Acute Respiratory Infections (ARIs) in Infants – Severe Cases Involve Bacterial Secondary Infections

In the first months of life, infants are especially susceptible to acute respiratory infections (ARIs), a group of illnesses that have long stood as a leading cause of pediatric morbidity and mortality. The dangers can include the familiar such as influenza, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and human parainfluenza viruses (HPIVs), as well as the emergent SARS-CoV-2, the virus responsible for COVID-19. Recent research underscores the critical nature of these infections and the continued need for additional research to better ensure that our children receive the care they need to battle these dangerous viruses.

For parents and guardians, the threat of these infections is both real and immediate. Symptoms such as coughing, congestion, and difficulty breathing can rapidly escalate, necessitating prompt medical intervention. Yet, as the landscape of ARIs evolves, parents need to seek care early before the ARI becomes severe. Emergency room physicians and pediatricians need be on the alert for ARIs and be ready to treat more severe cases with antibiotics in addition to supportive care. If they do not, the consequences can be dire.

What do we know about acute respiratory infections (ARIs) in infants?

Medical professionals know that viral acute respiratory infections are a major cause of death in young children. One of the most recent studies aimed to gather more information on common causes of morbidity and severe infections. The study, published in the global journal BMC Infections Diseases, focused on children ages five years and younger, reviewed more than 1,000 pediatric infections. There is little treatment for these ARI’s, because anti-viral medications are generally not helpful. Treatment for viral respiratory infection depends on supportive therapy, such as oxygen, IV fluids, nebulized treatments, and mechanical ventilation when necessary. However, bacterial coinfection in people with viral ARIs is one of the major causes of severe illness and hospitalization among children. Treatment with antibiotics has a role in severe ARI cases.

The presence of bacterial coinfection in viral ARI makes the respiratory illness more severe and life-threatening. Viral damage to the epithelial barrier in the respiratory tract causes impaired mucociliary function, which sweeps and clears the lungs of secretions. The viral infection weakens the body’s airway defenses and  makes a child more vulnerable to bacterial coinfection. Many severe cases are caused by a failure to timely watch for and timely treat a secondary bacterial infection that follows the initial viral infection. Viral damage to the epithelial lining of the airways impairs their mucociliary function. With weakened airway defenses, bacterial infection easily follows. This is the reason that antibiotics are used in severe ARI cases.

This data highlights the importance of seeking proper medical intervention when a child is fighting a viral infection. A recent publication by the United States Centers for Disease Control and Prevention explains that prior to COVID-19, ARIs often followed seasonal peaks, with the highest numbers of cases appearing in fall and winter months. During the pandemic, rates went down as people throughout the country followed stay at home orders and exercised extreme caution when it came to exposure to viruses. But things changed in 2021, when isolation was discontinued. Since then, medical professionals have reported an increase in children hospitalized with RSV and other acute respiratory infections during summer months. Although researchers are still gathering data, thus far, it appears these viruses are no longer following previous trends with hospitals reporting peaks of infection during the late fall and winter seasons. Researchers with the study predict that deviations from previous trends are a result of a year without community spread and expect seasonality trends to return in the future.

How can I better ensure my children receive the care they need?

ARI illnesses are debilitating for infants and terrifying for parents. An infant ill with one of these viruses typically suffers from cough, congestion and wheezing, but shortness of breath and vomiting can develop if the illness worsens. Parents can help by advocating for their children. Unfortunately, even when we take these steps, we may find the response of the medical team sometimes fails to meet our child’s needs. An emergency department physician or pediatrician may wrongly dismiss parental concerns and send the child home without a thorough exam. Legal remedies are likely available if an improper discharge results in serious injury. A medical malpractice claim can help hold the treating physician, hospital, and other responsible parties financially accountable for their mistakes.