Higher Rates Of Preterm Birth Research Articles

Another Frontier in Microbiome Research: Preterm Birth

After Elise and Todd Jackson’s son, Elijah, was born 14 weeks prematurely in 2002, he spent 7 months in the neonatal intensive care unit at Rockford Memorial Hospital in north central Illinois. Although Elijah is now an active and healthy 12-year-old, because of medical problems stemming from his prematurity, as an infant he was given a feeding tube, underwent surgery to close the duct between his pulmonary artery and aorta, and needed a tracheotomy to help him breathe. “I literallymoved toRockford tobewith him,” said Elise Jackson, whose home is 45 miles away in Elgin, Illinois. “I didn’t want to leave his bedside.” The exact cause of Elijah Jackson’s preterm birth was never determined, as is often the case with premature infants. Some well-known links with prematurity include urinary tract and vaginal infections, preeclampsia, diabetes, and conception using assisted reproductive technologies. But in a recent study, researchers at the March of Dimes Prematurity Research Center at Stanford University explored a lesser-known frontier: the relationship between preterm birth and the microbial composition of the vagina and other sites in the body. Finding new ways to prevent premature birth could help improve a somewhat embarrassing statistic: at 12%, the United States has a higher rate of preterm births than Canada, Mexico, Europe, and most Latin American countries (http://bit.ly /1x6idvM). One of 9 babies were born prematurely in the United States in 2012, according to the Centers for Disease Control and Prevention (CDC), and preterm birth, defined as birth occurring before 37 weeks of pregnancy, is the leading cause of death and long-termneurologicaldisabilities for infants (http://1.usa.gov/1yeRSuE).

Symptoms of Depression Predict Negative Birth Outcomes in African American Women: A Pilot Study.

African American women have higher rates of preterm birth and low-birth-weight infants compared with non-Hispanic white women. Symptoms of depression have also been related to these negative birth outcomes. Lower levels of social support and higher levels of avoidance coping and cortisol have been related to more symptoms of depression in pregnant women. The purpose of this pilot study was to examine the relationships among symptoms of depression, social support, avoidance coping, cortisol, and negative birth outcomes (ie, preterm birth, low-birth-weight infants) in a sample of African American women. This study used a prospective design. A convenience sample of 90 African American women completed questionnaires and had blood drawn in the second trimester of pregnancy. Birth data were collected from medical records. Based on the Center for Epidemiological Studies-Depression (CES-D) Scale scores, 28% of women were at increased risk for clinical depression (CES-D ≥ 16). Compared to women who gave birth at term, women who had preterm birth had higher CES-D scores (11.67 and 19.0, respectively) and used avoidance coping more often (7.98 and 13.14, respectively). Compared to women with normal-birth-weight infants, women with low-birth-weight infants had higher levels of cortisol (61.75 mcg/dL and 89.72 mcg/dL, respectively). Women at increased risk for clinical depression were 16 times more likely to have preterm birth and 4 times more likely to have low-birth-weight infants. Women with plasma cortisol levels in the top 25th percentile were 7 times more likely to have low-birth-weight infants. Preeclampsia during pregnancy also predicted preterm birth and low-birth-weight infants. Symptoms of depression in pregnancy may predict adverse birth outcomes. Interventions that have the potential to improve the mental health of pregnant women and ultimately birth outcomes need to be explored.

Parents’ experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of this review is to identify, appraise and synthesize the best available studies exploring parents’ experiences of transition when their infants are discharged from the Neonatal Intensive Care Unit. The review questions are: 1. How do parents describe their preparedness for bringing their infant(s) home? 2. How do the parents experience the event of discharge? 3. What issues do the parents describe as influencing their transition experiences when the infant is discharged from a NICU to home? INCLUSION CRITERIA Types of participants This review will consider studies that include mothers, fathers, step-parents or foster parents of infants who are hospitalized in a neonatal intensive care unit regardless of civil status, ethnicity or country of origin. Types of intervention(s)/phenomena of interest This review will include studies that investigate how parents experience the discharge of their infant from the Neonatal Intensive Care Unit. The included studies should describe parents’ experiences of being prepared for the discharge and the event of the discharge. Transition in this study is defined as: “a passage from one fairly stable state to another fairly stable state and it is a process triggered by a change”. The focus of this review is infants’ discharge from the Neonatal Intensive Care Unit. Context The context of this review is a Neonatal Intensive Care Unit defined as an intensive care unit of ill or premature and/or newborn infants. This review includes studies from all four classified levels for Neonatal Intensive Care Unit care TRUNCATED AT 250 WORDS

The Duration of Hospitalization and Readmission Rate of Low Birth Weight Infants in a Tertiary Referral Hospital in Isfahan, Iran

Background: Currently, the number of premature deliveries has been increasing, resulting in early postnatal discharge due to shortage of beds in the neonatal intensive care units (NICU). Methods: This descriptive-analytical study was conducted through investigating the premature infants’ files for gestational age (GA), birth weight (BW) and duration of the first hospitalization. Furthermore, the readmission rate during the first year of life and their causes were studied. Results: Overall, 495 infants were enrolled in this study. The range of GA and BW of infants who were admitted to NICU were 24-36 weeks and 470 - 2500 g, respectively. A total of 172 (34.74%) infants had a BW of less than 1500 g (VLBW), and 144 of them (29.09%) were severely premature (GA of between 24-31 weeks). The median (range) time of hospitalization in VLBW infants was 22 (1-75). Moreover, 76 (15.3%) infants were re-hospitalized during the first year of life, and 32 (6.4%) infants were readmitted during the first three months of life. The four most common causes of re-hospitalization during the first year of life were as follows: pneumonia (32.89%), icter (17.10%), treatment of retinopathy of prematurity (10.52%) and sepsis (9.20%). Conclusion: Hospital policies are changing due to the high rate of preterm births and lack of neonatal beds. The results of this study suggested that premature neonates, who are able to regulate body temperature at room temperature, and gain weight by oral feeding with no recent apnoea or bradycardia, could be discharged regardless of their gestational age and body weight.

Pregnancy outcomes among mothers aged 15 years or less.

The aim of this study was to determine pregnancy outcomes among early adolescent women (aged ≤ 15 years) compared with those in late adolescence (16-19 years) and adults aged 20-30 years. A retrospective cohort study was conducted on singleton pregnancies with maternal age ≤15 years (early adolescent), 16-19 years (late adolescent), and 20-30 years (adult). The primary outcomes for comparison were the rates of preterm birth, low birthweight, growth restriction and cesarean section. A total of 33 777 pregnancies, 298 early adolescent, 4456 late adolescent, and 29 023 adults, were enrolled. Most baseline characteristics were comparable but rates of pregnancy complicated by medical diseases were significantly higher in the adults, especially diabetes mellitus and chronic hypertension. When compared to the adult group, the early adolescent group had significantly higher rates of preterm birth (31.9% vs 14.5%, P < 0.001), growth restriction (11.7% vs 7.1%, P = 0.002), low birthweight (28.9% vs 14.7%, P < 0.001), while maternal morbidity, such as pre-eclampsia and placenta previa, was similar. Likewise, most of the main outcomes in early adolescents were also significantly higher than those in late adolescents, but with lesser degrees. Interestingly, the primary cesarean rate was significantly lower in early adolescent women (6.7% vs 12.3%, P = 0.005). Early adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes, in particular preterm birth and growth restriction, though most maternal morbidity was comparable with that in the control groups. Cesarean rate was significantly lower in early adolescent mothers. This information should be provided to women and their families.

International Perspectives: Impact of Syrian Refugees on Neonatal Care in Hopital Notre Dame de la Paix, Akkar, North Lebanon

This comparative epidemiologic study looks at the effect of the Syrian war on neonatal morbidity and medical care in the Akkar region of North Lebanon in 2013, comparing data of the Lebanese neonatal population as gathered by the National Collaborative Perinatal Neonatal Network before 2013 with that of the Syrian refugees in the year 2013. The study was conducted from Jan. 1 through Dec. 31, 2013, at Hopital Notre Dame de la Paix, Kobayat, a major referral center for Syrian refugees. It revealed that Syrian refugee mothers were younger, less educated, and had higher rates of preterm births and infants with congenital malformations compared with Lebanese mothers both in Akkar and on a national scale.

Embarazo después de los 40 años: características epidemiológicas

OBJETIVOS: Describir las características epidemiológicas y resultados obstétricos y perinatales en gestantes después de los 40 años. DISEÑO: Estudio Descriptivo retrospectivo.MATERIAL Y MÉTODOS: Se revisó las historias clínicas de todos los partos ocurridos en mujeres de 40 años o más atendidos en el IEMP del 1 enero del 2004 al 30 de noviembre de 2004. RESULTADOS: Se atendió 18568 partos, de los cuales 516 correspondieron a mujeres de 40 años o más, con una incidencia de 2.78%. Se distinguió 2 grupos, el grupo de nulíparas (n=46) y el grupo de multíparas (n=470). El 58.2% tenía entre 40 y 42 años al momento del parto. Ambos grupos tenían similares características en cuanto a edad promedio, estado civil, IMC y número de controles prenatales. La tasa de cesáreas en toda la población fue alta (56,8%) y mayor en el grupo de nulíparas (71,7%; p&lt;0,01). El grupo de nulíparas presentó mayores casos de partos disfuncionales, en los que se usó oxitocina (52,2%; p&lt;0,05). Se registró 15 (0,8%) muertes fetales intrauterinas, todas en mujeres multíparas. Hubo mayor tasa de partos pretérmino que en la población general, el grupo de nulíparas tuvo una tasa de 21,7%, sin diferencia significativa. Las mujeres multíparas tuvieron mayor número de neonatos macrosómicos (11,3%), que el grupo de nulíparas (p&lt; 0,05). CONCLUSIONES: Las nulíparas mayores de 40 años tienen mayor riesgo de parto disfuncional y mayores tasas de cesárea y pretérminos y las multíparas, mayor riesgo de muerte fetal intrauterina y macrosomia fetal.

Risk factors of recurrent preeclampsia and its relation to maternal and offspring outcome

To investigate the risks of recurrent preeclampsia and observe the incidence and long-term prognosis of recurrent preeclampsia. One hundred and fifteen women with preeclampsia history admitted in Women's Hospital, Zhejiang University School of Medicine from January 2009 to December 2013 were enrolled in the study. The clinical data were retrospectively analyzed. Among 115 women with preeclampsia, 82 cases (71.3%)had recurrent preeclampsia. The onset age, the pregnant interval time, regular prenatal check-up, weight gain during pregnancy, body mass index (BMI), hyperlipidemia, fetal growth restriction (FGR), maternal family history were closely associated with recurrent preeclampsia (P<0.05). Logistic regression analysis showed that the pregnant interval time, BMI, FGR were independent risk factors for preeclampsia recurrence. Compared with the preeclampsia in first pregnancy, the mather had earlier onset and termination of pregnancy, higher blood pressure, higher rate of urine protein ≥ 2+ and higher rate of complications in recurrent preeclampsia. The offspring had higher rate of preterm birth, especially the time of birth for 34 weeks or earlier and lower birth weight (P<0.05). The incidence of chronic hypertension in recurrent preeclampsia group was higher than that in no recurrence group (47.5% vs 23.3%, P<0.05); the overweight rate of first pregnant offspring in recurrence group was higher than that in no recurrence group (31.25% vs 6.70%, P<0.05). The onset age, time interval, regular prenatal check-up, weight gain during pregnancy, BMI, hyperlipidemia, FGR, maternal family history are closely associated with recurrent preeclampsia, and the pregnant interval time, BMI, FGR are independent risk factors for preeclampsia recurrence. Recurrent preeclampsia has more serious clinical outcome and complications, and prevention need to be emphasized.

Metformin for the management of gestational diabetes mellitus

Glycaemic control in women with gestational diabetes mellitus (GDM) has typically been achieved with diet, exercise and insulin therapy. Controversy exists in the literature about a potential role for metformin. A literature review was completed aiming to compare the glycaemic control, maternal and fetal out comes of metformin therapy with insulin. Searches were completed on databases, including Medline, PubMed and ScienceDirect. Seven randomised control trials (RCTs) fit the inclusion criteria, with a total sample size of 1514 women. The majority of studies found no difference in glycaemic control between metformin and insulin groups. When comparing maternal outcomes, those receiving metformin therapy recorded less maternal weight gain in four studies. Anumber of studies reported lower rates of neonatal hypoglycaemia, and one reported higher rates of preterm birth in the metformin group. There were no other differences in the recorded maternal and fetal outcomes. The Jadad score for assessing risk of bias for most included studies was either 3 or 4. The criteria for diagnosis of GDM, maternal and neonatal complications varied between studies. Only one study has published follow-up data, and most are single-centre trials with relatively small sample sizes. Though there is a growing body of evidence to suggest a role for metformin in GDM management, further large-scale, multicentre RCTs are needed before guidelines can be altered.

The effect of preterm birth on infant negative affect and maternal postpartum depressive symptoms: A preliminary examination in an underrepresented minority sample

ObjectiveTo examine the effect of preterm birth on maternal postpartum depressive symptoms and infant negative affect in an underrepresented minority sample. MethodParticipants were 102 mothers and their 3- to 10-month-old infants. Mothers completed the Edinburgh Postnatal Depression Scale and the Infant Behavior Questionnaire-Revised. ResultsRelative to normative samples, the current underrepresented minority sample of mostly Hispanics and Blacks displayed high rates of preterm birth (30%) and maternal postpartum depressive symptoms (17%). Preterm birth had a significant direct effect on postpartum depressive symptoms and infant negative affect. Additionally, there was an indirect effect of postpartum depressive symptoms on the relation between preterm birth and infant negative affect. Specifically, lower birth weight and gestational age predicted higher levels of depressive symptoms in the mother, and higher levels of depressive symptoms in the mother, in turn, predicted higher levels of infant negative affect. ConclusionFindings emphasize the importance of screening for postpartum depressive symptoms and infant negative affect among mothers and their preterm infants, especially among families from underrepresented minority backgrounds.

Regional and Racial Disparity of Preterm Birth Prevalence in Georgia, 1995–2012

Preterm birth (PTB), defined as a live birth with a gestational age of less than 37 weeks, is the leading cause of infant mortality in developed countries. Recent studies have shown increases in PTB rates through the 1990s and 2000s in the United States, especially in a few states in the southeast including Georgia. Although researchers have studied the epidemiology of PTB in several regions, the spatial-temporal patterns of PTB rates in Georgia remain largely unexplored. This paper examines the spatial variations of PTB prevalence in Georgia at the county level between 1995 and 2012. Spatial clusters are assessed using global Moran's I and local indicators of spatial association (LISA). For disparity analysis, comparisons are made between births classified by race (black vs. white) and by four levels of urbanization. Results indicated a steady increase in PTB rates for both black and white births of all four urbanization classifications from 1995 to 2007, followed by a general decline from 2007 to 2012 for all groups. More urbanized counties tended to have lower PTB rates than more rural counties when compared as groups. Spatial clustering of high PTB rates tended to occur in the southern portion of the state for both white and black births, growing more prominent in the south central region as time progressed. Alternatively, spatial clustering of low PTB rates tended to occur in counties located in the north and northeastern areas of Georgia. The findings from this exploratory research are expected to serve as the basis of further studies of PTB and its risk factors, as well as to more effectively allocating prenatal health care resources.

Comparison of Perinatal Risk Factors Associated with Autism Spectrum Disorder (ASD), Intellectual Disability (ID), and Co-occurring ASD and ID.

While studies report associations between perinatal outcomes and both autism spectrum disorder (ASD) and intellectual disability (ID), there has been little study of ASD with versus without co-occurring ID. We compared perinatal risk factors among 7547 children in the 2006-2010 Autism and Developmental Disability Monitoring Network classified as having ASD+ID, ASD only, and ID only. Children in all three groups had higher rates of preterm birth (PTB), low birth weight, small-for-gestational-age, and low Apgar score than expected based on the US birth cohort adjusted for key socio-demographic factors. Associations with most factors, especially PTB, were stronger for children with ID only than children with ASD+ID or ASD only. Associations were similar for children with ASD+ID and ASD only.

Is there a role for probiotics in the prevention of preterm birth?

Preterm birth (PTB) continues to be a global health challenge. An over-production of inflammatory cytokines and chemokines, as well as an altered maternal vaginal microbiome has been implicated in the pathogenesis of inflammation/infection-associated PTB. Lactobacillus represents the dominant species in the vagina of most healthy pregnant women. The depletion of Lactobacillus in women with bacterial vaginosis (BV) has been associated with an increased risk of PTB. It remains unknown at what point an aberrant vaginal microbiome composition specifically induces the cascade leading to PTB. The ability of oral or vaginal lactobacilli probiotics to reduce BV occurrence and/or dampen inflammation is being considered as a means to prevent PTB. Certain anti-inflammatory properties of lactobacilli suggest potential mechanisms. To date, clinical studies have not been powered with sufficiently high rates of PTB, but overall, there is merit in examining this promising area of clinical science.

Perinatal outcomes associated with assisted reproductive technology: the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART)

To compare on a population basis the birth outcomes of women treated with assisted reproductive technologies (ART), women with indicators of subfertility but without ART, and fertile women. Longitudinal cohort study. Not applicable. A total of 334,628 births and fetal deaths to Massachusetts mothers giving birth in a Massachusetts hospital from July 1, 2004, to December 31, 2008, subdivided into three subgroups for comparison: ART 11,271, subfertile 6,609, and fertile 316,748. None. Four outcomes-preterm birth, low birth weight, small for gestational age, and perinatal death-were modeled separately for singletons and twins with the use of logistic regression for the primary comparison between ART births and those to the newly created population-based subgroup of births to women with indicators of subfertility but no ART. For singletons, the risks for both preterm birth and low birth weight were higher for the ART group (adjusted odds ratios [AORs] 1.23 and 1.26, respectively) compared with the subfertile group, and risks in both the ART and the subfertile groups were higher than those among the fertile births group. For twins, the risk of perinatal death was significantly lower among ART births than fertile (AOR 0.55) or subfertile (AOR 0.15) births. The use of a population-based comparison group of subfertile births without ART demonstrated significantly higher rates of preterm birth and low birth weight in ART singleton births, but these differences are smaller than differences between ART and fertile births. Further refinement of the measurement of subfertile births and examination of the independent risks of subfertile births is warranted.

Early-Onset Neonatal Sepsis: Group B Streptococcal Compared to E. coli Disease

Background: Early onset sepsis (EOS) of the newborn is a severe disease and associated with high morbidity and mortality. Aim of the study was to compare perinatal, short-term outcome and laboratory data of neonates with early-onset sepsis (EOS) either due to Group B Streptococci (GBS) or Escherichia coli (E. coli) infection. Methods: Retrospective cohort analysis of all neonates with culture proven GBS and E. coli EOS born between 1993 and 2011 and hospitalized at the NICU of the Medical University of Graz, Austria. Data were analyzed regarding perinatal, laboratory and short-term outcome data. Results: During the study period 100 neonates with EOS due to GBS and 11 neonates with E. coli infection were hospitalized at our NICU. Perinatal and short-term outcome data differed between GBS and E. coli infection regarding gestational age (median 38 vs. 32 weeks, p=.005), birth weight (median 3095 vs. 1836 grams, p=.031), presence of hypothermia (0 vs. 18%, p=.009), duration of mechanical ventilation (4 vs. 8 days, p=.019), duration of therapy with supplemental oxygen (9 vs. 2 days, p=.031), length of hospitalization (15 vs. 22 days, p=.039), presence of chorioamnionitis (17 vs. 46%, p=.041) and maternal fever (2 vs. 18%, p=.049). Mortality rates did not differ significantly (6 vs. 18%, p=.180). Laboratory data regarding white blood cell count, IT-ratio, and CRP value were not different between groups within the first 72 hours of life. There was a significant decrease of GBS sepsis during the study period (p=0,014). Conclusion: Main differences between GBS and E. coli infections were due to higher rates of preterm birth in the E. coli group, clinical and laboratory characteristics only differed marginally.

DEFINING ELIGIBILITY CRITERIA FOR FUNDING POLICIES AROUND IN VITRO FERTILIZATION.

This review aims to assess the state of the science around the potential impact of certain patient characteristics on the safety and effectiveness of in vitro fertilization (IVF). Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of reviews and recent primary studies examining the impact of paternal age and maternal age, smoking, and body mass index (BMI) on the safety and effectiveness of IVF was performed. Papers, published between January 2007 and June 2014, were independently reviewed and critically appraised by two researchers using published quality assessment tools for reviews and primary studies. Due to heterogeneity across papers (different study designs and patient selection criteria), a qualitative analysis of extracted information was performed. Seventeen papers (ten systematic reviews and seven primary studies) were included. They comprised evidence from retrospective observational studies in which maternal age, BMI, and smoking status were explored as part of secondary analyses of larger studies. The majority of papers found that the likelihood of achieving a pregnancy was lower among women who were >40 years, had a BMI ≥ 25 and smoked. Advanced maternal age and BMI were also associated with higher rates of preterm birth and low birth weight. Based on available evidence, it may be appropriate to consider "maternal age" and "morbid obesity" in public funding policies that aim to maximize the effectiveness of IVF. However, given inconsistencies in the effect of smoking across different pregnancy-related outcomes, support for incorporating it into funding conditions appears weak.

Amniotic lamellar body count: predicting and distinguishing neonatal respiratory complications in twin pregnancies

BackgroundTwin pregnancies have a higher rate of preterm births, making precise prediction of neonatal respiratory disorders essential. We herein examined the amniotic lamellar body count (LBC) and found it to be an accurate predictor of respiratory disorders in twin pregnancies. MethodsFive hundred fourteen amniotic fluid samples, comprising 132 dichorionic twin (DCT) and 125 monochorionic twin (MCT) gestations, were obtained at cesarean section performed at 29 to 38 gestational weeks. Samples were analyzed immediately without centrifugation. ResultsThere were 26 neonates (5.1%) with respiratory distress syndrome (RDS) and 43 (8.4%) with transient tachypnea of the newborn (TTN). The LBC in neonates with TTN (5.12×104/μl) was between the counts in RDS (1.26×104/μl) and controls (10.6×104/μl), which differed significantly. Twin concordance rates were significantly higher for TTN in MCT gestations than DCT gestations (p=0.003) and delta LBC value was significantly smaller in MCT (3.15±0.4×104/μl) than DCT (5.17±0.5×104/μl) gestations (p=0.003). ConclusionsThe amniotic LBC is useful for predicting respiratory disorders, including RDS and TTN, in twin pregnancies. The data in this study may indicate a genetic predisposition to TTN among MCTs.

Born too small: who survives in the public hospitals in Lilongwe, Malawi?

ObjectiveMalawi has the highest estimated preterm birth rate in the world. The survival rate of these babies is not known. The main objective of this study was to demonstrate the...

Exploration of preterm birth rates using the public health exposome database and computational analysis methods.

Recent advances in informatics technology has made it possible to integrate, manipulate, and analyze variables from a wide range of scientific disciplines allowing for the examination of complex social problems such as health disparities. This study used 589 county-level variables to identify and compare geographical variation of high and low preterm birth rates. Data were collected from a number of publically available sources, bringing together natality outcomes with attributes of the natural, built, social, and policy environments. Singleton early premature county birth rate, in counties with population size over 100,000 persons provided the dependent variable. Graph theoretical techniques were used to identify a wide range of predictor variables from various domains, including black proportion, obesity and diabetes, sexually transmitted infection rates, mother’s age, income, marriage rates, pollution and temperature among others. Dense subgraphs (paracliques) representing groups of highly correlated variables were resolved into latent factors, which were then used to build a regression model explaining prematurity (R-squared = 76.7%). Two lists of counties with large positive and large negative residuals, indicating unusual prematurity rates given their circumstances, may serve as a starting point for ways to intervene and reduce health disparities for preterm births.

PS-324 Nosocomial Respiratory Syncytial Virus Infections In The Palivizumab-prophylaxis Era

<h3>Background</h3> Although respiratory syncytial virus (RSV) infection continues to be a leading cause of infant hospitalisation with a high transmission rate, recent data on nosocomial RSV infection are scarce. This study investigated the clinical and epidemiological characteristics of nosocomial RSV infection in the palivizumab-prophylaxis era. <h3>Methods</h3> The database of a tertiary paediatric medical centre was searched for all hospitalised patients with RSV-positive respiratory disease in 2008 through 2010. Data were compared between patients with community-associated and nosocomial disease and the qualification of the latter group for palivizumab was evaluated. <h3>Results</h3> Of the 873 children identified, 30 (3.4%) had a nosocomial infection. This group accounted for 0.06% of all admissions during the study period and 0.13 of every 1000 hospitalisation days. The nosocomial-infection group had higher rates of preterm birth and severe underlying disease than the community-associated RSV group, and a longer mean hospital stay. The nosocomial-infection group also had higher rates of intensive care unit admission and mechanical ventilation. Although 73% had underlying conditions, the vast majority (80%) did not qualify for RSV immunoprophylaxis. <h3>Conclusion</h3> Nosocomial RSV infection is a significant cause of morbidity among hospitalised infants, especially those with comorbidities and lengthy hospital stay, and is associated with a complicated clinical course. In addition to strict infection-control measures, extending palivizumab prophylaxis to additional selected high-risk populations should be considered.