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Published on: January 26, 2019
The impact of prophylaxis on paediatric intensive care unit admissions for RSV infection: a retrospective,
Michelle L Butt1, Amanda Symington, Marianne Janes
1School of Nursing, McMaster University, Hamilton, ON, L8N 3Z5, Canada.
Insights
Respiratory syncytial virus (RSV) is a major cause of pediatric hospitalizations. Current prophylaxis programs show limited impact, suggesting universal immunization may be needed to reduce intensive care unit admissions.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Respiratory Medicine
Background:
- Respiratory syncytial virus (RSV) is a primary cause of lower respiratory tract infections and hospitalizations in children under two years old.
- A retrospective study was conducted to analyze characteristics of pediatric intensive care unit (PICU) admissions for RSV infection post-implementation of a prophylaxis program.
Purpose of the Study:
- To examine patient characteristics, management, and outcomes of PICU admissions for RSV infection.
- To evaluate the effectiveness of the RSV prophylaxis program in a real-world setting.
Main Methods:
- Retrospective analysis of electronic medical records for PICU admissions due to RSV infection between 2003 and 2009.
- Data collected included demographics, underlying conditions, hospitalization criteria, diagnosis, management, complications, and palivizumab prophylaxis.
Main Results:
- 181 patients admitted with RSV (5.7% of total admissions), with 84% aged two years or younger.
- Most patients (70.2%) had no underlying illness; 79.6% received antibiotics.
- Only 3.3% of RSV infections occurred in children who received palivizumab prophylaxis. Two deaths were reported.
Conclusions:
- Over 88% of PICU admissions for RSV did not meet established prophylaxis guidelines.
- A significant proportion (66%) of young children admitted were preterm but not targeted for prophylaxis.
- Further reductions in RSV PICU admissions may require universal immunization programs rather than targeted prophylaxis.
Abstract:
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections and hospitalizations in children aged < 2 years. The aim of this retrospective, single-centre study was to examine the characteristics of patients admitted to a paediatric intensive care unit (PICU) with RSV infection following the implementation of a RSV prophylaxis programme. Electronic hospital medical records of all PICU admissions for RSV infection were searched from 2003 to 2009. Data on baseline demographics, underlying disease, criteria for hospitalization, respiratory diagnosis and management, complications and palivizumab prophylaxis were collected. A total of 181 patients were admitted with RSV infection, accounting for 5.7% of all admissions. Eighty-four percent were ≤ 2 years of age. Majority (70.2%) had no underlying medical illness, and 79.6% received antibiotics as part of their medical treatment. Comparison of children aged ≤ 2 years and those >2 years revealed that fewer of the younger cohort (20.4% versus 79.3%; p < 0.001) had an underlying medical condition. RSV infection occurred in 3.3% (n = 6) children who had received palivizumab prophylaxis, and there were two deaths. The results indicate that > 88% of all PICU admissions would not qualify for RSV prophylaxis under our established guidelines and 66% of the children aged ≤ 2 years were > 36 weeks gestation and are not currently targeted for prophylaxis. The number of high-risk infants admitted to PICU with RSV infection has likely plateaued, and further reductions in admission rates may only be realised with the use of universal, vaccine immunization programmes.
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