Complex Hospital Courses More Likely in Children Admitted With RSV vs Influenza

Results of a study published in Pediatric Pulmonology suggests that the risk for a complex hospital course, including the need for respiratory support, is higher among children hospitalized with respiratory syncytial virus (RSV) infection compared with influenza infection.

Researchers conducted a retrospective cohort study to assess the frequency of complex hospital courses among children hospitalized with RSV- vs influenza-associated lower respiratory tract infection between 2016 and 2019. Complex hospital courses were considered a composite of pediatric intensive care unit (PICU) admission, respiratory support, nasogastric tube feeds, prolonged hospitalization, and mortality. Secondary outcomes included hospital readmission within 7 days of discharge and time to respiratory support initiation. Outcomes between the groups were compared via multivariable logistic regression, with adjustments for race/ethnicity, sex, age, and gestational age.

Among a total of 1228 patients included in the analysis, 1,094 (89%) were hospitalized with RSV infection and 134 (11%) with influenza infection. Patients with influenza vs RSV infection were older (336 vs 165 days; P < 0.001) and more likely to have abnormal pulse (84.3% vs 73.5%; P < 0.01) and fever (27.6% vs 18.9% P = 0.02). Patients admitted with RSV infection were more likely to be diagnosed with bronchiolitis (98.6%), whereas those admitted with influenza infection were more likely to be diagnosed with viral pneumonia (77.6%).

No significant between-group differences were observed in regard to the number of patients with abnormal age-adjusted respiratory rates, oxygen saturation levels below 92%, and LRTI-related readmission rates at 7 days following hospital discharge.

In the adjusted analysis, the risk for a complex hospital course was significantly higher among patients in the RSV group compared with those in the influenza group (adjusted odds ratio [aOR], 3.5; 95% CI, 2.2-5.6). Further analysis between the groups showed that patients with RSV infection were more likely to require respiratory support (aOR, 4.1; 95% CI, 2.4-6.9), PICU admission (aOR, 2.4; 95% CI, 1.4-4.2), and prolonged hospitalization (adjusted incidence rate ratio, 1.3; 95% CI, 1.1-1.5). However, admissions for RSV were not significantly associated with the occurrence of nasogastric tube feeding (aOR, 2.3; 95% CI, 0.7-8.0) or mortality.

Stratified by age, the increased risk for complex hospital course observed in admissions for RSV vs influenza infection was higher among patients younger than 1 compared with those aged 1 year and older.

Study limitations include the single-center setting, retrospective design, and the inclusion of only patient data captured from electronic health records.

According to the researchers, “[I]dentifying LRTI admissions due to RSV and influenza may guide hospital admission needs, discharge criteria, and aid in providing families with anticipatory guidance regarding the hospitalization.”

This article originally appeared on Infectious Disease Advisor