Age-specific profiles and ICU predictors in pediatric plastic bronchitis: A multicenter Chinese cohort study, 2014-2025.

INTRODUCTION AND AIM: Plastic bronchitis (PB) is a rare yet critical respiratory condition in children, with age-specific clinical profiles and predictors for severe progression remaining poorly characterized.

METHODS

This multicenter, retrospective study analyzed 180 pediatric PB cases (2014-2025), categorizing patients into nursing (0-3 years), pre-school (>3-6 years), and school-age (≥6 years) groups. We compared demographics, clinical features, laboratory findings, and outcomes across these cohorts. Independent risk factors for ICU admission were identified via multivariate logistic regression.

RESULTS

Nursing children presented with more severe respiratory distress, exhibiting significantly higher rates of wheezing, dyspnea, and ICU admission (all P < 0.05) compared to older groups. Mycoplasma pneumoniae detection was more common in pre-school and school-age children (P < 0.001), whereas Human Bocavirus was predominant in nursing children (P = 0.001). Multivariable analysis identified prolonged hospitalization (OR 1.141, P < 0.001), elevated aspartate aminotransferase (AST) (OR 1.004, P = 0.028), and influenza A/B infection (OR 8.563, P = 0.001) as independent risk factors for ICU admission.

CONCLUSION

This study, representing the largest PB cohort to date, reveals that nursing children constitute a high-risk subgroup with distinct virologic patterns. Influenza infection, elevated AST, and extended hospital stay serve as key predictors for ICU care, underscoring the necessity of age-specific management protocols in pediatric PB.