{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:52:45Z","timestamp":1785909165390,"version":"3.56.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Clinical interpretation of respiratory sequencing results is difficult when analytical support is sparse or when sequencing findings do not align with routine laboratory reports. We expanded an ultra-low-yield index case into a retrospective descriptive pediatric case series to characterize recurrent interpretive scenarios and support a pragmatic laboratory reporting framework. We retrospectively reviewed archived upper respiratory specimens from pediatric patients with respiratory symptoms who had undergone both routine respiratory testing and sequencing-based pathogen analysis. Clinical features, routine-test interpretation, sequencing metrics, top reported hits, result-return timing, management review, and short-term outcomes were abstracted from retrievable records. Ten children aged 6\u201310 years were included. Routine testing was classified as influenza-positive in 8 cases and negative in 2 cases. Retained pathogen-associated contigs were sparse (median: 12.5; range: 5\u201317), and mapped read support was low (median: 408.5\u2005read pairs; range: 384\u2013453). Top low-support hits included rhinovirus\/rhinovirus B in 6 cases, respiratory syncytial virus in 2 cases, and Mycoplasma-related hits in 2 cases. The Mycoplasma-related findings were interpreted cautiously because limited report-level sequencing evidence and the absence of orthogonal confirmation, paired serology, lower-respiratory specimen confirmation, or specimen-matched negative-control review prevented confident distinction between active infection, carriage or colonization, transient detection, coinfection of uncertain relevance, and contamination. No case had documented orthogonal confirmation or a specimen-matched negative control. Provider-level clarification indicated the use of batch-level negative controls, the absence of respiratory pathogen-related background reads, contamination-aware filtering, and manual review, although raw batch-level quality-control (QC) reports were not independently retrievable. Low-yield respiratory sequencing results in this small, purposively selected pediatric series were best understood as analytically limited signals requiring cautious interpretation. Accordingly, these low-support detections should be treated as hypothesis-generating observations rather than disease-defining findings. The proposed framework should be interpreted as a preliminary reporting aid for structured interpretation, not as a validated diagnostic algorithm.<\/jats:p>","DOI":"10.3389\/fped.2026.1865124","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T05:41:08Z","timestamp":1785908468000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Low-yield respiratory sequencing in pediatric upper respiratory specimens: a case series and reporting framework"],"prefix":"10.3389","volume":"14","author":[{"given":"Yunxia","family":"Xiu","sequence":"first","affiliation":[{"name":"Second Clinical Medical School, Mudanjiang Medical University","place":["Mudanjiang, China"]},{"name":"Department of Laboratory Medicine, The Second Affiliated Hospital of Mudanjiang Medical University, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingjun","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Daqing People\u2019s Hospital","place":["Daqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiwei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Daqing People\u2019s Hospital","place":["Daqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"He","family":"Wang","sequence":"additional","affiliation":[{"name":"First Clinical Medical School, Mudanjiang Medical University","place":["Mudanjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Scientific Research, Mudanjiang Medical University","place":["Mudanjiang, 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