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Pediatric Respiratory Syncytial Virus Hospitalizations and Respiratory Support After the COVID-19 Pandemic

Zachary A Winthrop1, Jennifer M Perez1, Steven J Staffa1

  • 1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.

JAMA Network Open
|June 13, 2024
PubMed

Insights

Pediatric respiratory syncytial virus (RSV) hospitalizations surged post-pandemic, with older children requiring more advanced respiratory support. This trend highlights the need for updated strategies to manage increased RSV burden in children.

Area of Science:

  • Pediatric Infectious Diseases
  • Epidemiology
  • Public Health

Background:

  • A significant increase in pediatric respiratory syncytial virus (RSV) infections occurred globally following the COVID-19 pandemic.
  • Limited national data exists on hospitalization trends, intensive care unit (ICU) utilization, and advanced respiratory support for pediatric RSV cases post-pandemic.

Purpose of the Study:

  • To analyze the demographic characteristics, respiratory support modalities, and clinical outcomes of children with RSV infections.
  • To compare post-pandemic RSV trends with prepandemic data in tertiary pediatric hospitals.

Main Methods:

  • A cross-sectional study utilizing the Pediatric Health Information System (PHIS) database from 48 US children's hospitals.
  • Inclusion criteria: children aged 5 years or younger with RSV infection from July 1, 2017, to June 30, 2023.
  • Analysis included hospital presentations, ICU admissions, length of stay, demographics, respiratory support use, mortality, and CPR, comparing the 2022-2023 season with prepandemic averages.

Main Results:

  • RSV hospital presentations more than doubled post-pandemic (94,347 vs 39,698), with an 86.7% increase in hospitalizations.
  • Post-pandemic patients were older (median age 11.3 months vs 6.8 months) and had fewer comorbidities (17.6% vs 21.8%).
  • Advanced respiratory support use increased by 70.1%, with older children requiring high-flow nasal cannula (HFNC) or noninvasive ventilation (NIV).

Conclusions:

  • The post-COVID-19 era saw a substantial surge in pediatric RSV, leading to increased hospitalizations and a greater need for advanced respiratory support.
  • Children affected post-pandemic were older and presented with fewer comorbidities compared to prepandemic cases.
  • Findings suggest a need to re-evaluate vaccine allocation strategies to mitigate the growing burden of RSV in pediatric populations.
Abstract

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