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Published on: December 10, 2013
The Full Burden of RSV-related Pediatric Intensive Care Unit Admissions During Infancy: A Prospective National Study
Emily W E M Phijffer1, Joanne G Wildenbeest1, Carole N M Brouwer2
1From the Department of Paediatric Infectious Diseases and Immunology.
Insights
Severe respiratory syncytial virus (RSV) disease in infants leads to significant pediatric intensive care unit (PICU) admissions, with many experiencing adverse events and parents showing signs of post-traumatic stress disorder (PTSD). Preventive interventions could reduce this burden.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Public health
Background:
- Respiratory syncytial virus (RSV) is a major cause of infant lower respiratory tract infections, with a notable percentage requiring pediatric intensive care unit (PICU) admission.
- Understanding the full clinical impact of RSV, including less apparent burdens, is crucial for evaluating new preventive strategies.
Purpose of the Study:
- To comprehensively assess the burden of severe RSV disease on infants admitted to the PICU.
- To identify clinical characteristics, adverse events during PICU stay, and parental post-traumatic stress disorder (PTSD) following infant RSV hospitalization.
Main Methods:
- A nationwide, prospective, observational, multicenter study conducted in the Netherlands.
- Included infants under 12 months with laboratory-confirmed RSV-related PICU admission.
- Collected data on clinical features, adverse events, and parental PTSD symptoms post-discharge.
Main Results:
- Of 423 infants, most were term-born without comorbidities; 61.1% required invasive mechanical ventilation.
- Unwanted events occurred in 11.3% of patients, more frequently in those on invasive mechanical ventilation (91.9% vs. 52.4%).
- Three deaths (0.7%) occurred, all in infants with severe comorbidities; 29.2% of parents reported PTSD symptoms.
Conclusions:
- Severe RSV disease imposes a substantial burden beyond PICU admission, including adverse events and parental PTSD.
- A significant proportion of infants (75%) were under 3 months, highlighting the potential impact of RSV immunization programs.
- Implementing RSV immunization could substantially reduce the overall burden of severe RSV disease in infants.
Background:
Worldwide, respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections during infancy. Approximately 5% of hospitalized infants require pediatric intensive care unit (PICU) admission. Our objective was to capture a complete overview of the PICU admission, including the yet unseen burden, to understand the full clinical impact of new preventive interventions.
Methods:
A nationwide, prospective, observational, multicenter study was performed in the Netherlands. Patients included infants <12 months with laboratory-confirmed RSV-related PICU admission. Collected data were clinical characteristics, unwanted and detrimental events during admission and parental signs of post-traumatic stress disorder (PTSD) after admission.
Results:
Of 423 patients, most were term born (n=335, 79.2%) and had no comorbidities (n=292, 69.0%). Median age was 46 (interquartile range, 25.0-89.0) days. Invasive mechanical ventilation was used in 258 (61.1%) patients. In total, 51 unwanted events were observed in 48 (11.3%) patients. Events occurred more frequently in patients receiving invasive mechanical ventilation compared to patients receiving other types of respiratory support (91.9% versus 52.4%; P < 0.001). Three (0.7%) patients died, all with severe comorbidities. Follow-up showed signs of PTSD in 35/120 (29.2%) of the parents.
Conclusions:
The burden of severe RSV disease is broader than the PICU admission alone. During admission, 11% of infants experienced unwanted, detrimental events, and one-third of parents showed signs or symptoms of PTSD. Because 75% of infants were <3 months of age, the introduction of RSV immunization into the Dutch immunization program could have the potential to significantly decrease this yet unseen RSV burden too.
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