Abstract
<title>Abstract</title> <p>Background Severe viral pneumonia (SVP) remains a major cause of morbidity in children. This study aimed to characterize and compare six frequently detected respiratory viruses in pediatrics that with SVP. Methods A total of 450 children hospitalized with SVP were retrospectively enrolled. Respiratory pathogens were identified by target next‑generation sequencing (t‑NGS). Epidemiology, clinical characteristics, imaging features were compared among the six groups including human adenovirus (HAdV, n = 184), human rhinovirus (HRV, n = 131), respiratory syncytial virus (RSV, n = 53), human bocavirus (HBoV, n = 30), human parainfluenza virus (HPIV, n = 26), and human metapneumovirus (HMPV, n = 26). Results Age distribution differed significantly across different groups (p < 0.001); RSV, HBoV, HPIV, and HMPV clustered in early childhood (0–6 years), whereas HAdV and HRV affected older children. Fever duration was longest in HAdV (mean 7.65 days) and shortest in RSV (4.19 days, p < 0.001). Four clinical symptoms (pharyngeal congestion, tonsil swelling, three-sign recession, hypoxemia), three imaging features (pulmonary consolidation, pleurisy, interstitial emphysema) and plastic bronchitis, fiberoptic bronchoscope therapy demonstrated significant intergroup variation. HAdV was characterized by high consolidation (75.5%) and frequent virus-Mycoplasma pneumoniae (MP) co-infection (50.5%), while RSV exhibited the lowest consolidation rate (26.4%) and highest three-sign recession (37.7%). HPIV and HMPV were associated with the highest hypoxemia rates (both 30.8%). Seasonal patterns showed HAdV peaks in summer and winter, HRV in autumn, RSV in winter-spring, and HPIV in summer. Conclusions Six common respiratory viruses in pediatric SVP present distinguishable clinical, radiological, co-infection, and seasonal profiles. These virus-specific phenotypes may facilitate early etiological prediction, risk stratification, and tailored therapeutic strategies.</p>