Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak
Authors: Halasa Natasha , Zambrano Laura D. , Amarin Justin Z. , Stewart Laura S. , Newhams Margaret M. , Levy Emily R. , Shein Steven L. , Carroll Christopher L. , Fitzgerald Julie C. , Michaels Marian G. , Bline Katherine , Cullimore Melissa L. , Loftis Laura , Montgomery Vicki L. , Jeyapalan Asumthia S. , Pannaraj Pia S. , Schwarz Adam J. , Cvijanovich Natalie Z. , Zinter Matt S. , Maddux Aline B. , Bembea Melania M. , Irby Katherine , Zerr Danielle M. , Kuebler Joseph D. , Babbitt Christopher J. , Gaspers Mary Glas , Nofziger Ryan A. , Kong Michele , Coates Bria M. , Schuster Jennifer E. , Gertz Shira J. , Mack Elizabeth H. , White Benjamin R. , Harvey Helen , Hobbs Charlotte V. , Dapul Heda , Butler Andrew D. , Bradford Tamara T. , Rowan Courtney M. , Wellnitz Kari , Staat Mary Allen , Aguiar Cassyanne L. , Hymes Saul R. , Randolph Adrienne G. , Campbell Angela P. ,   RSV-PIC Investigators, Tomcany Merry , Michelson Kelly N. , Price Heather E. , Sanders Ronald C. , Dixon Lexie , Typpo Katri V. , Harwayne-Gidansky Ilana , Kucukak Suden , McNamara Elizabeth R. , Chen Sabrina R. , Listerud Eve , Vargas-Shiraishi Ofelia , Oberle Betty , Zorensky Frances , Mansour Rachel , Jumarang Jaycee , Johnston Marla , Bush Jenny L. , Dickey Shawn , Hill Shannon , Sullivan Melissa , Kietzman Abigail , Colston Candice , Murdock Meghan , Kelley Heather , Wright-Sexton Laura , Martin Maygan , Martin Lora , Malloch Lacy , Patterson Kayla , Sanders Cameron , Rohlfs Chelsea , Rice Marilyn , Howard Miranda , Murphy Makayla , Soma Vijaya L. , Ratner Adam J. , Job Megan J. , Mennie Colleen , Simkhada Kamala , Drapeau Noelle M. , Behl Supriya , Betters Kristina A. , Hayek Haya , Maranto Molly , Waters Aubrie , Flowers Maggie , Havlin Kevin , Furlong-Dillard Jamie , Porter Melissa , Nason Jennifer , Ray Madison , Gossett Kristen , Crandall Hillary , Heller Evan , Foley Jennifer , Rasal Rajashri , Marlow Christine , Senthil Anurithi , Myers Kimberly , Tudor Betsy , Adler Amanda , Garcia Nereyda , Treister Natalie , McQuillen Patrick S. , Sun Kathleen , Villarreal-Chico Denise , Kainaroi Sophia , Williams John V. 
Published: August 2023

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 &amp;lt;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.