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

2023; American Medical Association; Volume: 6; Issue: 8 Linguagem: Inglês

10.1001/jamanetworkopen.2023.28950

2574-3805

Natasha Halasa, Laura D. Zambrano, Justin Z. Amarin, Laura S Stewart, Margaret M. Newhams, Emily R. Levy, Steven L. Shein, Christopher L. Carroll, Julie Fitzgerald, Marian G. Michaels, Katherine Bline, Melissa L. Cullimore, Laura L. Loftis, Vicki Montgomery, Asumthia Jeyapalan, Pia S. Pannaraj, Adam J. Schwarz, Natalie Z. Cvijanovich, Matt S. Zinter, Aline B. Maddux, Melania M. Bembea, Katherine Irby, Danielle M. Zerr, Joseph D. Kuebler, Christopher J. Babbitt, Mary Glas Gaspers, Ryan A. Nofziger, Michele Kong, Bria M. Coates, Jennifer E. Schuster, Shira J. Gertz, Elizabeth H. Mack, Benjamin R. White, Helen Harvey, Charlotte V. Hobbs, Heda Dapul, Andrew Butler, Tamara T. Bradford, Courtney M. Rowan, Kari Wellnitz, Mary Allen Staat, Cassyanne L. Aguiar, Saul Hymes, Adrienne G. Randolph, Angela P. Campbell, Merry Tomcany, Kelly Michelson, Heather E. Price, Ronald C. Sanders, Lexie Dixon, Katri Typpo, Ilana Harwayne‐Gidansky, Suden Kücükak, 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 E. Hill, Melissa Sullivan, Abigail Kietzman, Candice Colston, Meghan Murdock, Heather M. Kelley, Laura Wright-Sexton, Maygan Martin, Lora Martin, Lacy Malloch, Kayla Patterson, Cameron Sanders, Chelsea Rohlfs, Marilyn Rice, Miranda Howard, M. Gail Murphy, Vijaya L Soma, Adam J. Ratner, Megan Job, Colleen Mennie, Kamala Simkhada, Noelle M. Drapeau, Supriya Behl, Kristina Betters, Haya Hayek, Molly Maranto, Aubrie Waters, Maggie Flowers, Kevin M Havlin, Jamie Furlong-Dillard, Melissa Porter, Jennifer Nason, M. Ray, Kristen Gossett, Hillary Crandall, Evan G Heller, Jennifer Foley, Rajashri Rasal, Christine Marlow, Anurithi Senthil, Kimberly R. Myers, Betsy Tudor, Amanda Adler, Nereyda Garcia, Natalie Treister, Patrick S. McQuillen, Kathleen Sun, Denise Villarreal-Chico, Sophia Kainaroi, John V. Williams,

Congenital Diaphragmatic Hernia Studies

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.