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Journal Article Research Support, N.I.H., Extramural Epublish 11 citations

PubMed: 39453655 DOI: 10.1001/jamanetworkopen.2024.40997

Respiratory Syncytial Virus and US Pediatric Intensive Care Utilization.

JAMA Netw Open 7(10):e2440997

Authors: Alice Shanklin, Taylor Olson, Anita K Patel, Eduardo A Trujillo Rivera, Murray M Pollack

Affiliations

  • Division of Pediatric Critical Care Medicine, Children's National Hospital, Washington, DC. Now with Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center, New York, New York.
  • Division of Pediatric Critical Care Medicine, Children's National Hospital, Washington, DC.
  • Research Division of Biostatistics and Study Methodology, Children's National Hospital, Washington, DC.

Abstract

Importance

Bronchiolitis is the most common diagnosis necessitating respiratory support and pediatric intensive care, and respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. In 2023, the monoclonal antibody nirsevimab and the maternal RSVpreF vaccine were implemented to prevent RSV in infants.

Objective

To determine the potential association of novel RSV prevention strategies with pediatric intensive care unit (ICU) utilization.

Design, Setting, and Participants

This retrospective cross-sectional study examined US pediatric ICU encounters with and without RSV from January 1, 2017, to June 1, 2023. Data were from Oracle Cerner RealWorld Data, a national electronic health record database. All children (aged >1 day and <18 years) admitted to an ICU during the study period were included in the analysis. Statistical analysis was performed from February to May 2024.

Main Outcomes and Measures

The primary outcomes were ICU encounters with RSV and ICU encounters with RSV eligible for RSV prevention.

Results

There were 119 782 ICU encounters from 53 hospitals; 65 757 encounters (54.9%) were male; median (IQR) age was 4.5 (1.1-12.5) years, median (IQR) ICU length of stay was 1.8 (1.0-3.9) days; 13 702 ICU encounters (11.4%) had RSV, of which 38.6% (5217) were eligible for prevention (4.4% of total ICU encounters). Encounters with RSV accounted for 21.1% (109 334) of ICU days, of which 43.8% (47 888) were eligible for prevention (9.2% of total ICU days). Encounters with RSV were associated with a greater use of positive pressure ventilation (4074 [29.7%] vs 18 821 [17.7%]; P < .001) and vasoactive medications (3057 [22.3%] vs 18 570 [17.5%]; P < .001) compared with those without RSV.

Conclusions and Relevance

The findings of this retrospective cross-sectional study of RSV and US pediatric intensive care utilization suggest that if 65% to 85% of eligible children received RSV prevention, an estimated 2.1% to 2.8% reduction in pediatric ICU encounters and an estimated 4.5% to 5.9% reduction in pediatric ICU days could be achieved.

MeSH

Respiratory Syncytial Viruses, Cross-Sectional Studies, Intensive Care Units, Pediatric, Clinical Medicine, Viruses, Intensive Care Units, Child

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