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Hospitalization Outcomes of Full-Term and Premature Children Aged Less Than 2 Years Hospitalized With RSV
Abigail L Salthouse1,2, Ayzsa Tannis1, Rachel E Rutkowski1
1Coronavirus and Other Respiratory Viruses Division, US Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
Premature infants face higher risks for severe respiratory syncytial virus (RSV) disease, including prolonged hospitalization and ICU admission. Bronchopulmonary dysplasia (BPD) further increases hospitalization duration in these vulnerable children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Prematurity and bronchopulmonary dysplasia (BPD) can impact lung development, potentially increasing young children's susceptibility to severe respiratory syncytial virus (RSV) disease.
- Understanding the specific risks associated with prematurity and BPD in hospitalized children with RSV is crucial for targeted interventions.
Purpose of the Study:
- To characterize children under 2 years old hospitalized with RSV, analyzing outcomes based on prematurity and BPD status.
- To evaluate prematurity and BPD as risk factors for severe in-hospital outcomes in pediatric RSV hospitalizations.
Main Methods:
- Population-based surveillance of RSV-associated acute respiratory illness hospitalizations in children under 2 years old across 7 medical centers (2016-2023).
- Utilized Poisson regression to estimate adjusted relative risks (aRRs) for prolonged hospitalization, ICU admission, and assisted ventilation.
- Compared outcomes for premature infants (with and without BPD) against term infants, adjusting for surveillance site and palivizumab receipt.
Main Results:
- Among 5844 children hospitalized with RSV, 20.8% were premature. Of these, 6.6% had BPD.
- Compared to term infants, all premature infants (<6 months chronological age) showed increased risks for prolonged hospitalization (aRR=1.3), ICU admission (aRR=1.4), and assisted ventilation (aRR=2.0).
- Premature infants with BPD experienced a heightened risk of prolonged hospitalization up to 23 months of age.
Conclusions:
- Premature infants represent 1 in 5 hospitalizations for RSV in children under 2 years.
- All premature infants exhibit elevated risks for severe in-hospital outcomes during early infancy compared to term infants.
- Infants with BPD and prematurity remain at increased risk for prolonged hospitalization through 23 months of age.
Background:
Prematurity may place young children at increased risk for severe respiratory syncytial virus (RSV) disease because of differences in lung development. We describe characteristics of children aged less than 2 years hospitalized with RSV by prematurity and bronchopulmonary dysplasia (BPD) status and examine both as risk factors for severe in-hospital outcomes.
Methods:
During 2016-2023, population-based surveillance was conducted at 7 medical centers for hospitalizations with RSV-associated acute respiratory illness in children. Poisson regression with robust variance was used to estimate adjusted relative risks (aRRs) of prolonged hospitalization (≥3 days), intensive care unit (ICU) admission, and assisted ventilation by age in children with prematurity without and with BPD compared with term children after adjustment for surveillance site and palivizumab receipt.
Results:
Among 5844 children, 4626 (79.2%) were term and 1218 (20.8%) were premature, including 1138 (93.4%) without BPD and 80 (6.6%) with BPD. Compared with term children, all premature children had greater risks for prolonged hospitalization (aRR = 1.3; 95% CI, 1.2-1.5), ICU admission (aRR = 1.4; 95% CI, 1.2-1.6), and assisted ventilation (aRR = 2.0; 95% CI, 1.4-2.8) at chronological age less than 6 months. Premature children with BPD also had greater risk for prolonged hospitalization at all ages through 23 months.
Conclusions:
Premature children accounted for 1 in 5 hospitalizations among children aged less than 2 years hospitalized with RSV. Compared with term children, all premature children had increased risk for severe in-hospital outcomes in early infancy, and those with BPD remained at increased risk of prolonged hospitalization through age 23 months.
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