{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T09:08:37Z","timestamp":1779700117374,"version":"3.53.1"},"reference-count":18,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Objectives: We aimed to describe the healthcare utilization and economic burden of lower respiratory tract infections (LRTIs) among children aged 1\u201324 months across five tertiary hospitals in Saudi Arabia. Methods: This multicenter retrospective cohort study included 14,320 children diagnosed with LRTIs between August 2021 and July 2025. Data were extracted from the electronic medical records of the Ministry of National Guard Health Affairs. Demographics were analyzed using a patient-level dataset, whereas healthcare utilization and costs were evaluated at the episode level. Data were analyzed using descriptive and inferential statistics and multivariable logistic regression. Results: A total of 14,320 children contributed 22,895 LRTI-related episodes during the study period. Nearly half of the cohort (49.4%) were aged 1\u20136 months, and bronchiolitis was the predominant diagnosis (84.6%), followed by pneumonia (15.1%). Overall, 34.4% of patients required hospitalization, while 7.1% required ICU admission. LRTIs accounted for 21.0% of all pediatric ward admissions across participating hospitals. Total direct healthcare costs reached USD 23.0 million. Although ICU admissions represented only 7.1% of episodes, they accounted for 45.1% of total healthcare expenditures. In multivariable analysis, pneumonia was independently associated with higher odds of ICU admission compared with bronchiolitis (aOR 2.91, 95% CI 2.43\u20133.48; p &lt; 0.001). Significant seasonal variation in LRTI episodes was observed, with higher episode volumes during winter months (p = 0.004). Conclusions: Pediatric LRTIs impose substantial clinical and financial burdens, particularly among younger infants, marked by disproportionate ICU-related costs.<\/jats:p>","DOI":"10.3390\/pediatric18030071","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T08:06:26Z","timestamp":1779696386000},"page":"71","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare Utilization and Economic Burden of Pediatric Lower Respiratory Tract Infections Across Five Tertiary Hospitals in Saudi Arabia"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4177-7041","authenticated-orcid":false,"given":"Nawaf M.","family":"Almuqati","sequence":"first","affiliation":[{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 9515, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5261-9196","authenticated-orcid":false,"given":"Mohammed Y.","family":"Al-Hindi","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 9515, Saudi Arabia"},{"name":"Department of Neonatal Intensive Care, King Abdulaziz Medical City\u2014Western Region, Ministry of National Guard Health Affairs (MNGHA), Jeddah 9515, Saudi Arabia"},{"name":"King Abdullah International Medical Research Centre (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Jeddah 9515, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5522-2505","authenticated-orcid":false,"given":"Hibah A.","family":"Moussa","sequence":"additional","affiliation":[{"name":"College of Medicine, King Abdulaziz University, Jeddah 80200, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1371-5893","authenticated-orcid":false,"given":"Sama H.","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"College of Medicine, King Abdulaziz University, Jeddah 80200, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4400-6792","authenticated-orcid":false,"given":"Manar A.","family":"Almuntashri","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 9515, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansour A.","family":"Al-Qurashi","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 9515, Saudi Arabia"},{"name":"Department of Neonatal Intensive Care, King Abdulaziz Medical City\u2014Western Region, Ministry of National Guard Health Affairs (MNGHA), Jeddah 9515, Saudi Arabia"},{"name":"King Abdullah International Medical Research Centre (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs (MNGHA), Jeddah 9515, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mawyah O.","family":"Barayyan","sequence":"additional","affiliation":[{"name":"School of Medicine and Dentistry, University of Central Lancashire, Preston PR1 2HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaykhah M.","family":"Bin-Sifran","sequence":"additional","affiliation":[{"name":"Ibn Sina National College for Medical Studies, Jeddah 21462, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/S0140-6736(16)31012-1","article-title":"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980\u20132015: A systematic analysis for the Global Burden of Disease Study 2015","volume":"388","author":"Wang","year":"2016","journal-title":"Lancet"},{"key":"ref_2","unstructured":"(2020). GBD 2017 Lower Respiratory Infections Collaborators. Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: An analysis for the Global Burden of Disease Study 2017. Lancet Infect. Dis., 20, 60\u201379."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/1824-7288-39-22","article-title":"Virological and clinical characterizations of respiratory infections in hospitalized children","volume":"39","author":"Bicer","year":"2013","journal-title":"Ital. J. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"24615","DOI":"10.1038\/srep24615","article-title":"Hospitalization risk factors for children\u2019s lower respiratory tract infection: A population-based cross-sectional study in Mongolia","volume":"6","author":"Dagvadorj","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"127","DOI":"10.4103\/atm.ATM_60_18","article-title":"Bronchiolitis in children: The Saudi initiative of bronchiolitis diagnosis, management, and prevention (SIBRO)","volume":"13","author":"Alharbi","year":"2018","journal-title":"Ann. Thorac. Med."},{"key":"ref_6","first-page":"53","article-title":"Lower respiratory tract infections among Saudi children: A review of literature","volume":"10","author":"Mohamed","year":"2020","journal-title":"Int. J. Pharm. Phytopharm. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"190","DOI":"10.4103\/atm.atm_69_24","article-title":"Saudi initiative of bronchiolitis diagnosis, management, and prevention 2024 updated consensus on the prevention of respiratory syncytial virus","volume":"19","author":"Alharbi","year":"2024","journal-title":"Ann. Thorac. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jiph.2017.06.001","article-title":"Seasonal variations of respiratory viruses detected from children with respiratory tract infections in Riyadh, Saudi Arabia","volume":"11","author":"Albogami","year":"2018","journal-title":"J. Infect. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1007\/s00705-019-04300-2","article-title":"Epidemiology of respiratory viruses in Saudi Arabia: Toward a complete picture","volume":"164","author":"Farrag","year":"2019","journal-title":"Arch. Virol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"8844420","DOI":"10.1155\/2020\/8844420","article-title":"Clinical and epidemiological determinants of lower respiratory tract infections in hospitalized pediatric patients","volume":"2020","author":"Mirkarimi","year":"2020","journal-title":"Int. J. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.medin.2020.04.023","article-title":"Viral etiology and outcome of severe lower respiratory tract infections among critically ill children admitted to the PICU","volume":"45","author":"Duyu","year":"2021","journal-title":"Med. Intensiv."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"29","DOI":"10.3345\/kjp.2014.57.1.29","article-title":"Prevalence of respiratory viral infection in children hospitalized for acute lower respiratory tract diseases and association of rhinovirus and influenza virus with asthma exacerbations","volume":"57","author":"Kwon","year":"2014","journal-title":"Korean J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/irv.12911","article-title":"Epidemiology of acute lower respiratory tract infection hospitalizations in Thai children: A 5-year national data analysis","volume":"16","author":"Sitthikarnkha","year":"2022","journal-title":"Influenza Other Respir. Viruses"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"95","DOI":"10.4103\/2141-9248.126610","article-title":"Risk factors for acute respiratory tract infections in under-five children in Enugu Southeast Nigeria","volume":"4","author":"Ujunwa","year":"2014","journal-title":"Ann. Med. Health Sci. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1542\/peds.2014-0244","article-title":"Hospitalizations for severe lower respiratory tract infections","volume":"134","author":"Greenbaum","year":"2014","journal-title":"Pediatrics"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1007\/s00431-020-03790-6","article-title":"Use of procalcitonin and C-reactive protein in the diagnosis of bacterial infection in infants with severe bronchiolitis","volume":"180","author":"Alejandre","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"010408","DOI":"10.7189\/jogh.06.010408","article-title":"Cost of management of severe pneumonia in young children: Systematic analysis","volume":"6","author":"Zhang","year":"2016","journal-title":"J. Glob. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1590\/0074-02760150341","article-title":"Respiratory syncytial virus seasonality in Brazil: Implications for the immunisation policy for at-risk populations","volume":"111","author":"Freitas","year":"2016","journal-title":"Mem. Inst. Oswaldo Cruz"}],"container-title":["Pediatric Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7503\/18\/3\/71\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T08:55:09Z","timestamp":1779699309000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7503\/18\/3\/71"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":18,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["pediatric18030071"],"URL":"https:\/\/doi.org\/10.3390\/pediatric18030071","relation":{},"ISSN":["2036-7503"],"issn-type":[{"value":"2036-7503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]}}}