Objective:

To describe the epidemiology, clinical characteristics, monthly viral distribution, treatment practices, and antibiotic utilization patterns among hospitalized children with acute viral respiratory illness during the peak respiratory virus period, highlighting its significance for clinical management.

Key Findings:

• Mean age of patients was 3.2 ± 2.9 years, with 58.2% being male.
• 42.8% of patients required supplemental oxygen and 12.1% required ICU admission.
• Respiratory pathogens were detected in 72.9% of patients, with RSV (35.5%) and Enterovirus (22.1%) being the most common.
• Viral positivity was associated with younger age, longer hospital stays, and increased oxygen requirement (p < 0.05).
• Higher inflammatory markers and antibiotic use were noted in patients with negative swab results (p < 0.05).

Interpretation:

RSV and Enterovirus were the predominant causes of pediatric ARI hospitalization during winter in Saudi Arabia. Early viral identification using multiplex PCR may reduce unnecessary antibiotic use and improve clinical management.

Limitations:

• The study is limited to a single tertiary care hospital, which may affect generalizability and the applicability of findings to other settings.
• Retrospective design may introduce biases in data collection and analysis, potentially impacting the reliability of results.

Conclusion:

Findings support continued regional viral surveillance to guide seasonal preparedness and clinical management, emphasizing the need for effective public health strategies.