Pediatric intensive care unit admission due to respiratory syncytial virus: Retrospective multicenter study

Abstract

Background: We investigated the characteristics and clinical outcomes of respiratory syncytial virus (RSV)-related pediatric intensive care unit (PICU) hospitalization and assessed the palivizumab (PZ) prophylaxis eligibility according to different guidelines from Korea, EU, and USA.

Methods: In this multicenter study, children <18 years of age hospitalized in six PICU from different hospitals due to severe RSV infection between September 2008 and March 2013 were included. A retrospective chart review was performed.

Results: A total of 92 patients were identified. The median length of PICU stay was 6 days (range, 1-154 days) and median PICU care cost was USD2,741 (range, USD556-98 243). Of 62 patients who were <2 years old at the beginning of the RSV season, 33 (53.2%) were high-risk patients for severe RSV infection. Hemodynamically significant congenital heart disease (22.6%) was the most common risk factor, followed by chronic lung disease (11.3%), neuromuscular disease or congenital abnormality of the airway (NMD/CAA) (11.3%), and prematurity (8.1%). The percentage of patients eligible for PZ prophylaxis ranged from 38.7% to 48.4% based on the guidelines, but only two (2.2%) received PZ ≤30 days prior to PICU admission. The median duration of mechanical ventilation was longer in children with NDM/CAA than in those without risk factors (26 days; range, 24-139 days vs 6 days, range, 2-68 days, P = 0.033). RSV-attributable mortality was 5.4%.

Conclusions: Children <2 years old with already well-known high risks represent a significant proportion of RSV-related PICU admissions. Increasing of the compliance for PZ prophylaxis practice among physicians is needed. Further studies are needed to investigate the burden of RSV infection in patients hospitalized in PICU, including children with NMD/CAA.

Keywords: eligibility; guideline; neuromuscular disorder or congenital abnormality of the airway; pediatric intensive care unit; respiratory syncytial virus.

Figure 1

Flow of case selection. Of the two excluded cases of encephalitis, one was Listeria meningoencephalitis, and the other was of unknown origin in a 40‐month‐old boy. In the latter case, the patient had no respiratory symptom except fever, and follow‐up test was negative. PICU, pediatric intensive care unit; RSV, respiratory syncytial virus.

Figure 2

Seasonal distribution of respiratory syncytial virus (RSV)‐related pediatric intensive care unit (PICU) admissions according to (a) age at the time of RSV detection (■, <12 months; , 12–24 months; □, >24 months); and (b) presence of risk factors (■, risk; □, no risk). (a) Sixty‐nine of 92 cases (75.0%) occurred in children <2 years of age at the time of RSV detection; 59 of 92 (64.1%) occurred in children <1 year of age. (b) Forty‐nine of 92 patients (53.3%) had at least one of risk factor for severe RSV infection. Risk factors for severe RSV infection include prematurity (gestational age <35 weeks), chronic lung disease, hemodynamically significant congenital heart disease, congenital abnormality of the airway or neuromuscular disorder, Down syndrome or profound immunocompromisation.

Figure 3

Palivizumab prophylaxis eligibility. 2013 K‐NHIS guidelines vs 2014 AAP guidelines, 38.7% vs 48.4% (P = 0.07, Mann–Whitney test). AAP, American Academy of Pediatrics; EMA, European Medicines Agency; K‐NHIS, National Healthcare Insurance Service in South Korea.