Delving into pediatric respiratory emergencies: a clinico-etiological study from a tertiary care hospital in western india

ORIGINAL ARTICLE

Delving into pediatric respiratory emergencies: A clinico-etiological study from a tertiary care hospital in western India

Bela Verma¹, Sonu Antony¹, Meghana Tiwary², Vishal Bhavsar², Meeta Vashi³.

¹Department of Pediatrics, GMC and GT Hospital, Mumbai, India,
²GGMC and Sir JJ Hospital, Mumbai, India,
³WHO Surveillance Medical Officer, Mumbai, India.

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Abstract
Background: Acute respiratory illness (ARI) remains a leading cause of childhood morbidity and mortality in low-resource settings like India. This study aimed to describe the clinico-etiological profile, management, and outcomes of pediatric ARI cases presenting to the emergency department of a tertiary care hospital in Mumbai.
Methods: This retrospective observational study included 80 children aged 1 month to 12 years admitted with ARI (defined per WHO criteria) over 10 months (August 2024-May 2025). Data on demographics, clinical features, investigations, treatment, and outcomes were extracted from case records. Descriptive statistics and appropriate tests assessed associations with mortality.
Results: Most patients (77.5%) were aged 1 month to 5 years, with slight male predominance (55%; ratio 1.22:1). Common symptoms included increased respiratory effort (93.7%), fever (85.0%), and cough (68.8%). Undernutrition was found in 60% and incomplete immunization in 65%. Hypoxia (43.8%) and anemia (90%) were frequent; blood cultures were positive in 8.8%. Chest radiography showed abnormalities in 96.3%, with consolidation in 60%. Non-respiratory causes contributed to 16.3% of respiratory distress. Ventilatory support was required in 86.3%, with 27.5% mortality. Significant mortality associations included residence outside Mumbai (p=0.002), abnormal nutrition (p=0.012), hypoxia (p=0.001), and inotrope duration (p=0.001).
Conclusion: Severe ARI in tertiary settings carries high mortality, influenced by comorbidities, delays, and resource limitations. Non-respiratory etiologies are notable, emphasizing broad differential diagnosis. Enhancing care in peripheral areas and strengthening referral systems are the need of the hour.

Why this article important?

We believe this manuscript is highly suitable for publication in The Pediatric On Call journal for the following reasons: • It addresses a major global child health priority - acute respiratory infections/pneumonia—which remain leading causes of under-5 morbidity and mortality, particularly in low- and middle-income countries (LMICs). • The study provides real-world insights from a high-burden tertiary setting in India, emphasizing preventable factors (e.g., nutrition, immunization, referral delays) and the need for strengthened peripheral care and referral systems. This highlights the pragmatic issues faced by clinicians, especially pediatricians and intensivists on a ground level, especially in a resource constrained setting.

Summary of article

This retrospective observational study describes the clinical presentation, etiological factors, management practices and outcomes (notably 27.5% mortality) in 80 children aged 1 month to 12 years with acute respiratory illness (ARI) admitted to a tertiary care emergency department over a 10-month period. Key findings highlight the significant burden of severe ARI in young children in a low-resource setting, with prevalent comorbidities such as undernutrition (60%), hypoxia (43.8%), anemia (90%), and incomplete immunization (65%). Non-respiratory causes contributed to 16.3% of total cases, and mortality was strongly associated with factors like residence outside the city of Mumbai, abnormal nutrition, hypoxia, and prolonged inotrope use.

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