Admission to the intensive care unit for respiratory syncytial virus bronchiolitis: a national survey before palivizumab use

Abstract

Objective: Preterm infants, especially those with chronic lung disease (CLD), are considered more susceptible to severe respiratory illness from respiratory syncytial virus (RSV) infection than healthy term infants, and are therefore targeted for prophylactic administration of immune globulins. The impact of this practice on the more severe cases of bronchiolitis (i.e., pediatric intensive care unit [PICU] admission, mechanical ventilation, mortality) has not been reported to date. The aim of this study was to evaluate PICU admissions, need for mechanical ventilation, and mortality attributable to RSV bronchiolitis in Israel before the introduction of RSV prophylaxis to the country.

Design and setting: Prospective survey of 11 PICUs in Israel during the RSV season (November 2000-March 2001).

Patients: All patients admitted to the PICU because of bronchiolitis, and the subgroups who needed mechanical ventilation or who died, were analyzed for known risk factors, namely, prematurity, CLD, and chronic oxygen dependence.

Results: A total of 105 patients with RSV bronchiolitis met the inclusion criteria, of whom 33 were mechanically ventilated. Most of the patients (84% total admission, 88% ventilated) were born after 32 weeks' gestation, and 89% and 88%, respectively, did not have CLD. Only 16% and 9%, respectively, met any of the American Academy of Pediatrics criteria for RSV prophylaxis, such that 84% of the whole sample and 91% of the ventilated patients were not candidates for RSV prophylaxis. Five patients died, 2 of them with cyanotic heart disease.

Conclusions: Most of the infants with severe RSV bronchiolitis were born at term and did not have CLD. The great majority of patients admitted to the PICU for bronchiolitis were not candidates for RSV prophylaxis. Administration of RSV prophylaxis to the predefined high-risk population could be expected to yield no significant change in PICU admissions or number of infants needing mechanical ventilation. New risk-stratified guidelines for RSV prophylaxis are needed.