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An In vitro Model to Study Immune Responses of Human Peripheral Blood Mononuclear Cells to Human Respiratory Syncytial Virus Infection
Published on: December 10, 2013
Respiratory Syncytial Virus and US Pediatric Intensive Care Utilization
Alice Shanklin1,2, Taylor Olson1, Anita K Patel1
1Division of Pediatric Critical Care Medicine, Children's National Hospital, Washington, DC.
Insights
New RSV prevention strategies, like nirsevimab and the RSVpreF vaccine, could significantly reduce pediatric intensive care unit (ICU) admissions and days of care. Widespread adoption may decrease ICU encounters by 2.1-2.8% and ICU days by 4.5-5.9%.
Area of Science:
- Pediatric critical care medicine
- Infectious disease epidemiology
- Public health interventions
Background:
- Bronchiolitis, commonly caused by respiratory syncytial virus (RSV), is a leading reason for pediatric intensive care unit (ICU) admission.
- In 2023, new preventative measures including the monoclonal antibody nirsevimab and the maternal RSVpreF vaccine were introduced to protect infants from RSV.
Purpose of the Study:
- To evaluate the impact of novel RSV prevention strategies on pediatric ICU utilization in the United States.
- To determine the potential association between increased RSV prevention uptake and reduced pediatric ICU encounters.
Main Methods:
- A retrospective cross-sectional study analyzed US pediatric ICU data from January 1, 2017, to June 1, 2023.
- Data were sourced from a national electronic health record database (Oracle Cerner RealWorld Data).
- Included were all children (aged >1 day and <18 years) admitted to an ICU, with statistical analysis conducted between February and May 2024.
Main Results:
- Out of 119,782 pediatric ICU encounters, 11.4% were associated with RSV.
- RSV encounters utilized more positive pressure ventilation (29.7% vs. 17.7%) and vasoactive medications (22.3% vs. 17.5%) compared to non-RSV encounters.
- Approximately 4.4% of total ICU encounters and 9.2% of total ICU days were attributed to RSV-positive children eligible for prevention strategies.
Conclusions:
- Widespread adoption of RSV prevention (65-85% of eligible children) could lead to a notable decrease in pediatric ICU utilization.
- An estimated 2.1% to 2.8% reduction in pediatric ICU encounters and a 4.5% to 5.9% reduction in ICU days are projected.
- These findings highlight the significant potential of novel RSV prevention strategies to alleviate the burden on pediatric intensive care resources.
Importance:
Bronchiolitis is the most common diagnosis necessitating respiratory support and pediatric intensive care, and respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. In 2023, the monoclonal antibody nirsevimab and the maternal RSVpreF vaccine were implemented to prevent RSV in infants.
Objective:
To determine the potential association of novel RSV prevention strategies with pediatric intensive care unit (ICU) utilization.
Design, Setting, And Participants:
This retrospective cross-sectional study examined US pediatric ICU encounters with and without RSV from January 1, 2017, to June 1, 2023. Data were from Oracle Cerner RealWorld Data, a national electronic health record database. All children (aged >1 day and <18 years) admitted to an ICU during the study period were included in the analysis. Statistical analysis was performed from February to May 2024.
Main Outcomes And Measures:
The primary outcomes were ICU encounters with RSV and ICU encounters with RSV eligible for RSV prevention.
Results:
There were 119 782 ICU encounters from 53 hospitals; 65 757 encounters (54.9%) were male; median (IQR) age was 4.5 (1.1-12.5) years, median (IQR) ICU length of stay was 1.8 (1.0-3.9) days; 13 702 ICU encounters (11.4%) had RSV, of which 38.6% (5217) were eligible for prevention (4.4% of total ICU encounters). Encounters with RSV accounted for 21.1% (109 334) of ICU days, of which 43.8% (47 888) were eligible for prevention (9.2% of total ICU days). Encounters with RSV were associated with a greater use of positive pressure ventilation (4074 [29.7%] vs 18 821 [17.7%]; P < .001) and vasoactive medications (3057 [22.3%] vs 18 570 [17.5%]; P < .001) compared with those without RSV.
Conclusions And Relevance:
The findings of this retrospective cross-sectional study of RSV and US pediatric intensive care utilization suggest that if 65% to 85% of eligible children received RSV prevention, an estimated 2.1% to 2.8% reduction in pediatric ICU encounters and an estimated 4.5% to 5.9% reduction in pediatric ICU days could be achieved.
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