Abstract
Respiratory syncytial virus (RSV) bronchiolitis causes substantial morbidity and mortality in young children, but insight into the burden of RSV bronchiolitis on pediatric intensive care units (PICUs) is limited. We aimed to determine the burden of RSV bronchiolitis on the PICUs in the Netherlands. Therefore, we identified all children ≤ 24 months of age with RSV bronchiolitis between 2003 and 2016 from a nationwide PICU registry. Subsequently we manually checked their patient records for correct diagnosis and collected patient characteristics, additional clinical data, respiratory support modes, and outcome. In total, 2161 children were admitted to the PICU for RSV bronchiolitis. The annual number of admissions increased significantly during the study period (β 4.05, SE 1.27, p = 0.01), and this increase was mostly driven by increased admissions in children up to 3 months old. Concomitantly, non-invasive respiratory support significantly increased (β 7.71, SE 0.92, p < 0.01), in particular the use of high flow nasal cannula (HFNC) (β 6.69, SE 0.96, p < 0.01), whereas the use of invasive ventilation remained stable.Conclusion: The burden of severe RSV bronchiolitis on PICUs has increased in the Netherlands. Concomitantly, the use of non-invasive respiratory support, especially HFNC, has increased.What is Known:• RSV bronchiolitis is a major cause of childhood morbidity and mortality and may require pediatric intensive care unit admission.• The field of pediatric critical care for severe bronchiolitis has changed due to increased non-invasive respiratory support options.What is New:• The burden of RSV bronchiolitis for the Dutch PICUs has increased. These data inform future strategic PICU resource planning and implementation of RSV preventive strategies.• There was a significant increase in the use of high flow nasal cannula at the PICU, but the use of invasive mechanical ventilation did not decrease.
Highlights
With a worldwide hospitalization rate of over three million children and an in-hospital mortality of up to 75,000 cases annually, respiratory syncytial virus (RSV) bronchiolitis is a leading cause of childhood morbidity and mortality [1, 2]
The burden of severe RSV bronchiolitis on pediatric intensive care units (PICUs) has increased in the Netherlands
RSV bronchiolitis is a major cause of childhood morbidity and mortality and may require pediatric intensive care unit admission
Summary
With a worldwide hospitalization rate of over three million children and an in-hospital mortality of up to 75,000 cases annually, respiratory syncytial virus (RSV) bronchiolitis is a leading cause of childhood morbidity and mortality [1, 2]. Hospitalization numbers for RSV bronchiolitis seem to be decreasing, bronchiolitis-associated healthcare costs have increased in several countries since 2000 [3,4,5]. Only 2% of children with RSV bronchiolitis require PICU admission for mechanical ventilation, it is estimated that PICU care accounts for 18% of the total RSV-related hospital costs [3]. RSV prevention strategies with (extended) monoclonal antibodies focus on children at risk for severe RSV bronchiolitis, such as those born prematurely or with comorbidity [8,9,10]. Most children with RSV bronchiolitis admitted to a PICU may not have a qualifying risk factor [11, 12]
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