Respiratory Infections in Patients Eligible for Pediatric Palliative Care

BACKGROUND: Advances in pediatric care have increased the survival of children with life-limiting conditions, leading to a growing population requiring pediatric palliative care (PPC). Respiratory tract infections are among the leading causes of hospitalization in these patients. This study aimed to describe the features of respiratory infections in children eligible for PPC. METHODS: The present study is a monocentric retrospective study including pediatric patients eligible for PPC with an Assessment of Complex Clinical-Care Needs in Pediatrics (ACCAPED) score ≥30 who were followed by a third-level hospital in Bologna, Italy. Hospitalizations for respiratory infections occurring between January 2019 and February 2025 were analyzed. Clinical, microbiologic, laboratory and therapeutic data were collected. RESULTS: Among 319 eligible PPC patients, 99 experienced at least 1 infectious hospitalization, accounting for 117 admissions due to respiratory infections in 56 children. Lower respiratory tract infections predominated (86.3%), with viral pathogens identified in most cases. Respiratory support required escalation in 76.9% of admissions, while 6% required pediatric intensive care, and mortality was 1.7%. Pseudomonas aeruginosa was the most frequently isolated bacterial pathogen, especially among tracheostomized patients. Multivariate analysis identified an Assessment of Complex Clinical-Care Needs in Pediatrics score ≥75 [odds ratio (OR): 2.43; 95% confidence interval (CI): 1.04-5.68; P = 0.041] and C-reactive protein ≥8 mg/dL (OR: 3.85; 95% CI: 1.48-10.00; P = 0.0058) as independent predictors of respiratory support escalation. CONCLUSIONS: Respiratory infections represent a major cause of hospitalization in children receiving PPC. High clinical complexity and elevated inflammatory markers independently predict worsening respiratory status, supporting their use for early risk stratification and individualized management.