Clinical characteristics and in-hospital outcomes associated with RSV-ALRI compared to other viral ALRI in hospitalised children under two years old

Acacia Ozturk; Mei Chan; Jahid Rahman Khan; Nan Hu; Brendan McMullan; Philip N Britton; Adam Bartlett; Rama Kandasamy; Gemma L Saravanos; Bernadette Prentice; Ting Shi; Adam Jaffe; Louisa Owens; Nusrat Homaira

doi:10.1093/infdis/jiae543

Clinical characteristics and in-hospital outcomes associated with RSV-ALRI compared to other viral ALRI in hospitalised children under two years old

J Infect Dis. 2024 Nov 1:jiae543. doi: 10.1093/infdis/jiae543. Online ahead of print.

Authors

Acacia Ozturk¹, Mei Chan¹, Jahid Rahman Khan¹, Nan Hu¹, Brendan McMullan^{1

2}, Philip N Britton^{3

4}, Adam Bartlett², Rama Kandasamy^{3

4}, Gemma L Saravanos⁵, Bernadette Prentice^{1

2}, Ting Shi⁶, Adam Jaffe^{1

2}, Louisa Owens^{1

2}, Nusrat Homaira^{1

2

7}

Affiliations

¹ Discipline of Pediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Australia.
² Sydney Children's Hospital, Randwick, Sydney, Australia.
³ Sydney Medical School, University of Sydney, Sydney, Australia.
⁴ The Children's Hospital at Westmead, Sydney Australia.
⁵ Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁶ Usher Institute, Old Medical School, Teviot Place, University of Edinburgh, Edinburgh, United Kingdom.
⁷ James P. Grant School of Public Health, Dhaka, Bangladesh.

PMID: 39484989
DOI: 10.1093/infdis/jiae543

Abstract

Background: Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections (ALRIs) associated hospitalisations in children. It is unclear if hospitalized RSV-ALRI differs in clinically from other viral ALRIs. We aimed to compare the disease impact of hospitalised RSV with other viral ALRI in children under 2 years.

Methods: We conducted a retrospective study using electronic medical records of children under 2 hospitalized with ALRIs at Sydney Children's Hospitals Network from 2020-2022. We compared demographics and clinical features between RSV-positive and RSV-negative (positive for other viruses) cases. Poisson quasi-likelihood regression was used to estimate adjusted prevalence ratios (aPRs) for three in-hospital outcomes: length of stay, need for respiratory support and intensive care.

Results: We examined 330 children under 2 years hospitalized with RSV-positive ALRIs and 330 with RSV-negative ALRIs (positive for other viruses). RSV-positive cases were older (12 vs. 8 months, p<0.001) and more often presented with cough (99% vs. 92%), fever (80% vs. 58%), crackles (89% vs. 76%), hypoxia (50% vs. 36%), and lethargy (36% vs. 20%). They were also more likely to undergo chest x-rays (74% vs. 49%) and receive antibiotics (65% vs. 35%). Adjusted analysis showed RSV-positive children had a higher likelihood of LOS > 2 days (aPR 1.95, 95% CI 1.14-3.36).). However, there were no differences in the need for intensive care or respiratory support.

Conclusion: Children with RSV-ALRI exhibited more severe symptoms, received more antibiotics, and had longer hospital stays compared to those with other viral ALRIs, underscoring the need for effective prevention and treatment strategies for RSV.

Keywords: ALRI; Acute lower respiratory infection; Children; RSV.

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