‘Young, term and previously healthy infants’ made up RSV peak 2022 ICU admissions
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Key takeaways:
- Around 80% of infants hospitalized with an RSV-related illness did not have underlying medical conditions.
- Premature infants accounted for only 29% of those admitted to the ICU during the 2022 RSV seasonal peak.
Healthy infants born at term characterized the population admitted to the ICU for respiratory syncytial virus lower respiratory tract infections last year, according to results published in JAMA Network Open.
“Despite the known risk factors for severe [respiratory syncytial virus (RSV)] disease, which often include infants and children with a history of prematurity and/or an underlying medical condition, our study discovered that the majority of children hospitalized for RSV, even those with severe illness, are actually young, term and previously healthy infants,” Natasha Halasa, MD, MPH, Craig Weaver Professor of Pediatrics in the division of pediatric infectious diseases at Monroe Carell Jr. Children’s Hospital at Vanderbilt, told Healio.
In a cross-sectional study of peak 2022 RSV transmission data, which spanned October to December, Halasa and colleagues analyzed 600 infants (median age, 2.6 months; 60.2% boys) with an RSV-related critical illness from a total of 39 pediatric hospitals in the U.S. who had a stay that lasted for 24 hours or longer to characterize and assess outcomes of this patient population.
Researchers observed that lower respiratory tract infections accounted for nearly all of the infants’ admissions (99%); however, admitted infants also presented with apnea/bradycardia (12.8%), which appeared more prevalent among infants who received intubation and among those aged younger than 3 months old (n = 323).
Many infants were healthy (81.2%) — proven through a lack of underlying medical conditions — and born at term (71.1%).
Two infants died during hospitalization, but for the remainder of the population, the median hospitalization duration was 5 days.
Almost a quarter of infants (23.8%) underwent invasive mechanical ventilation for a median of 6 days, 70.6% of whom were aged younger than 3 months. Among those who did not require intubation, researchers found that 40.5% received high-flow nasal cannula, 25% received bilevel positive airway pressure and 8.7% received CPAP. Only four infants (0.7%) required extracorporeal membrane oxygenation.
When dividing the cohort according to age younger or older than 3 months, researchers found that both age groups primarily received oxygen support by high-flow nasal cannula, followed by intubation for younger infants and bilevel positive airway pressure or noninvasive ventilation for older infants.
Notably, disease severity scores were higher among those aged younger than 3 months vs. infants aged 3 months or older. Younger infants also had extended stays in the ICU (4 days vs. 3 days; P = .002) and hospital (6 days vs. 5 days; P = .001), according to researchers.
When evaluating clinical outcomes among the total cohort, researchers found a heightened likelihood for intubation among infants aged younger than 3 months (adjusted prevalence ratio [aPR] = 2.05; 95% CI, 1.51-2.78), infants born preterm (aPR = 2.09; 95% CI, 1.22-3.59) and infants of parents publicly insured (aPR = 1.47; 95% CI, 1.07-2).
An additional risk factor for intubation was a history of bronchopulmonary dysplasia (aPR = 2.2; 95% CI, 1-4.8), which is likely due to the fact that the condition affects premature infants, according to researchers.
“Last year’s RSV surge significantly impacted clinicians,” Halasa told Healio. “Many pediatric ICUs were at full capacity, leading to the diversion of infants to alternative care locations.
“With the newly approved nirsevimab [Beyfortus, Sanofi], a long-acting RSV-neutralizing monoclonal antibody, we are hopeful,” Halasa added. “If it’s widely adopted and effectively implemented, future studies may document a notable decrease in the RSV-related burden.”
Reference:
- Study finds most infants receiving ICU-level care for RSV had no underlying medical condition. https://news.vumc.org/2023/08/15/study-finds-most-infants-receiving-icu-level-care-for-rsv-had-no-underlying-medical-condition/. Published Aug. 15, 2023. Accessed Aug. 15, 2023.
For more information:
Natasha Halasa, MD, MPH, can be reached at natasha.halasa@vumc.org.