. 2023 Aug 1;6(8):e2328950.

doi: 10.1001/jamanetworkopen.2023.28950.

Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak

Natasha Halasa¹, Laura D Zambrano², Justin Z Amarin¹, Laura S Stewart¹, Margaret M Newhams³, Emily R Levy⁴, Steven L Shein⁵, Christopher L Carroll⁶, Julie C Fitzgerald⁷, Marian G Michaels⁸, Katherine Bline⁹, Melissa L Cullimore¹⁰, Laura Loftis¹¹, Vicki L Montgomery¹², Asumthia S Jeyapalan¹³, Pia S Pannaraj¹⁴, Adam J Schwarz¹⁵, Natalie Z Cvijanovich¹⁶, Matt S Zinter¹⁷, Aline B Maddux¹⁸, Melania M Bembea¹⁹, Katherine Irby²⁰, Danielle M Zerr²¹, Joseph D Kuebler²², Christopher J Babbitt²³, Mary Glas Gaspers²⁴, Ryan A Nofziger²⁵, Michele Kong²⁶, Bria M Coates²⁷, Jennifer E Schuster²⁸, Shira J Gertz²⁹, Elizabeth H Mack³⁰, Benjamin R White³¹, Helen Harvey³², Charlotte V Hobbs³³, Heda Dapul³⁴, Andrew D Butler³⁵, Tamara T Bradford³⁶, Courtney M Rowan³⁷, Kari Wellnitz³⁸, Mary Allen Staat³⁹, Cassyanne L Aguiar⁴⁰, Saul R Hymes⁴¹, Adrienne G Randolph^{3

42

43}, Angela P Campbell²; RSV-PIC Investigators

Collaborators, Affiliations

Collaborators

RSV-PIC Investigators:
Merry Tomcany, Kelly N Michelson, Heather E Price, Ronald C Sanders Jr, Lexie Dixon, Katri V Typpo, Ilana Harwayne-Gidansky, Suden Kucukak, Elizabeth R McNamara, Sabrina R Chen, Eve Listerud, Ofelia Vargas-Shiraishi, Betty Oberle, Frances Zorensky, Rachel Mansour, Jaycee Jumarang, Marla Johnston, Jenny L Bush, Shawn Dickey, Shannon Hill, Melissa Sullivan, Abigail Kietzman, Candice Colston, Meghan Murdock, Heather Kelley, Laura Wright-Sexton, Maygan Martin, Lora Martin, Lacy Malloch, Kayla Patterson, Cameron Sanders, Chelsea Rohlfs, Marilyn Rice, Miranda Howard, Makayla Murphy, Vijaya L Soma, Adam J Ratner, Megan J Job, Colleen Mennie, Kamala Simkhada, Noelle M Drapeau, Supriya Behl, Kristina A Betters, Haya Hayek, Molly Maranto, Aubrie Waters, Maggie Flowers, Kevin Havlin, Jamie Furlong-Dillard, Melissa Porter, Jennifer Nason, Madison Ray, Kristen Gossett, Hillary Crandall, Evan Heller, Jennifer Foley, Rajashri Rasal, Christine Marlow, Anurithi Senthil, Kimberly Myers, Betsy Tudor, Amanda Adler, Nereyda Garcia, Natalie Treister, Patrick S McQuillen, Kathleen Sun, Denise Villarreal-Chico, Sophia Kainaroi, John V Williams

Affiliations

¹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
² Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
³ Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
⁴ Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
⁵ Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
⁶ Department of Pediatrics, Connecticut Children's Medical Center, Hartford.
⁷ Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia.
⁸ Division of Infectious Diseases, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
⁹ Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio.
¹⁰ Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska.
¹¹ Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston.
¹² Department of Pediatrics, University of Louisville and Norton Children's Hospital, Louisville, Kentucky.
¹³ Division of Pediatric Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida.
¹⁴ Division of Infectious Diseases, Children's Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles.
¹⁵ Division of Critical Care Medicine, Children's Hospital Orange County, Orange, California.
¹⁶ Division of Critical Care, Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital Oakland, Oakland.
¹⁷ Division of Critical Care, Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital San Francisco, San Francisco.
¹⁸ Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora.
¹⁹ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
²⁰ Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock.
²¹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington.
²² Division of Pediatric Critical Care, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York.
²³ Division of Pediatric Critical Care, Miller Children's and Women's Hospital of Long Beach, Long Beach, California.
²⁴ Division of Critical Care, Department of Pediatrics, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona.
²⁵ Division of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio.
²⁶ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham.
²⁷ Division of Pediatric Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
²⁸ Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
²⁹ Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey.
³⁰ Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston.
³¹ Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City.
³² Division of Pediatric Critical Care, Rady Children's Hospital-San Diego, San Diego, California.
³³ Division of Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, Jackson.
³⁴ Division of Pediatric Critical Care Medicine, Department of Pediatrics, New York University Grossman School of Medicine, New York.
³⁵ Division of Pediatric Critical Care, St Christopher's Hospital for Children, Philadelphia, Pennsylvania.
³⁶ Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans.
³⁷ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis.
³⁸ Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City.
³⁹ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁴⁰ Division of Pediatric Rheumatology, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk.
⁴¹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Bernard and Millie Duker Children's Hospital, Albany Med Health System, Albany, New York.
⁴² Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
⁴³ Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts.

PMID: 37581884
PMCID: PMC10427947
DOI: 10.1001/jamanetworkopen.2023.28950

Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak

Natasha Halasa et al. JAMA Netw Open. 2023.

. 2023 Aug 1;6(8):e2328950.

doi: 10.1001/jamanetworkopen.2023.28950.

Authors

Collaborators

RSV-PIC Investigators:
Merry Tomcany, Kelly N Michelson, Heather E Price, Ronald C Sanders Jr, Lexie Dixon, Katri V Typpo, Ilana Harwayne-Gidansky, Suden Kucukak, Elizabeth R McNamara, Sabrina R Chen, Eve Listerud, Ofelia Vargas-Shiraishi, Betty Oberle, Frances Zorensky, Rachel Mansour, Jaycee Jumarang, Marla Johnston, Jenny L Bush, Shawn Dickey, Shannon Hill, Melissa Sullivan, Abigail Kietzman, Candice Colston, Meghan Murdock, Heather Kelley, Laura Wright-Sexton, Maygan Martin, Lora Martin, Lacy Malloch, Kayla Patterson, Cameron Sanders, Chelsea Rohlfs, Marilyn Rice, Miranda Howard, Makayla Murphy, Vijaya L Soma, Adam J Ratner, Megan J Job, Colleen Mennie, Kamala Simkhada, Noelle M Drapeau, Supriya Behl, Kristina A Betters, Haya Hayek, Molly Maranto, Aubrie Waters, Maggie Flowers, Kevin Havlin, Jamie Furlong-Dillard, Melissa Porter, Jennifer Nason, Madison Ray, Kristen Gossett, Hillary Crandall, Evan Heller, Jennifer Foley, Rajashri Rasal, Christine Marlow, Anurithi Senthil, Kimberly Myers, Betsy Tudor, Amanda Adler, Nereyda Garcia, Natalie Treister, Patrick S McQuillen, Kathleen Sun, Denise Villarreal-Chico, Sophia Kainaroi, John V Williams

Affiliations

¹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
² Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia.
³ Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
⁴ Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota.
⁵ Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
⁶ Department of Pediatrics, Connecticut Children's Medical Center, Hartford.
⁷ Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia.
⁸ Division of Infectious Diseases, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
⁹ Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio.
¹⁰ Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska.
¹¹ Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston.
¹² Department of Pediatrics, University of Louisville and Norton Children's Hospital, Louisville, Kentucky.
¹³ Division of Pediatric Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida.
¹⁴ Division of Infectious Diseases, Children's Hospital Los Angeles and Departments of Pediatrics and Molecular Microbiology and Immunology, University of Southern California, Los Angeles.
¹⁵ Division of Critical Care Medicine, Children's Hospital Orange County, Orange, California.
¹⁶ Division of Critical Care, Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital Oakland, Oakland.
¹⁷ Division of Critical Care, Department of Pediatrics, University of California, San Francisco Benioff Children's Hospital San Francisco, San Francisco.
¹⁸ Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora.
¹⁹ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
²⁰ Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock.
²¹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington.
²² Division of Pediatric Critical Care, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York.
²³ Division of Pediatric Critical Care, Miller Children's and Women's Hospital of Long Beach, Long Beach, California.
²⁴ Division of Critical Care, Department of Pediatrics, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona.
²⁵ Division of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio.
²⁶ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham.
²⁷ Division of Pediatric Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
²⁸ Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.
²⁹ Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey.
³⁰ Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston.
³¹ Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City.
³² Division of Pediatric Critical Care, Rady Children's Hospital-San Diego, San Diego, California.
³³ Division of Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, Jackson.
³⁴ Division of Pediatric Critical Care Medicine, Department of Pediatrics, New York University Grossman School of Medicine, New York.
³⁵ Division of Pediatric Critical Care, St Christopher's Hospital for Children, Philadelphia, Pennsylvania.
³⁶ Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans.
³⁷ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis.
³⁸ Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City.
³⁹ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁴⁰ Division of Pediatric Rheumatology, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk.
⁴¹ Division of Pediatric Infectious Diseases, Department of Pediatrics, Bernard and Millie Duker Children's Hospital, Albany Med Health System, Albany, New York.
⁴² Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
⁴³ Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts.

PMID: 37581884
PMCID: PMC10427947
DOI: 10.1001/jamanetworkopen.2023.28950

Erratum in

Errors in Figure 2, Results, and Tables 1 and 2.
[No authors listed] [No authors listed] JAMA Netw Open. 2024 Jul 1;7(7):e2428669. doi: 10.1001/jamanetworkopen.2024.28669. JAMA Netw Open. 2024. PMID: 39052300 Free PMC article. No abstract available.

Abstract

Importance: Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide.

Objective: To evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission.

Design, setting, and participants: This cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states. Participants were infants admitted for 24 or more hours between October 17 and December 16, 2022, to a unit providing intensive care due to laboratory-confirmed RSV infection.

Exposure: Respiratory syncytial virus.

Main outcomes and measures: Data were captured on demographics, clinical characteristics, signs and symptoms, laboratory values, severity measures, and clinical outcomes, including receipt of noninvasive respiratory support, invasive mechanical ventilation, vasopressors or extracorporeal membrane oxygenation, and death. Mixed-effects multivariable log-binomial regression models were used to assess associations between intubation status and demographic factors, gestational age, and underlying conditions, including hospital as a random effect to account for between-site heterogeneity.

Results: The first 15 to 20 consecutive eligible infants from each site were included for a target sample size of 600. Among the 600 infants, the median (IQR) age was 2.6 (1.4-6.0) months; 361 (60.2%) were male, 169 (28.9%) were born prematurely, and 487 (81.2%) had no underlying medical conditions. Primary reasons for admission included LRTI (594 infants [99.0%]) and apnea or bradycardia (77 infants [12.8%]). Overall, 143 infants (23.8%) received invasive mechanical ventilation (median [IQR], 6.0 [4.0-10.0] days). The highest level of respiratory support for nonintubated infants was high-flow nasal cannula (243 infants [40.5%]), followed by bilevel positive airway pressure (150 infants [25.0%]) and continuous positive airway pressure (52 infants [8.7%]). Infants younger than 3 months, those born prematurely (gestational age <37 weeks), or those publicly insured were at higher risk for intubation. Four infants (0.7%) received extracorporeal membrane oxygenation, and 2 died. The median (IQR) length of hospitalization for survivors was 5 (4-10) days.

Conclusions and relevance: In this cross-sectional study, most US infants who required intensive care for RSV LRTIs were young, healthy, and born at term. These findings highlight the need for RSV preventive interventions targeting all infants to reduce the burden of severe RSV illness.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Halasa reported receiving grants from Sanofi, Quidel, and Merck outside the submitted work. Dr Levy reported receiving grants from the National Institute of Allergy and Infectious Diseases, Centers of Excellence for Influenza Research and Response, and the Health Resources and Services Administration Regional Pandemic Pediatric Network outside the submitted work. Dr Fitzgerald reported receiving grants from the National Institutes of Health (NIH) outside the submitted work. Dr Cullimore reported receiving grants from the Centers for Disease Control and Prevention (CDC) and grants from the NIH outside the submitted work; and financial compensation for a minor child to participate in a clinical trial funded by industry. Dr Pannaraj reported receiving grants from AstraZeneca outside the submitted work. Dr Cvijanovich reported receiving grants from Boston Children’s Hospital Subaward during the conduct of the study; grants from Cincinnati Children’s Hospital Subaward and grants from the National Institute of Child Health and Human Development (NICHD) outside the submitted work. Dr Maddux reported receiving grants from the NIH/NICHD during the conduct of the study. Dr Bembea reported receiving grants from the NIH, Department of Defense funds paid to the institution, and grants from Grifols Investigator Sponsored Research paid to the institution outside the submitted work. Dr Zerr reported receiving grants from Boston Children’s Hospital/CDC during the conduct of the study; grants from Merck investigator-initiated research on RSV and industry-sponsored research for several different protocols, and personal fees from Allovir Service outside the submitted work. Dr Kong reported receiving grants from the NIH outside the submitted work. Dr Coates reported receiving grants from American Lung Association and grants from American Thoracic Society outside the submitted work. Dr Hobbs reported receiving personal fees from DYNAMED.com clinical database and reviewer and personal fees from Biofire/Biomerieux (2021-2022) outside the submitted work. Dr Rowan reported receiving grants from the National Heart, Lung, and Blood Institute (NHLBI) outside the submitted work. Dr Wellnitz reported receiving grants from the NHLBI and the NIH outside the submitted work. Dr Staat reported receiving grants from the NIH outside the submitted work. Dr Aguiar reported receiving funding from the CDC to primary institution outside the submitted work. Dr Randolph reported receiving grants from the NIH to institution outside the submitted work. No other disclosures were reported.

Figures

**Figure 1.. Signs and Symptoms in Infants Requiring Intensive Care for Respiratory Syncytial Virus Infection**

**Figure 2.. Factors Associated With Risk for Intubation in Infants Requiring Intensive Care for Respiratory Syncytial Virus Infection**
PR indicates prevalence ratio.

See this image and copyright information in PMC

References

1. Shi T, Balsells E, Wastnedge E, et al. . Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: systematic review and meta-analysis. J Glob Health. 2015;5(2):020416. doi:10.7189/jogh.05.020416 - DOI - PMC - PubMed
1. Obando-Pacheco P, Justicia-Grande AJ, Rivero-Calle I, et al. . Respiratory syncytial virus seasonality: a global overview. J Infect Dis. 2018;217(9):1356-1364. doi:10.1093/infdis/jiy056 - DOI - PubMed
1. Hall CB, Weinberg GA, Iwane MK, et al. . The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009;360(6):588-598. doi:10.1056/NEJMoa0804877 - DOI - PMC - PubMed
1. Suh M, Movva N, Jiang X, et al. . Respiratory syncytial virus is the leading cause of United States infant hospitalizations, 2009-2019: a study of the national (nationwide) inpatient sample. J Infect Dis. 2022;226(suppl 2):S154-S163. doi:10.1093/infdis/jiac120 - DOI - PMC - PubMed
1. Rha B, Curns AT, Lively JY, et al. . Respiratory syncytial virus-associated hospitalizations among young children: 2015-2016. Pediatrics. 2020;146(1):e20193611. doi:10.1542/peds.2019-3611 - DOI - PubMed

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Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak

Collaborators

Affiliations

Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak

Authors

Collaborators

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical