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Pediatric intensive care unit admission due to respiratory syncytial virus: Retrospective multicenter study
Ji-Man Kang1,2, Jina Lee3, Yun-Kyung Kim4
1Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, , Korea.
Insights
Respiratory Syncytial Virus (RSV) hospitalizations in pediatric intensive care units (PICUs) disproportionately affect high-risk children under two. Palivizumab (PZ) prophylaxis eligibility is high, yet uptake remains low, necessitating improved physician compliance for severe RSV prevention.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Public health
Background:
- Respiratory Syncytial Virus (RSV) is a major cause of pediatric intensive care unit (PICU) admissions.
- Understanding the characteristics and outcomes of RSV-related PICU hospitalizations is crucial for public health.
- Assessing palivizumab (PZ) prophylaxis eligibility across different international guidelines is important for optimizing prevention strategies.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of pediatric patients hospitalized in the PICU due to severe RSV infection.
- To evaluate the eligibility for palivizumab (PZ) prophylaxis among these patients based on Korean, EU, and USA guidelines.
- To identify risk factors associated with severe RSV infection and prolonged PICU stays.
Main Methods:
- A multicenter retrospective chart review was conducted.
- Included were children under 18 years old hospitalized in six PICUs for severe RSV infection between September 2008 and March 2013.
- Data on patient demographics, risk factors, clinical outcomes, and PZ prophylaxis were analyzed.
Main Results:
- Of 92 identified patients, 53.2% of those under two years old were high-risk for severe RSV infection, with congenital heart disease being the most common risk factor.
- Palivizumab (PZ) prophylaxis eligibility ranged from 38.7% to 48.4% by guideline, but only 2.2% received it within 30 days of admission.
- RSV-attributable mortality was 5.4%, with longer mechanical ventilation durations observed in children with neuromuscular disease or congenital airway abnormalities (NMD/CAA).
Conclusions:
- High-risk children under two years old constitute a significant portion of RSV-related PICU admissions.
- There is a need to increase physician compliance with palivizumab (PZ) prophylaxis guidelines.
- Further research is warranted to fully understand the burden of RSV infection in PICU patients, particularly those with NMD/CAA.
Background:
We investigated the characteristics and clinical outcomes of respiratory syncytial virus (RSV)-related pediatric intensive care unit (PICU) hospitalization and assessed the palivizumab (PZ) prophylaxis eligibility according to different guidelines from Korea, EU, and USA.
Methods:
In this multicenter study, children <18 years of age hospitalized in six PICU from different hospitals due to severe RSV infection between September 2008 and March 2013 were included. A retrospective chart review was performed.
Results:
A total of 92 patients were identified. The median length of PICU stay was 6 days (range, 1-154 days) and median PICU care cost was USD2,741 (range, USD556-98 243). Of 62 patients who were <2 years old at the beginning of the RSV season, 33 (53.2%) were high-risk patients for severe RSV infection. Hemodynamically significant congenital heart disease (22.6%) was the most common risk factor, followed by chronic lung disease (11.3%), neuromuscular disease or congenital abnormality of the airway (NMD/CAA) (11.3%), and prematurity (8.1%). The percentage of patients eligible for PZ prophylaxis ranged from 38.7% to 48.4% based on the guidelines, but only two (2.2%) received PZ ≤30 days prior to PICU admission. The median duration of mechanical ventilation was longer in children with NDM/CAA than in those without risk factors (26 days; range, 24-139 days vs 6 days, range, 2-68 days, P = 0.033). RSV-attributable mortality was 5.4%.
Conclusions:
Children <2 years old with already well-known high risks represent a significant proportion of RSV-related PICU admissions. Increasing of the compliance for PZ prophylaxis practice among physicians is needed. Further studies are needed to investigate the burden of RSV infection in patients hospitalized in PICU, including children with NMD/CAA.
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