Children born preterm admitted to paediatric intensive care for bronchiolitis: a systematic review and meta-analysis

Abstract

Background To undertake a systematic review of studies describing the proportion of children admitted to a paediatric intensive care unit (PICU) for respiratory syncytial virus (RSV) and/or bronchiolitis who were born preterm, and compare their outcomes in PICU with children born at term. Methods We searched Medline, Embase and Scopus. Citations and references of included articles were searched. We included studies published from the year 2000 onwards, from high-income countries, that examined children 0–18 years of age, admitted to PICU from the year 2000 onwards for RSV and/or bronchiolitis. The primary outcome was the percentage of PICU admissions born preterm, and secondary outcomes were observed relative risks of invasive mechanical ventilation and mortality within PICU. We used the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies to assess risk of bias. Results We included 31 studies, from 16 countries, including a total of 18,331 children. Following meta-analysis, the pooled estimate for percentage of PICU admissions for RSV/bronchiolitis who were born preterm was 31% (95% confidence interval: 27% to 35%). Children born preterm had a greater risk of requiring invasive ventilation compared to children born at term (relative risk 1.57, 95% confidence interval 1.25 to 1.97, I2 = 38%). However, we did not observe a significant increase in the relative risk for mortality within PICU for preterm-born children (relative risk 1.10, 95% confidence interval: 0.70 to 1.72, I2 = 0%), although the mortality rate was low across both groups. The majority of studies (n = 26, 84%) were at high risk of bias. Conclusions Among PICU admissions for bronchiolitis, preterm-born children are over-represented compared with the preterm birth rate (preterm birth rate 4.4% to 14.4% across countries included in review). Preterm-born children are at higher risk of mechanical ventilation compared to those born at term.

Critical Case of a Preterm Infant Infected With Respiratory Syncytial Virus Managed in the Pediatric Intensive Care Unit: A Case Report

“…This vulnerability becomes more pronounced if they are diagnosed with RSV. Such diagnoses can lead to severe critical illnesses, necessitating intensive medical care [3]. This situation underscores the importance of early detection and proactive management strategies to mitigate the risks associated with RSV in this susceptible infant population.…”

“…However, children under two years old and born at 31-36 weeks gestational age (GA) face a higher risk of hospitalization and PICU admission for community-acquired alveolar pneumonia (CAAP) [1][2], especially RSV-associated CAAP, compared to those born after 36 weeks GA. Late-preterm infants have a 50% higher risk of RSV-related CAAP than full-term infants. Also, preterm children, disproportionately represented in PICU admissions for bronchiolitis [3], exceed the general preterm birth rates (4.4-14.4% globally) and face a greater likelihood of requiring mechanical ventilation than full-term infants. In this pediatric case, the patient admitted to the PICU underwent comprehensive monitoring and treatment due to a severe respiratory condition.…”

“…The child was brought to the pediatric intensive care unit (PICU) [3] for persistent observation and therapy involving regular nebulization, chest physiotherapy, and nasal suctioning. Unfortunately, the child's health worsened, necessitating the start of continuous positive airway pressure (CPAP: 10-12 cm H2O) therapy, which was not well received for two days.…”