Severe RSV bronchiolitis in children

Abstract

Background: Respiratory syncytial virus (RSV) bronchiolitis is one of the most common respiratory tract infections in children, resulting in substantial global morbidity and mortality. However, we have limited insight in the burden of severe RSV bronchiolitis for which paediatric intensive care unit (PICU) admission is indicated. Our aim was to determine the PICU burden of severe RSV bronchiolitis in the Netherlands. Second, we aimed to define the potential impact of a maternal vaccination strategy on severe RSV bronchiolitis.

Methods: We had access to a unique nationwide PICU registry to study patient characteristics and dynamics in 2161 children ≤24 months with a confirmed RSV infection from 2003 to 2016. We manually subtracted additional clinical data, respiratory support modes and outcome. We defined children born term and ≤3 months of age on admission as children who possibly could have benefitted from a maternal vaccination strategy.

Results: The number of PICU admissions increased significantly during the study period (β 4.05, p=0.01). The use of non-invasive respiratory support in these children, especially high flow nasal cannula, increased significantly (β 8.86, p< 0.01), whereas the number of children requiring invasive ventilation remained stable. We identified 1152 (53.3%) term children aged ≤3 months age on admission.

Conclusion: The burden of severe RSV bronchiolitis for the PICU has increased in the Netherlands. Concomitantly, the use of non-invasive mechanical ventilation modalities has increased. A maternal vaccination strategy may have a high beneficial impact on the PICU burden of RSV bronchiolitis.