Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak

Abstract

ImportanceRespiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide.ObjectiveTo evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission.Design, Setting, and ParticipantsThis cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states. Participants were infants admitted for 24 or more hours between October 17 and December 16, 2022, to a unit providing intensive care due to laboratory-confirmed RSV infection.ExposureRespiratory syncytial virus.Main Outcomes and MeasuresData were captured on demographics, clinical characteristics, signs and symptoms, laboratory values, severity measures, and clinical outcomes, including receipt of noninvasive respiratory support, invasive mechanical ventilation, vasopressors or extracorporeal membrane oxygenation, and death. Mixed-effects multivariable log-binomial regression models were used to assess associations between intubation status and demographic factors, gestational age, and underlying conditions, including hospital as a random effect to account for between-site heterogeneity.ResultsThe first 15 to 20 consecutive eligible infants from each site were included for a target sample size of 600. Among the 600 infants, the median (IQR) age was 2.6 (1.4-6.0) months; 361 (60.2%) were male, 169 (28.9%) were born prematurely, and 487 (81.2%) had no underlying medical conditions. Primary reasons for admission included LRTI (594 infants [99.0%]) and apnea or bradycardia (77 infants [12.8%]). Overall, 143 infants (23.8%) received invasive mechanical ventilation (median [IQR], 6.0 [4.0-10.0] days). The highest level of respiratory support for nonintubated infants was high-flow nasal cannula (243 infants [40.5%]), followed by bilevel positive airway pressure (150 infants [25.0%]) and continuous positive airway pressure (52 infants [8.7%]). Infants younger than 3 months, those born prematurely (gestational age <37 weeks), or those publicly insured were at higher risk for intubation. Four infants (0.7%) received extracorporeal membrane oxygenation, and 2 died. The median (IQR) length of hospitalization for survivors was 5 (4-10) days.Conclusions and RelevanceIn this cross-sectional study, most US infants who required intensive care for RSV LRTIs were young, healthy, and born at term. These findings highlight the need for RSV preventive interventions targeting all infants to reduce the burden of severe RSV illness.

Characterisation of RSV infections in children without chronic diseases aged 0–36 months during the post-COVID-19 winter season 2022/2023

“…This phenomenon appeared to slow down in the 2022/2023 season despite the earlier onset compared to pre pandemic years ( 13 ). Hence, the initial curb of infections in 0–36-month-olds could have potentially resulted in this wave of RSV cases in late November/early December 2022 and increased hospitalisation rates, as also recorded by the US RSV Network ( 20 , 21 ).…”

“…The literature offers limited data on the severity and course of RSV infections in primary health care settings, as many studies have focused on the outpatient setting or hospitalised patients ( 2 , 10 , 11 , 21 , 22 ). In the first years of life, infants face a significant burden due to RSV in both inpatient and outpatient settings ( 23 – 25 ).…”

Noninvasive Positive Pressure Ventilation Use and In-Hospital Cardiac Arrest in Bronchiolitis

“…The characteristics of children with IHCA in this cohort differ from the general bronchiolitis population. Most children admitted with bronchiolitis do not have underlying conditions ( 24 ). However, our data demonstrate that most of the children with bronchiolitis who suffered an IHCA had preexisting chronic conditions.…”

Safety of RSV Vaccine among Pregnant Individuals: A Real-World Pharmacovigilance Study Using Vaccine Adverse Event Reporting System

“…Among the various pathogens of concern, Respiratory Syncytial Virus (RSV) represents a substantial burden for infants under 6 months of age 3 , accounting for around 1.4 million hospitalizations and 45,700 deaths globally each year 4 . In the U.S., RSV infections stands as the leading cause of infant hospitalizations among those younger than 6 months 5 , highlighting the need for an effective intervention to reduce the burden of the disease 6 , all while weighing potential benefits and risks 3,5 . In response, the Food and Drug Administration (FDA) has recently approved two agents for protecting infants against severe RSV illness: nirsevimab, a long-acting monoclonal antibody developed for newborns 7 , and RSVPreF (Abrysvo, Pfizer), a novel RSV vaccine formulated with the prefusion F protein, approved for pregnant individuals 8 .…”