Risk factors for respiratory syncytial virus bronchiolitis hospitalizations in children with chronic diseases

Background: Respiratory syncytial virus (RSV) bronchiolitis is the most common lower respiratory tract disorder causing hospitalization in infants. Due to decreased hospitalization rates of premature infants following Palivizumab immune prophylaxis, the proportion of infants with chronic diseases not eligible for Palivizumab has increased. Aim: To characterize infants hospitalized during 2014–2018 with RSV bronchiolitis, to compare between those with and without chronic conditions, and to identify risk factors for severe disease. Methods: This retrospective study analyzed demographic and clinical data of patients younger than 2 years admitted with bronchiolitis during four consecutive RSV seasons. Results: Of 1124 hospitalizations due to RSV bronchiolitis, 244 (22%) were in infants with chronic diseases. Although 20/1124 qualified for RSV prophylaxis, only eight received immune prophylaxis. Compared to otherwise healthy infants, children with chronic diseases had longer hospitalizations, median 4.8 days (interquartile range [IQR]: 3.4–8.3) versus 3.7 days (IQR: 2.7–5.1), p <.001; and higher pediatric intensive care unit (PICU) and readmission rates (9% vs. 4.5%, p =.007% and 3% vs. 1%, p =.055, respectively). Children with Down's syndrome comprised 2% of all hospitalizations, but 8% of PICU admissions; their median length of hospitalization was 10.7 days (IQR: 6.6–17.6). Respiratory tract malformations were present in 2% of hospitalizations, and comprised 4% of PICU admissions. Conclusion: Among infants admitted with RSV bronchiolitis, those with chronic diseases had longer hospitalizations and higher rates of transfer to the PICU. Children with multiple comorbidities, and especially those with Down's syndrome, are at particularly high risk for severe hospitalization and may benefit from RSV immune prophylaxis.