Clinical and epidemiological characteristics of dengue with warning signs among hospitalized children in Vietnam: A cross-sectional study.

ObjectiveDengue is a major vector-borne viral infection and a frequent cause of pediatric hospitalization in endemic settings. This study described the clinical and laboratory characteristics of hospitalized children with laboratory-confirmed dengue in northern Vietnam and examined factors associated with dengue with warning signs (DWS).MethodsThis hospital-based cross-sectional study included retrospective and prospective components. Medical records were retrospectively reviewed for eligible children aged 0-16 years admitted from 1 September to 29 December 2022, whereas eligible children in the same age group were prospectively enrolled from 30 December 2022 to 31 August 2023. DWS was classified according to the World Health Organization 2009 criteria and the Vietnamese Ministry of Health guideline. Multivariable logistic regression was used to identify factors associated with DWS.ResultsAmong 319 children, 126 (39.5%) met the criteria for DWS. In the multivariable analysis, age >10 years (adjusted odds ratio [aOR] 2.17, 95% confidence interval [CI] 1.28-3.66; p = 0.004), urban residence (aOR 2.88, 95% CI 1.27-6.51; p = 0.011), platelet count ≤100 × 109/L (aOR 3.34, 95% CI 1.86-5.97; p < 0.001), and AST ≥100 U/L (aOR 2.83, 95% CI 1.58-5.05; p < 0.001) were independently associated with DWS. Among children with DWS, the most frequently observed warning signs were abdominal pain or tenderness (64.3%), persistent vomiting (31.7%), and mucosal bleeding (25.4%).ConclusionsDWS was common among hospitalized children with dengue at a tertiary children's hospital in northern Vietnam. Older age, urban residence, thrombocytopenia, and elevated aspartate aminotransferase may help identify children who require closer monitoring during hospitalization.