{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T06:12:54Z","timestamp":1776147174593,"version":"3.50.1"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017594","name":"Medical Science and Technology Project of Zhejiang Province","doi-asserted-by":"publisher","award":["2025KY1314"],"award-info":[{"award-number":["2025KY1314"]}],"id":[{"id":"10.13039\/501100017594","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"\n Background<\/jats:title>\n Human rhinovirus (HRV) is a leading cause of acute respiratory infections and hospitalization in children. However, risk factors for progression to bronchitis vs. pneumonia remain incompletely characterized.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to identify and distinguish independent predictors for these outcomes using a machine learning approach.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A retrospective cohort study was conducted among hospitalized children with HRV infection at the First Affiliated Hospital of Ningbo University. A two-stage feature selection method (Random Forest and LASSO) was used, followed by multinomial logistic regression to quantify associations with progression to bronchitis or pneumonia.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 1,125 children, 29% progressed to bronchitis and 59% to pneumonia. Multinomial logistic regression revealed distinct risk profiles. Progression to bronchitis was strongly associated with lower airway obstruction, including dyspnea (\n OR:<\/jats:italic>\n 4.35, 95%\n CI<\/jats:italic>\n : 2.35\u20138.06), wheezing on auscultation (\n OR:<\/jats:italic>\n 2.98, 95%\n CI<\/jats:italic>\n : 1.89\u20134.69), and cough (\n OR:<\/jats:italic>\n 2.61, 95%\n CI<\/jats:italic>\n : 1.52\u20134.49). Progression to pneumonia was uniquely linked to prior antibiotic use (\n OR:<\/jats:italic>\n 2.09, 95%\n CI<\/jats:italic>\n : 1.34\u20133.25), viral co-infection (\n OR:<\/jats:italic>\n 1.97, 95%\n CI<\/jats:italic>\n : 1.25\u20133.10), and coagulation abnormalities (\n OR:<\/jats:italic>\n 1.04, 95%\n CI<\/jats:italic>\n : 1.00\u20131.08). Elevated IgM was a common risk factor for both, while older age was protective against both (\n OR:<\/jats:italic>\n 0.89, 95%\n CI<\/jats:italic>\n : 0.83\u20130.96).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Bronchitis progression is primarily associated with airway obstruction, whereas pneumonia is linked to more complex clinical scenarios, including prior medication, co-infections, and coagulopathy. These findings can improve early risk stratification and guide targeted interventions.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fped.2026.1787440","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T05:37:04Z","timestamp":1776145024000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors for progression to bronchitis or pneumonia in hospitalized children with human rhinovirus infection: a retrospective cohort study using machine learning"],"prefix":"10.3389","volume":"14","author":[{"given":"Qiaoyan","family":"Dai","sequence":"first","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingying","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qidong","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Ningbo University","place":["Ningbo, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"521","DOI":"10.3390\/v11060521","article-title":"Impact of rhinovirus infections in children","volume":"11","author":"Vandini","year":"2019","journal-title":"Viruses"},{"key":"B2","doi-asserted-by":"publisher","first-page":"216","DOI":"10.2174\/0115733963267129230919091338","article-title":"Acute bronchiolitis: the less, the better?","volume":"20","author":"Virgili","year":"2024","journal-title":"Curr Pediatr Rev"},{"key":"B3","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1186\/s12887-024-05300-1","article-title":"Epidemiological characteristics of eleven common respiratory viral infections in children","volume":"24","author":"Li","year":"2024","journal-title":"BMC Pediatr"},{"key":"B4","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s12985-015-0262-z","article-title":"Rhinovirus is an important pathogen in upper and lower respiratory tract infections in Mexican children","volume":"12","author":"Aponte","year":"2015","journal-title":"Virol J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1097\/INF.0b013e31818ffc1b","article-title":"Rhinovirus associated with severe lower respiratory tract infections in children","volume":"28","author":"Louie","year":"2009","journal-title":"Pediatr Infect Dis J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e29876","DOI":"10.1002\/jmv.29876","article-title":"Viral respiratory infections requiring hospitalization in early childhood related to subsequent asthma onset and exacerbation risks","volume":"96","author":"Ha","year":"2024","journal-title":"J Med Virol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.3390\/children11111303","article-title":"Exploring the clinical characteristics and outcomes of rhinovirus infection in hospitalized children compared with other respiratory viruses","volume":"11","author":"Covaci","year":"2024","journal-title":"Children"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1016\/S0140-6736(17)32152-9","article-title":"Global, regional, and national age-sex specific mortality for 264 causes of death, 1980\u20132016: a systematic analysis for the global burden of disease study 2016","volume":"390","author":"Naghavi","year":"2017","journal-title":"Lancet"},{"key":"B9","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1183\/09031936.00062907","article-title":"Do childhood respiratory infections continue to influence adult respiratory morbidity?","volume":"33","author":"Dharmage","year":"2009","journal-title":"Eur Respir J"},{"key":"B10","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/S1579-2129(11)60004-9","article-title":"Relationship between lower respiratory tract infections in the first year of life and the development of asthma and wheezing in children","volume":"46","author":"Puig","year":"2010","journal-title":"Arch Bronconeumol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e0385323","DOI":"10.1128\/spectrum.03853-23","article-title":"Characteristics of upper respiratory tract rhinovirus in children with allergic rhinitis and its role in disease severity","volume":"12","author":"Gao","year":"2024","journal-title":"Microbiol Spectr"},{"key":"B12","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1097\/00006454-199701000-00010","article-title":"Rhinovirus infection associated with serious lower respiratory illness in patients with bronchopulmonary dysplasia","volume":"16","author":"Chidekel","year":"1997","journal-title":"Pediatr Infect Dis J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e13422","DOI":"10.1111\/tid.13422","article-title":"Epidemiology and persistence of rhinovirus in pediatric lung transplantation","volume":"22","author":"Ammerman","year":"2020","journal-title":"Transplant Infect Dis"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e13301","DOI":"10.1111\/tid.13301","article-title":"Assessment of immunodeficiency scoring index performance in enterovirus\/rhinovirus respiratory infection after allogeneic hematopoietic stem cell transplantation","volume":"22","author":"P\u00e9rez","year":"2020","journal-title":"Transplant Infect Dis"},{"key":"B15","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1002\/iid3.77","article-title":"Rhinovirus wheezing illness in infancy is associated with medically attended third year wheezing in low risk infants: results of a healthy birth cohort study","volume":"3","author":"de Winter","year":"2015","journal-title":"Immun Inflamm Dis"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e13741","DOI":"10.1111\/pai.13741","article-title":"The role of respiratory syncytial virus- and rhinovirus-induced bronchiolitis in recurrent wheeze and asthma\u2014a systematic review and meta-analysis","volume":"33","author":"Makrinioti","year":"2022","journal-title":"Pediatr Allergy Immunol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1111\/all.13624","article-title":"Bronchiolitis needs a revisit: distinguishing between virus entities and their treatments","volume":"74","author":"Jartti","year":"2019","journal-title":"Allergy"},{"key":"B18","doi-asserted-by":"publisher","first-page":"426","DOI":"10.3390\/pathogens14050426","article-title":"Systemic IL-10 and IFN-\u03b3 levels in respiratory syncytial virus- and rhinovirus-infected Bulgarian children with acute bronchiolitis and their impact on clinical manifestation","volume":"14","author":"Kostadinova","year":"2025","journal-title":"Pathogens"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1016\/j.jaci.2020.11.002","article-title":"Integrated-omics endotyping of infants with rhinovirus bronchiolitis and risk of childhood asthma","volume":"147","author":"Raita","year":"2021","journal-title":"J Allergy Clin Immunol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.ijid.2022.02.055","article-title":"Rhinoviruses: molecular diversity and clinical characteristics","volume":"118","author":"Bouzid","year":"2022","journal-title":"Int J Infect Dis"},{"key":"B21","author":"Dalmasso","year":""},{"key":"B22","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1183\/13993003.01132-2015","article-title":"Towards the standardisation of lung sound nomenclature","volume":"47","author":"Pasterkamp","year":"2016","journal-title":"Eur Respir J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.ijid.2023.04.003","article-title":"Determinants of poor clinical outcome in patients with influenza pneumonia: a systematic review and meta-analysis","volume":"131","author":"Arranz-Herrero","year":"2023","journal-title":"Int J Infect Dis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"3130","DOI":"10.1002\/ppul.27221","article-title":"Systematic review and meta-analysis of the accuracy of lung ultrasound and chest radiography in diagnosing community acquired pneumonia in children","volume":"59","author":"Shi","year":"2024","journal-title":"Pediatr Pulmonol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"8608","DOI":"10.3758\/s13428-024-02494-1","article-title":"Random forest analysis and lasso regression outperform traditional methods in identifying missing data auxiliary variables when the MAR mechanism is nonlinear (p.s. stop using Little\u2019s MCAR test)","volume":"56","author":"Hayes","year":"2024","journal-title":"Behav Res Methods"},{"key":"B26","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.eswa.2019.05.028","article-title":"A comparison of random forest variable selection methods for classification prediction modeling","volume":"134","author":"Speiser","year":"2019","journal-title":"Expert Syst Appl"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1016\/j.clnu.2022.04.018","article-title":"A simple assessment model based on phase angle for malnutrition and prognosis in hospitalized cancer patients","volume":"41","author":"Zhang","year":"2022","journal-title":"Clin Nutr"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1632","DOI":"10.1093\/aje\/kwae023","article-title":"Targeted learning with an undersmoothed LASSO propensity score model for large-scale covariate adjustment in health-care database studies","volume":"193","author":"Wyss","year":"2024","journal-title":"Am J Epidemiol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"915","DOI":"10.3390\/v13050915","article-title":"Microarray technology may reveal the contribution of allergen exposure and rhinovirus infections as possible triggers for acute wheezing attacks in preschool children","volume":"13","author":"Niespodziana","year":"2021","journal-title":"Viruses"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1728","DOI":"10.1111\/all.12991","article-title":"Rhinovirus-specific antibody responses in preschool children with acute wheeze reflect severity of respiratory symptoms","volume":"71","author":"Stenberg-Hammar","year":"2016","journal-title":"Allergy"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e0001522","DOI":"10.1128\/cmr.00015-22","article-title":"The microbial etiology of community-acquired pneumonia in adults: from classical bacteriology to host transcriptional signatures","volume":"35","author":"Gadsby","year":"2022","journal-title":"Clin Microbiol Rev"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1038\/s41409-022-01790-8","article-title":"Exposure to antibiotics with anaerobic activity before respiratory viral infection is associated with respiratory disease progression after hematopoietic cell transplant","volume":"57","author":"Ogimi","year":"2022","journal-title":"Bone Marrow Transplant"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e0055121","DOI":"10.1128\/Spectrum.00551-21","article-title":"Viral and atypical bacterial detection in young Nepalese children hospitalized with severe pneumonia","volume":"9","author":"Mathisen","year":"2021","journal-title":"Microbiol Spectr"},{"key":"B34","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/j.ebiom.2014.11.012","article-title":"Rhinovirus-induced VP1-specific antibodies are group-specific and associated with severity of respiratory symptoms","volume":"2","author":"Niespodziana","year":"2015","journal-title":"EBioMedicine"},{"key":"B35","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1186\/s12879-022-07456-6","article-title":"Clinical significance of Mycoplasma pneumoniae specific IgM titer in children hospitalized with Mycoplasma pneumoniae pneumonia","volume":"22","author":"Choo","year":"2022","journal-title":"BMC Infect Dis"},{"key":"B36","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.jpeds.2016.07.045","article-title":"Value of procalcitonin measurement for early evidence of severe bacterial infections in the pediatric intensive care unit","volume":"179","author":"Lautz","year":"2016","journal-title":"J Pediatr"},{"key":"B37","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s13613-025-01470-y","article-title":"Use of procalcitonin in therapeutic decisions in the pediatric intensive care unit","volume":"15","author":"Tissi\u00e8res","year":"2025","journal-title":"Ann Intensive Care"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e0304690","DOI":"10.1371\/journal.pone.0304690","article-title":"Prevalence and predictors of antibiotic prescription among patients hospitalized with viral lower respiratory tract infections in Southern Province, Sri Lanka","volume":"19","author":"Medrano","year":"2024","journal-title":"PLoS One"},{"key":"B39","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1186\/s12879-022-07289-3","article-title":"Incidence of lower respiratory tract infection and associated viruses in a birth cohort in the Philippines","volume":"22","author":"Otani","year":"2022","journal-title":"BMC Infect Dis"},{"key":"B40","doi-asserted-by":"publisher","first-page":"e77158","DOI":"10.7759\/cureus.77158","article-title":"Ultrasonography compared to computed tomography in pediatric complicated pneumonia: beyond radiation","volume":"17","author":"Ajmire","year":"2025","journal-title":"Cureus"},{"key":"B41","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1186\/s12890-022-01896-1","article-title":"The coming era of a new auscultation system for analyzing respiratory sounds","volume":"22","author":"Kim","year":"2022","journal-title":"BMC Pulm Med"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1460050","DOI":"10.3389\/fmed.2024.1460050","article-title":"Artificial intelligence and wheezing in children: where are we now?","volume":"11","author":"Venditto","year":"2022","journal-title":"Front Med"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1787440\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T05:37:05Z","timestamp":1776145025000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1787440\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":42,"alternative-id":["10.3389\/fped.2026.1787440"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1787440","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]},"article-number":"1787440"}}