ArticleFrontiers in pediatrics2026
Association of preterm birth with severity of molecularly-confirmed acute viral respiratory illness presenting to the emergency department: a multi-year analysis.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Prematurity is a recognized risk factor for respiratory morbidity, but its association with illness severity across viral etiologies in contemporary emergency department (ED) cohorts is not well studied. Objective: To evaluate the association between prematurity and the severity of molecularly-confirmed acute viral respiratory illness (AVRI) in children presenting to the ED. Methods: We conducted a retrospective cohort study of pediatric ED encounters from January 1, 2019, through December 31, 2025. Children 0 -18 years of age who presented to the ED with clinically significant AVRI defined as respiratory distress with hypoxemia, or hypercarbia, and who underwent respiratory viral PCR testing with at least one pathogen identified were included in the study. Prematurity was defined as birth before 37 completed weeks of gestation. Outcomes included respiratory support modalities requirement, ICU admission, hospital LOS, and mortality. Multivariable logistic regression analysis was used for binary outcomes, and generalized linear model with gamma distribution and log link was used for LOS, adjusting for age, sex, year, and viral agents. Results: A total of 16,518 met inclusion criteria, of which 2,384 encounters were born preterm while 14,134 encounters were born at term. Preterm encounters were younger (21 months vs. 26 months). The most frequently detected pathogens were rhinovirus and/or enterovirus (RV/EV) in 6,432 encounters (38.9%), RSV in 2,427 (14.7%), adenovirus in 1,523 (9.2%), parainfluenza in 1,315 (8.0%), influenza in 858 (5.2%), and human metapneumovirus in 600 (3.6%). Coinfection occurred in 12.4% of encounters and was more common among preterm encounters (14.3% vs. 12.1%, Conclusions: Prematurity was associated with higher respiratory support requirement, greater likelihood of PICU admission and longer hospital LOS in children presenting to the ED with clinically significant AVRI.
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