Oxygen Support Needs Greater in Children With RSV vs Influenza or COVID-19

Children hospitalized with respiratory syncytial virus (RSV) had a greater disease burden than children hospitalized with influenza or COVID-19 during the 2021-2022 respiratory virus season, according to a study in the Journal of Pediatrics.

Investigators compared demographic and clinical characteristics and outcomes of pediatric patients hospitalized with RSV, influenza, or COVID-19 at Children’s Hospital Colorado in Aurora, Colorado, during the 2021-2022 season. The retrospective cohort study used public health surveillance data from the Colorado Department of Public Health and Environment (CDPHE). Participants were children (aged <18 years) with RSV, influenza, or SARS-CoV-2 infection admitted from October 1, 2021, to April 30, 2022, when SARS-CoV-2 delta and omicron variants were also circulating.

The primary outcome was intensive care unit (ICU) admission. Multivariable log-binomial regression modeling was used to assess the association regarding pathogen type and ICU admission, pneumonia and bronchiolitis diagnosis, hospital length of stay, and highest level of respiratory support received.

A total of 837 hospitalized children were included in the analysis: 487 with RSV, 303 with COVID-19, and 47 with influenza. The children had an overall median age of 1.5 years (interquartile range, 0.4, 4.1), and 45% were female. The patients with RSV were younger (median age, 1 year) vs those with SARS-CoV-2 (2.7 years) and influenza (6.1 years). A higher proportion of children who had influenza were Hispanic/Latinx (43.1%) vs those with RSV (31.2%) and SARS-CoV-2 (35.3%; P =.0143).

Of the hospitalized children with influenza and known vaccination status, 28 (68%) were either partially or fully vaccinated. Of those with SARS-CoV-2 infection, 36 (32.4%) were partially vaccinated or had their primary series. A higher proportion of asymptomatic children had SARS-CoV-2 (7.2%) compared with influenza (2.0%) and RSV (0.2%; P <.0001).

The median hospital length of stay was greater in children with RSV (4 days vs 3 days for SARS-CoV-2 and influenza; P =.0009). ICU admission rates and hospital length of stay were not significantly different, although children with SARS-CoV-2 more frequently received pressor support (8.2%) and invasive mechanical ventilation for their highest level of respiratory support (7.2%) compared with the children who had RSV and influenza (P < .001 for both).

In multivariable log-binomial regression analyses, using COVID-19 as the reference group, ICU admission risk was greater in children who had influenza (relative risk [RR] 1.97; 95% CI, 1.22-3.19). Children with RSV had a higher risk of pneumonia (RR 2.32; 95% CI, 1.54-3.52) and bronchiolitis (RR 2.93; 95% CI, 2.28-3.78). A hospital stay of more than 4 days (RR 1.40; 95% CI, 1.12-1.76) and greater oxygen support (RR 2.01; 95% CI, 1.54-2.63) also were more likely in children with RSV.

Study limitations include the use of retrospective data involving only hospitalized children; the single-center design; the inability to provide population-based estimates of disease burden; and lack of evaluation of other viral pathogens, such as rhinovirus.

“In a season with pathogen cocirculation of RSV, influenza, and SARS-CoV-2, hospitalizations were primarily RSV-associated, predominantly due to respiratory illnesses, with requirements for higher levels of oxygen and noninvasive respiratory support compared with the needs of children with SARS-CoV-2 and influenza,” stated the investigators. “Given the likely seasonal cocirculation of these pathogens, ongoing comparison of their clinical characteristics and evaluation of their overall disease burden is essential to optimize treatment and prevention strategies.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Pulmonology Advisor