SMMC study finds respiratory infections place heavy burden on children and hospital care
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GREAT BAY--Respiratory infections are often dismissed as common childhood illnesses, but a five-year study conducted at St. Maarten Medical Center shows that they account for a substantial share of medical visits and hospital admissions among children on the island.
The research reviewed the records of children treated at SMMC for respiratory symptoms between September 2018 and September 2023. It examined how often these illnesses occurred, which viruses were linked to more serious breathing problems and whether infections followed a seasonal pattern in St. Maarten’s tropical climate.
During the five-year study, children made 14,530 outpatient visits to SMMC. Just over half of those visits, 7,380, involved a respiratory infection. Respiratory infections also caused 508 of the 1,816 pediatric hospital admissions, or about 28 per cent. Nine of those children required intensive care, and one child died.
The more detailed analysis focused on the 508 children who were admitted to hospital with respiratory infections. Their average age was about three years, and nearly two-thirds were boys. Just over half were tested to identify the specific virus causing their illness.
Among younger children, lower respiratory infections were the most common diagnosis, followed by upper respiratory infections and viral wheezing. The viruses detected most often were rhino/enterovirus and RSV, followed by adenovirus and parainfluenza.
Older children were more likely to be admitted with viral wheezing, followed by upper and lower respiratory infections. Asthma flare-ups were also recorded in this group. Rhino/enterovirus was by far the most common virus found, while influenza was the second most common.
In simpler terms, respiratory illness was not a small or occasional part of pediatric care at SMMC. It was one of the main reasons children were brought to the hospital and one of the leading causes of admission.
The authors of the study are Drs. Sam Engels, Radboud UMC Epidemiologist; Drs. Martijn Tilanus, SMMC Pediatrician; Drs. Radjin Steingrover, SMMC and St. Maarten Laboratory Services Medical Microbiologist; and Dr. Lilly Verhagen, SMMC and Radboud UMC Pediatrician and Infectious Diseases and Immunology Subspecialist.
RSV was linked to more serious illness
One of the clearest findings involved respiratory syncytial virus, better known as RSV.
RSV is a common virus that can resemble a cold in many people. In babies and young children, however, it can move into the lower airways and cause serious breathing difficulties. Children admitted with RSV were more likely than those with several other respiratory viruses to require oxygen. They were also more likely to experience rapid or difficult breathing.
RSV was particularly associated with severe illness among younger children. The average age of children diagnosed with the virus was under one year, showing why babies and toddlers require special attention when respiratory symptoms begin to worsen. The findings do not mean every child who contracts RSV will become seriously ill. Many recover without hospital care. However, the study confirms that RSV is one of the viruses most likely to place young children under greater respiratory stress.
A common cold virus was also more serious than expected
The researchers also found that rhino/enterovirus was linked to breathing difficulties and an increased need for oxygen among hospitalised children. These viruses are commonly associated with colds, congestion and wheezing and are often viewed as relatively mild. The study showed that this is not always the case, particularly among children sick enough to be admitted to hospital.
Rhino/enterovirus was the most frequently identified virus in the children who were tested. It was also common among children who had to be admitted more than once for respiratory illness. This does not necessarily mean the virus alone caused every severe case. Some children may already have been more vulnerable to breathing problems, while others had more than one infection at the same time. The finding nevertheless shows that what begins as a familiar cold can become serious in some children.
One in five admitted children needed oxygen
Among the 508 children hospitalised with respiratory infections, approximately two-thirds experienced rapid or difficult breathing. One in five required oxygen treatment. Lower respiratory tract infections, including illnesses affecting the lungs and lower airways, were especially common among children aged two and younger. Older children were more likely to experience viral wheezing, while asthma-related episodes were seen in children aged six and above.
The average hospital stay became shorter after the COVID-19 period, declining from just over three days to approximately two-and-a-half days. The use of antibiotics among admitted children also fell significantly. The researchers noted that antibiotics do not treat viral infections. Better testing and diagnosis may help doctors avoid prescribing them when a virus, rather than bacteria, is responsible for the illness.
St. Maarten’s RSV season differs from colder countries
Perhaps the most useful local finding was the timing of RSV cases. In Europe and North America, RSV is usually associated with the colder winter months. Medical prevention schedules are often built around that pattern. St. Maarten does not follow the same cycle.
The study found repeated RSV peaks around June and July and again during September and October. These periods fall largely within the rainy season, which runs from May through November. That difference matters because preventive treatment works best when it is provided before the virus begins circulating heavily.
At the time covered by the study, RSV preventive treatment for eligible children was administered in October. However, one of the main local peaks had already occurred several months earlier. The researchers therefore concluded that the timing of RSV prevention should be reconsidered to better match St. Maarten’s actual infection pattern.
Why local research is important
Much of the medical guidance used in the Caribbean is based on research conducted in Europe, North America or other temperate areas. Those guidelines remain useful, but seasonal information cannot always be transferred directly to a tropical island.
Rainfall, temperature, travel patterns and the movement of residents and visitors can affect when respiratory viruses circulate. St. Maarten also serves as a referral centre for children from Saba and St. Eustatius, giving the findings wider relevance.
The study demonstrates why local healthcare decisions should be supported by Caribbean data. Knowing when RSV is most active can help hospitals plan staffing, oxygen supplies, testing and preventive measures before cases begin to rise. It can also help doctors warn parents during the periods when babies and young children may face the greatest risk.
Did respiratory illness become worse after COVID-19?
The study found stronger links between RSV and serious breathing problems during the period following the COVID-19 pandemic. Children with RSV were more likely to need oxygen after the pandemic than before it. RSV and rhino/enterovirus were also more strongly associated with rapid or difficult breathing in the later period.
However, the researchers were careful not to conclude that the viruses definitely became more dangerous. Testing increased significantly after the pandemic, meaning doctors had much more information about which viruses children carried. The number of tested patients before COVID-19 was also smaller, making a direct comparison more difficult.
One possible explanation is that children had less exposure to common viruses during lockdowns and other restrictions, leaving some with lower immunity when normal social contact resumed. Another possibility is that different strains circulated later. The study identified a pattern worth watching, but larger research involving more Caribbean islands would be required to confirm the reason.
What parents should take from the findings
The study is not intended to cause alarm. Most childhood respiratory infections remain manageable, and serious outcomes were limited in the cases reviewed. It does show, however, that parents should not automatically treat every infection as “just a cold,” particularly in babies and very young children.
Warning signs include unusually fast breathing, difficulty breathing, the chest pulling inward while the child breathes, persistent wheezing, poor feeding, unusual tiredness or a bluish colour around the lips. Parents who notice serious or worsening symptoms should seek medical attention rather than waiting for the illness to pass on its own.
What happens next
The researchers said broader RSV prevention should be considered, along with a schedule that reflects the virus’s local seasonality. The findings are also being used to support the RSV Roadmap project, a collaboration involving SMMC, Radboud UMC and regional partners. That project will examine how newer RSV preventive measures can be introduced in a way that fits the healthcare systems and seasonal patterns of the Dutch Caribbean.
The study has limitations. Virus-specific testing was largely available for hospitalised children rather than the much larger outpatient group. It also focused mainly on St. Maarten and involved a moderate number of tested patients. Even with those limitations, its central message is clear.
Respiratory infections create a significant burden for children, families and hospital services in St. Maarten. RSV and rhino/enterovirus are linked to some of the more serious cases, while the timing of RSV circulation differs from the schedules commonly used in colder countries.
For SMMC, the research provides information that can improve preparation and prevention. For parents, it offers a better understanding of why some childhood respiratory infections require closer attention.
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