D3.169 - Paediatric Severe Acute Respiratory Infections in Malta: A Three-Year Review

Severe acute respiratory infections (SARI) remain a major contributor to paediatric morbidity worldwide. Understanding their burden, diagnostic spectrum, and clinical characteristics over extended periods is essential for service planning and optimisation of acute care pathways. We aimed to evaluate the prevalence, diagnostic distribution, and clinical features of SARI among paediatric medical admissions in Malta over a three-year period.

A retrospective observational study was conducted including all paediatric medical admissions at Mater Dei Hospital, the national hospital in Malta, between February 2023 and January 2026. SARI cases were identified according to institutional criteria and compared with non-SARI admissions. Demographic and clinical data including final diagnoses, presenting symptoms, and oxygen requirement were analysed descriptively.

During the study period, 10,453 children were admitted under paediatrics. Of these, 3,098 (29.6%) met criteria for SARI, while 7,355 (70.4%) were classified as non-SARI cases.

Upper respiratory tract infections (URTI) constituted the largest proportion of SARI diagnoses (n=962), followed by lower respiratory tract infections (LRTI) (n=749) and viral induced wheeze (n=711). Bronchiolitis accounted for 425 cases, asthma exacerbations for 168 cases, and croup for 83 cases.

Cough was nearly universal (n=3,074; 99.2%). Fever was reported in 2,141 cases (69.1%), while 957 (30.9%) were afebrile. Shortness of breath was documented in 1,856 children (59.9%), and coryzal symptoms in 2,104 (67.9%). Vomiting was present in 626 cases (20.2%).

Despite the severity classification, the majority of patients did not require supplemental oxygen (n=2,812; 90.8%). Oxygen therapy was required in 286 children (9.2%).

Over a three-year period, SARI accounted for nearly one-third of all paediatric medical admissions, highlighting its sustained burden beyond seasonal peaks. The diagnostic spectrum was broad, with URTI and LRTI predominating, while only a minority required oxygen therapy. These findings emphasise the heterogeneity of SARI presentations and the importance of continued surveillance to inform resource allocation, respiratory support planning, and preventative strategies in paediatric populations.