnosed with moderate-to-severe bronchiolitis requiring oxygen therapy. Participants received LFO via face mask (6-10 L/min) or HFNCO (2 L*kg/min). Primary outcomes were the time that heart rate (HR) and respiratory rate (RR) return to their normal range for age and the time that baseline clinical respiratory score (CRS) regress to a lower severity score. Secondary outcomes were changes in HR, RR, and CRS over time, length of stay (LOS), duration of oxygen requirement, treatment failure, and adverse event (AE). Results: Eighty-seven children were enrolled (48 in LFO; 39 in HFNCO). The time that HR and RR baseline values reached their normal range for age was shorter in HFNCO therapy (2.0h [1.0-4.0] vs. 12.0h [2.0-24.0] and 4.0 h [2.0-12.0] vs. 24.0 h [4.0-48.0], respectively; P< .001); additionally, the improvement in CRS emerged more quickly in children treated with HFNCO (2.0 h [1.0-4.0] vs. 4.0 h [2.0-24.0]; P = .003). While the duration of oxygen requirement (19.0 h [4.0-30.0] vs. 29.5 h [14.0-45.7]; P = .009) and treatment failure (3% vs. 21%) was statistically lower in children who received HFNCO, there were no differences in LOS and AE between groups. Conclusion: HFNCO may provide enhanced respiratory support with a notable improvement in HR, RR, and CRS than LFO. Comprehensive studies are needed to assess the clinical efficacy of HFNCO therapy.

Objective: To determine whether viral coinfection is a risk for severe lower respiratory tract infection (LRTI). Working Hypothesis: Children with viral coinfection had a higher risk for admission to the intensive care unit (ICU) than those with a single virus infection. Study Design: Retrospective, observational study for ten years. Patient-Subject Selection: Children between 1-60 months of age hospitalized with LRTI. Methodology: We defined severe LRTI as admission to the ICU for high-flow nasal cannula oxygen/bilevel positive airway pressure/invasive ventilation and assessed demographic and laboratory data with potential risk factors from the patients’ medical records. Results: Of 2115 children hospitalized with LRTI, 562 had severe, and 1553 had mild disease. Viral coinfection was present in 28.3% of all patients, and those with viral coinfection were at a higher risk of severe LRTI than those with a single virus infection (43.8% vs. 22.7%; aOR, 3.44; 95% CI, 2.74-4.53). Respiratory syncytial virus (RSV) and rhinovirus (except for between 25-60 months) coinfections were associated with severe LRTI in all ages, whereas parainfluenza virus-3 (PIV3; 7-24 months) and bocavirus (7-12 months) coinfections led to severe LRTI in early childhood. Moreover, influenza-A coinfection caused severe LRTI in children between 7-12 and 25-60 months. Other risk factors included young age, prematurity, history of atopy, exposure to tobacco smoke, underlying condition, neutrophilia, lymphopenia, and high CRP value. Conclusion: Children with viral coinfection, particularly with rhinovirus, RSV, influenza-A, PIV3, and bocavirus, may be followed closely regarding the clinical changes.