Risk Factors and Clinical Predictors of Severe Viral Gastroenteritis in Infants: A Multicenter Study in Iraqi Pediatric Hospitals

الملخص

Viral gastroenteritis remains one of the main causes of morbidity and hospitalization among infants in low- and middle-income countries. Although advances in vaccinations and oral rehydration therapy have been made, severe illness remains an important burden among children visiting pediatric hospitals in Iraq. Determination of clinical risk factors and predictors is vital to facilitate appropriate management of cases. Aim: The objective of the current research is the determination of risk factors and clinical predictors of severe viral gastroenteritis in infants aged 2-24 months visiting hospitals in Iraq. Methods: The multicenter cross-sectional study took place in three pediatric centers of Thi-Qar governorates in Iraq during January 2023 - December 2023. A total sample size of 420 patients diagnosed with viral gastroenteritis was examined. Severe illness was defined using the Modified Vesikari Score (MVS). Logistic regression analysis was used to determine independent predictors of severe illness. Results: Among 420 patients, 147 (35.0%) demonstrated severe gastroenteritis (MVS ≥11). Rotavirus infection was found in 48.6%, norovirus – in 21.4% and adenovirus – in 12.1%. The main independent predictors of severe disease were: rotavirus infection (OR = 4.12, 95% CI: 2.54–6.68); exclusive formula feeding (OR = 3.07, 95% CI: 1.88–5.01); age <12 months (OR = 2.84, 95% CI: 1.72–4.68); insufficient rotavirus vaccination (OR = 2.65, 95% CI: 1.60–4.39); moderate and severe malnutrition (OR = 2.47, 95% CI: 1.43–4.26); vomiting ≥6 times/day (OR = 2.31, 95% CI: 1.39–3.84). Dehydration was observed in 62.6% of patients, and 18.4% needed intravenous hydration. Conclusion: Rotavirus infection, formula feeding, young age, incomplete immunization, and malnutrition were established as independent predictors of severe viral gastroenteritis. Increasing vaccination rate, encouraging breastfeeding, and proper nutrition should be the priorities in preventing severe disease cases.