To the Editor:
A report of pediatric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in New York City included 21 patients with pediatric acute respiratory distress syndrome (PARDS).1 A diagnosis of PARDS mandates the presence of respiratory failure, defined as the use of positive pressure mechanical ventilation, either invasive or noninvasive. Therefore, it might be helpful to determine the incidence of PARDS in patients with respiratory failure and various respiratory viruses, as it is possible that specific viruses are more frequently associated with the development of PARDS.
Historical data for the incidence of PARDS in patients with respiratory failure and human metapneumovirus,2 human rhinovirus/enterovirus,3 pandemic 2009 H1N1 influenza A,4 and respiratory syncytial virus2 in New York City were compared with data for the SARS-CoV-2 in New York City1 (Table ). The proportion of patients with PARDS was not similar between viruses (P < .0001), and post-testing with the Bonferroni correction revealed that PARDS was more likely with SARS-CoV-2 vs either respiratory syncytial virus (P < .0001) or human rhinovirus/enterovirus (P < .0001). Assuming that no patient with SARS-CoV-2 treated with noninvasive ventilation alone was included in the PARDS severity stratification, the incidence of severe PARDS was similar between viruses (P = .38; human rhinovirus/enterovirus excluded as data not available).
Table.
PARDS and respiratory viruses in New York City
| SARS-CoV-2 | Human metapneumovirus2 | Human rhinovirus/enterovirus3 | Pandemic 2009 H1N1 influenza A4∗ | Respiratory syncytial virus2 | |
|---|---|---|---|---|---|
| Patients with respiratory failure, n | 27 | 32 | 97 | 28 | 107 |
| Patients with PARDS, n (%) | 21 (78) | 13 (41) | 22 (23) | 12 (43) | 33 (31) |
| Patients with severe PARDS, n (%) | 5 (19) | 5 (16) | Not available | 6 (21) | 11 (10) |
Historical data reviewed and PARDS classification determined by author.
This suggests that SARS-CoV-2 is associated with an increased risk of PARDS, but not severe PARDS, in children with respiratory failure compared with several other common respiratory viruses. Additional data could help better assess the impact and contribute to our understanding of the pathophysiology of respiratory virus infections in critically ill children.
Footnotes
The author declares no conflicts of interest.
References
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