Clinical Features and Predictors of Severity in Children Hospitalized With Human Metapneumovirus: A Multicenter Italian Study

BACKGROUND: Human metapneumovirus (hMPV) is an important cause of pediatric lower respiratory tract infection. We describe the epidemiology and clinical severity of hMPV-associated pediatric hospitalizations in Italy in the post-coronavirus disease 2019 period and identify predictors of pediatric intensive care unit (PICU) admission and prolonged hospitalization. METHODS: We conducted a multicenter observational study across 11 tertiary care centers in Italy. Children hospitalized for ≥48 hours with laboratory-confirmed hMPV infection between January 2023 and June 2025 were included. Clinical features were analyzed overall and compared across co-infection categories and age groups. Associations with prolonged hospitalization (>7 days) and PICU admission were evaluated using logistic regression models. RESULTS: A total of 312 children were hospitalized with hMPV infection (median age 14 months, interquartile range 5-36); 86.2% were