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Risk factors associated with severe RSV disease among hospitalized children in the second year of life: a multicenter

Keren Armoni Domany1,2, Inbal Golan-Tripto3,4, Nitzan Burrack4,5

  • 1Pediatric Pulmonology Unit, E. Wolfson Medical Center, Holon, Israel.

European Journal of Pediatrics
|November 27, 2025
PubMed

Insights

Children aged 12-23 months with prematurity, chronic lung disease, congenital heart disease, or Down syndrome face higher risks of severe RSV hospitalization. These findings highlight the need for targeted preventive strategies in these high-risk populations during their second year of life.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Public Health

Background:

  • Children with prematurity, congenital heart disease (CHD), chronic lung disease of prematurity (CLD), or Down syndrome (DS) are at increased risk for severe respiratory syncytial virus (RSV)-related illness in their first year of life.
  • The second year of life is increasingly relevant for long-acting RSV prevention strategies.

Purpose of the Study:

  • To assess the association between key risk factors and severe RSV-related disease in hospitalized children aged 12-23 months.
  • To evaluate outcomes including prolonged hospitalization and Pediatric Intensive Care Unit (PICU) admission based on the presence of specific risk factors.

Main Methods:

  • A retrospective multicenter study included 1023 children aged 12-23 months hospitalized with RSV between 2017-2021.
  • Compared outcomes for children with risk factors (prematurity, CHD, CLD, DS) versus those without, adjusting for demographics and COVID-19 pandemic status.
  • Analyzed prolonged hospitalization (>3 days) and PICU admission rates.

Main Results:

  • 22% of children had at least one risk factor: prematurity (183), CLD (28), CHD (45), or DS (20).
  • Prematurity (with or without CLD), CHD, and DS were independently associated with prolonged hospitalization.
  • DS, CHD, and having any risk factor were associated with increased PICU admission.

Conclusions:

  • Children aged 12-23 months with prematurity, CLD, major CHD, or DS experience significantly higher rates of prolonged RSV hospitalization.
  • Children with one or more risk factors, particularly DS and major CHD, are at the highest risk for severe RSV complications.
  • Preventive strategies targeting these high-risk populations during their second year of life are warranted.
Abstract

Keywords:
BronchiolitisChronic lung diseaseCongenital heart diseaseDown syndromePrematurityRespiratory Syncitial Virus (RSV)

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