RSV Bronchiolitis Research Articles

Parental Socioeconomic Status and an Infant’s Risk of Hospital Admission for RSV

Abstract Background While clinical risk factors for RSV bronchiolitis are well established, data on socioeconomic risk factors is lacking. We explored the association of parental education, income, and employment status on an infant’s risk of hospitalization for RSV bronchiolitis. Methods This population-based retrospective case-control study covered all RSV-related hospital admissions of under 1-year old children in Finland between 2004 and 2018. Controls were matched by month and year of birth, sex, province of residence, and family size. Registry data were linked using unique personal identity codes. Cases and controls were compared using adjusted odds-ratios (aOR) calculated for socioeconomic outcomes including maternal and paternal education, household income, and parental employment. Results A total of 10 767 infants and 50 054 controls were included in the study. Lower parental education significantly raised the risk for RSV hospital admission in infants, the risk growing with decreasing education levels; aOR 1.03 (0.96-1.09) with post-secondary education, 1.12 (1.05-1.2) with secondary education, and 1.33 (1.2-1.47) with primary education. Combined parental income was not significant: aOR 0.97 (CI 0.91-1.05), 1.02 (CI 0.95-1.1), 1(CI 0.92-1.08) and 0.94 (CI 0.85-1.04), respectively with decreasing income level. Unemployment of both parents seemed to be a risk factor for the child’s RSV hospital admission, aOR 1.24 (1.12-1.38). Conclusions Lower parental socioeconomic status may increase the risk of an infant’s RSV hospitalization. Socioeconomic risk factors should be considered when designing RSV infection primary prevention strategies.

Nasal microRNA signatures for disease severity in infants with respiratory syncytial virus bronchiolitis: a multicentre prospective study

BackgroundRespiratory syncytial virus (RSV) bronchiolitis contributes to a large morbidity and mortality burden globally. While emerging evidence suggests that airway microRNA (miRNA) is involved in the pathobiology of RSV infection,...

Nirsevimab and Hospitalization for RSV Bronchiolitis

BackgroundRespiratory syncytial virus (RSV) is the leading cause of bronchiolitis, resulting in 3 million hospitalizations each year worldwide. Nirsevimab is a monoclonal antibody against RSV that has an extended half-life. Its postlicensure real-world effectiveness against RSV-associated bronchiolitis is unclear.MethodsWe conducted a prospective, multicenter, matched case–control study to analyze the effectiveness of nirsevimab therapy against hospitalization for RSV-associated bronchiolitis in infants younger than 12 months of age. Case patients were infants younger than 12 months of age who were hospitalized for RSV-associated bronchiolitis between October 15 and December 10, 2023. Control patients were infants with clinical visits to the same hospitals for conditions unrelated to RSV infection. Case patients were matched to control patients in a 2:1 ratio on the basis of age, date of hospital visit, and study center. We calculated the effectiveness of nirsevimab therapy against hospitalization for RSV-associated bronchiolitis (primary outcome) by means of a multivariate conditional logistic-regression model with adjustment for confounders. Several sensitivity analyses were performed.ResultsThe study included 1035 infants, of whom 690 were case patients (median age, 3.1 months; interquartile range, 1.8 to 5.3) and 345 were matched control patients (median age, 3.4 months; interquartile range, 1.6 to 5.6). Overall, 60 case patients (8.7%) and 97 control patients (28.1%) had received nirsevimab previously. The estimated adjusted effectiveness of nirsevimab therapy against hospitalization for RSV-associated bronchiolitis was 83.0% (95% confidence interval [CI], 73.4 to 89.2). Sensitivity analyses gave results similar to those of the primary analysis. The effectiveness of nirsevimab therapy against RSV-associated bronchiolitis resulting in critical care was 69.6% (95% CI, 42.9 to 83.8) (27 of 193 case patients [14.0%] vs. 47 of 146 matched control patients [32.2%]) and against RSV-associated bronchiolitis resulting in ventilatory support was 67.2% (95% CI, 38.6 to 82.5) (27 of 189 case patients [14.3%] vs. 46 of 151 matched control patients [30.5%]).ConclusionsIn a real-world setting, nirsevimab therapy was effective in reducing the risk of hospitalized RSV-associated bronchiolitis. (Funded by the National Agency for AIDS Research–Emerging Infectious Disease and others; ENVIE ClinicalTrials.gov number, NCT06030505.)

Potential impact of nirsevimab and bivalent maternal vaccine against RSV bronchiolitis in infants: A population-based modelling study

BackgroundA new monoclonal antibody (nirsevimab; Beyfortus®) and a bivalent prefusion RSV vaccine (Abrysvo®) for maternal immunization have been approved recently. This is a modelling study to estimate the potential impact of different immunization programs with these products on RSV-bronchiolitis. MethodsPopulation-based real-world data from primary care and hospitalizations were considered. RSV bronchiolitis dynamics in absence of these immunization scenarios were explained by a multivariate age-structured Bayesian model. Then, the potential impact was simulated under different assumptions including the most recent clinical trial data. Differences in endpoints, populations, and timeframes between trials make the two products’ efficacy difficult to compare. ResultsA seasonal with catch-up program, assuming a constant effectiveness of 79.5 % during the first 5 months followed by a linear decay to 0 by month 10 with nirsevimab, would prevent between 5121 and 8846 RSV bronchiolitis per 100,000 infants-years. Assuming 77.3 % effectiveness with the same decay, between 976 and 1686 RSV-hospitalizations per 100,000 infants-years could be prevented depending on the uptake. A year-round maternal immunization program, with 51 % of effectiveness during the first 6 months followed by a linear decay to 0 by month 10 would prevent between 3246 and 5606 RSV bronchiolitis cases per 100,000 infants-years. Assuming 56.9 % effectiveness with the same decay, between 713 and 1231 RSV-hospitalizations per 100,000 infants-years could be prevented. ConclusionsOur results suggest that each strategy would effectively reduce RSV-bronchiolitis.

Impact of universal immunization program with monoclonal antibody nirsevimab on reducing the burden of serious bronchiolitis that need pediatric intensive care.

Nirsevimab appears to have an important impact on reducing the number and length of stay of PICU admissions due to RSV bronchiolitis. • Bronchiolitis is the mostcommon viral infection of the lower respiratory tract in infants. • It represents 13% of the total pediatric intensive care admissions, typically during winter. This is one of the causes that produces a collapse in the health care systems all around the world. • In October 2023, universal immunization with monoclonal antibody nirsevimab of all children under 6 months of age was started in the majority of autonomous communities in Spain. • Recent publications from the nirsevimab clinical trials have evidenced a high RSV protective effect, but data on its effect on real life patients who require pediatric intensive care unit admission are missing.

Bronchiolitis in Infants and Children before the Surge of COVID-19: Predictors of Outcome and Length of Stay

Background:: Despite the available clinical practice guidelines, many management decisions in bronchiolitis are made subjectively, resulting in variable length of stay and unplanned ICU admissions. We hypothesized that certain independent predictors would affect the length of stay (LOS) and care escalation. Objectives:: To identify predictors for increased LOS and ICU admissions in acute bronchiolitis. Methods:: We conducted a retrospective descriptive cohort study involving 589 children admitted to MZH with acute bronchiolitis in 2 years. Predictors evaluated were age, gender, family history of asthma, prematurity, fever, hypoxemia, comorbidities, RSV, and medications (salbutamol, steroids, and antibiotics). Results:: Acute bronchiolitis comprised 8.75% of Pediatric admissions and 2.9% of total hospital admissions. The mean age is 8.28±6.1(2-30 months); 83% were infants, 39.2% were girls, 15% were preterm, and 25.1% had a family history of asthma. Despite 84.9% having X-rays, significant findings were present in 21.3%. RSV positive 22.5%. The mean LOS was 3.6±1.6(1-11 days). Age less than 2 months(P=0.029 OR=1.8, CI1.1 - 3.3), family history of asthma (P=0.03 OR=1.8, CI1.14 - 2.9), hypoxemia on admission (P<0.001 OR=3, CI1.8 - 4.9), presence of comorbidity (P=0.012), and significant radiographic findings (P<0.002, OR=2.7, CI1.6 - 4.6) were predictors of longer LOS. Prematurity (P<0.001, OR 8.8, CI 2.7-28.4), RSV bronchiolitis (P<0.002, OR=3.02, CI=1.5 – 6.03), and hypoxemia on admission (P< 0.042 OR=4.6, CI1.1 - 14.9) are qualified as independent predictors for escalated care. Conclusion(s):: RSV bronchiolitis, especially in preterm infants, may prompt a low threshold for admission and escalate the care. Evidence-based treatments, respiratory support, and treatment of comorbidities help to achieve optimal LOS.

Inpatient Rsv-Management 2016-2022: Epidemiology and Adherence to A Bronchiolitis Treatment Standard at a German University Children's Hospital.

This study analyzes the RSV season 2021/2022 in a referral children's hospital, compares the epidemiology and illness severity with RSV-infected inpatients from 2016 to 2020 and audits the adherence to our internal therapy standard for RSV bronchiolitis. Inpatients with rtPCR-confirmed RSV infection (Jan. 2016 to Jan. 2022). The audit comprises 306 RSV inpatients, on average 50 hospitalizations per year; in 03/2020, a rapid RSV Season-Offset was observed. In the winter season 2020/2021, no patient with RSV was hospitalized. Beginning in July, we noticed a rapid increase of RSV-admissions (most cases in Sept./Oct, duration until Dec. 2021; n=53). In 2021-2022, a significant larger share needed PICU admission (9.4% vs 3.2%, p=0.040). Adherence to the internal guidance was low; only 11.8% (n=36) of all patients received supportive treatment without inhalative or systemic medications, 37% of all patients received antibiotics. This audit confirms the strong impact of public preventive measures directed against SARS-CoV-2 transmission on RSV epidemiology. Few weeks after easing public COVID-19 restrictions (summer 2021), RSV inpatient cases rapidly increased, lasting until Dec. 2021. The audit of bronchiolitis management revealed surprisingly low adherence to the internal guidance, despite a face-to-face educational session with the attending pediatricians in Oct. 2021. Low adherence resulted in an unnecessary exposure of RSV patients to systemic medications of questionable benefit including antibiotics.

Neutrophil responses to RSV infection show differences between infant and adult neutrophils

IntroductionRespiratory syncytial virus (RSV) causes a severe respiratory condition, bronchiolitis, in infants but not in adults. Bronchiolitis is characterised by neutrophilic infiltration in the airways, but whether neutrophils enhance recovery...

Nirsevimab (Beyfortus®) in the prevention of RSV bronchiolitis

Depuis le 15 septembre 2023, le Beyfortus® est disponible et remboursé en France dans l’indication « prévention des infections des voies respiratoires inférieures dues au virus respiratoire syncytial (VRS) chez les nouveau-nés et les nourrissons au cours de leur première saison de circulation du VRS ». Cette indication repose sur trois essais randomisés en double insu (avec des objectifs distincts) ayant inclus des populations de nourrissons exposés à des niveaux de risque de forme grave très hétérogènes. L’efficacité de ce médicament préventif est bien démontrée sur le critère « apparition d’une bronchiolite à VRS » survenant dans les 5 mois post-traitement. Pour des raisons méthodologiques et biostatistiques, la démonstration est scientifiquement moins bien établie sur le critère « hospitalisation pour infection respiratoire basse due au VRS », même si elle est probable. En termes de sécurité d’emploi, il reste à vérifier que l’utilisation possiblement massive de cet anticorps monoclonal ne provoque pas de mutation virale susceptible de rendre ce médicament inefficace. La disponibilité de Beyfortus® pour les sujets à bas risque (de très loin les plus nombreux) apporte un bénéfice pertinent pour les nourrissons, leurs parents souvent effrayés devant les symptômes de leur enfant, et probablement pour le système de soins.

Clinical relevance of viral codetection in infants with respiratory syncytial virus bronchiolitis

IntroductionRespiratory syncytial virus (RSV) is the main cause of severe bronchiolitis, especially in infants. The aim of this study is to assess whether codetection of RSV and other respiratory viruses could affect the severity of this infection comparing with unique RSV detection. MethodsA prospective study from 2016 to 2019 including children under 2 years who were admitted in the Emergency Service of the Hospital Universitari Arnau de Vilanova de Lleida (Spain) was performed. Nasopharyngeal samples from all patients were sent to the laboratory for RSV real-time PCR detection (GeneXpert®). A multiplex PCR that detects other respiratory viruses was done in all RSV-positive samples. Patients’medical records were checked to collect clinical data (hospital length of stay, BROSJOD score, ICU admission, need for ventilatory support or transfer to a reference hospital). Patients were divided in two groups: infants with unique RSV detection and infants with viral codetection. Bivariant analyses were performed to analyze the data obtained. ResultsDuring the period of study 437 RSV bronchiolitis were diagnosed. In 199 of them (177/437; 45,5%) another respiratory virus was detected concomitantly. Bivariant analyses do not show statistically significant differences between both groups. ConclusionsViral codetection in infants with RSV bronchiolitis is frequent. However, it does not seems to affect the severity of this infection.

Relevancia clínica de la codetección viral en lactantes con bronquiolitis por virus respiratorio sincitial

IntroductionRespiratory syncytial virus (RSV) is the main cause of severe bronchiolitis, especially in infants. The aim of this study is to assess whether codetection of RSV and other respiratory viruses could affect the severity of this infection comparing with unique RSV detection. MethodsA prospective study from 2016 to 2019 including children under 2 years who were admitted in the Emergency Service of the Hospital Universitari Arnau de Vilanova de Lleida (Spain) was performed. Nasopharyngeal samples from all patients were sent to the laboratory for RSV real-time PCR detection (GeneXpert®). A multiplex PCR that detects other respiratory viruses was done in all RSV-positive samples. Patients’ medical records were checked to collect clinical data (hospital length of stay, BROSJOD score, ICU admission, need for ventilatory support or transfer to a reference hospital). Patients were divided in 2 groups: infants with unique RSV detection and infants with viral codetection. Bivariant analyses were performed to analyze the data obtained. ResultsDuring the period of study 437 RSV bronchiolitis were diagnosed. In 199 of them (177/437; 45.5%) another respiratory virus was detected concomitantly. Bivariant analyses do not show statistically significant differences between both groups. ConclusionsViral codetection in infants with RSV bronchiolitis is frequent. However, it does not seems to affect the severity of this infection.

374 - An abnormal finding of lung blebs in an infant with RSV bronchiolitis

374 - An abnormal finding of lung blebs in an infant with RSV bronchiolitis

PEDIATRIC LEIGH SYNDROME: EVIDENCE OF IMMUNE DYSFUNCTION AND SUCCESSFUL TREATMENT WITH IMMUNOGLOBULIN REPLACEMENT

<h3>Introduction</h3> Leigh syndrome (LS) is a heterogenous, progressive neurodegenerative mitochondrial disorder (MD). Genetic mutations of electron transport chain complex subunits result in defective oxidative phosphorylation and impaired ATP production. Energy deprivation during periods of increased energy consumption (e.g. illness, infection) can trigger disease progression and death. Recent work recognizes immunodeficiency as a new phenotype of MD. Immune dysfunction has not been established as a clinical feature of LS. We propose LS features immune dysfunction with clinical response to immunoglobulin replacement through a case series of six LS patients with recurrent SIRS/infections and complete immunologic phenotyping. <h3>Case Description</h3> Our case series includes six patients (9-17yo) with early onset LS. Symptoms developed 3d-12mo of life – developmental delay, hypotonia, feeding difficulties, multisystemic effects. Patients presented to a tertiary academic medical center with recurrent infections including viral airway infections, RSV bronchiolitis, otitis media, and sepsis. An immunologic workup was notable for deficient vaccine response to polysaccharide antigens, decreased class-switched B cells and memory T cells (CD45RO⁺) in all 6 patients. Immunoglobulin therapy was initiated – after replacement, 4 out of 6 patients experienced decreased infections (hospitalizations/year reduced by 53-89%). <h3>Discussion</h3> Immunodeficiency is a feature of LS. Our case series demonstrated clinical and laboratory evidence of immune dysfunction with specific antibody deficiency phenotype and low class-switched B cells & memory T cells. Evaluation should include complete immunologic workup. LS survival is poor – infection is a main cause of death in ∼20% LS patients. Immunoglobulin replacement in LS may improve outcomes and decrease morbidity/mortality.

Cilia-related gene signature in the nasal mucosa correlates with disease severity and outcomes in critical respiratory syncytial virus bronchiolitis.

BackgroundRespiratory syncytial virus (RSV) can cause life-threatening respiratory failure in infants. We sought to characterize the local host response to RSV infection in the nasal mucosa of infants with critical bronchiolitis and to identify early admission gene signatures associated with clinical outcomes.MethodsNasal scrape biopsies were obtained from 33 infants admitted to the pediatric intensive care unit (PICU) with critical RSV bronchiolitis requiring non-invasive respiratory support (NIS) or invasive mechanical ventilation (IMV), and RNA sequencing (RNA-seq) was performed. Gene expression in participants who required shortened NIS (</= 3 days), prolonged NIS (> 3 days), and IMV was compared.FindingsIncreased expression of ciliated cell genes and estimated ciliated cell abundance, but not immune cell abundance, positively correlated with duration of hospitalization in infants with critical bronchiolitis. A ciliated cell signature characterized infants who required NIS for > 3 days while a basal cell signature was present in infants who required NIS for </= 3 days, despite both groups requiring an equal degree of respiratory support at the time of sampling. Infants who required invasive mechanical ventilation had increased expression of genes involved in neutrophil activation and cell death.InterpretationIncreased expression of cilia-related genes in clinically indistinguishable infants with critical RSV may differentiate between infants who will require prolonged hospitalization and infants who will recover quickly. Validation of these findings in a larger cohort is needed to determine whether a cilia-related gene signature can predict duration of illness in infants with critical bronchiolitis. The ability to identify which infants with critical RSV bronchiolitis may require prolonged hospitalization using non-invasive nasal samples would provide invaluable prognostic information to parents and medical providers.

Respiratory Syncytial Virus Burden and Healthcare Utilization in United States Infants

BackgroundRespiratory syncytial virus (RSV) is the leading cause of hospitalizations in United States infants aged <1 year, but research has focused on select populations.MethodsNational (Nationwide) Inpatient Sample and National Emergency Department (ED) Sample data (2011–2019) were used to report RSV hospitalization (RSVH), bronchiolitis hospitalization (BH), and ED visit counts, percentage of total hospitalizations/visits, and rates per 1000 live births along with inpatient mortality, mechanical ventilation (MV), and total charges (2020 US dollars).ResultsAverage annual RSVH and RSV ED visits were 56 927 (range, 43 845–66 155) and 131 999 (range, 89 809–177 680), respectively. RSVH rates remained constant over time (P = .5), whereas ED visit rates increased (P = .004). From 2011 through 2019, Medicaid infants had the highest average rates (RSVH: 22.3 [95% confidence interval {CI}, 21.5–23.1] per 1000; ED visits: 55.9 [95% CI, 52.4–59.4] per 1000) compared to infants with private or other/unknown insurance (RSVH: P < .0001; ED visits: P < .0001). From 2011 through 2019, for all races and ethnicities, Medicaid infants had higher average RSVH rates (up to 7 times) compared to infants with private or other/unknown insurance. RSVH mortality remained constant over time (P = .8), whereas MV use (2019: 13% of RSVH, P < .0001) and mean charge during hospitalization (2019: $21 513, P < .0001) increased. Bronchiolitis patterns were similar.ConclusionsThis study highlights the importance of ensuring access to RSV preventive measures for all infants.

Influenza vaccine administration in a paediatric intensive care unit.

We describe the clinical profile of children and outcomes of influenza immunisation for patients in a paediatric intensive care unit (PICU). Over two influenza seasons: 19/04/2018 to 07/08/2018 and 02/05/2019 to 10/10/2019, an immunisation nurse and PICU nurse coordinator met weekly and identified patients to receive the influenza vaccine. An inpatient list of PICU patients was screened for eligible patients: greater than 6 months of age, did not have imminent procedures (e.g. surgery) or were not critically unwell, as determined by the treating team, to receive the influenza vaccine. Patients were excluded if they had undergone surgery in the previous 24 hours or were being treated palliatively. Sixty patients in PICU were identified, with 43% (26/60) receiving the vaccine while in PICU and 17% (10/60) once discharged from PICU to the general ward environment. The majority of patients immunised were in PICU due to cardiac surgery/cardiology or general medical conditions, such as cerebral palsy or RSV bronchiolitis. There were no reported adverse events following immunisation. We have demonstrated the suitability and acceptability of children in the PICU receiving the seasonal influenza vaccine and tailored interventions to follow-up once discharged from PICU to optimise protection.

ONE LUNG LUCY: PEDIATRIC ARDS IN A CHILD WITH LUNG AGENESIS

TYPE: Case Report TOPIC: Critical Care INTRODUCTION: Pediatric acute respiratory distress syndrome (PARDS) is a relatively common clinical problem in the PICU. However, ARDS in a pediatric patient with one lung is unique and not well defined. We present such a case and highlight challenges in management. CASE PRESENTATION: Our patient is a 14month old girl who presented to the ER in acute hypoxemic respiratory failure secondary to RSV bronchiolitis. Her past medical history is significant for left lung agenesis and supracardiac total anomalous pulmonary venous return (surgically repaired). She was admitted to the PICU and subsequently developed severe ARDS, with peak OI of 28. Single lung protective strategy was initially applied with the use of lower tidal volumes of 5-6 ml/kg and a PEEP of 6. Inhaled NO was employed and she was subsequently placed on tidal volumes of 8ml/kg and PEEP of 8 with subsequent improved lung compliance. She was successfully extubated after 2 weeks of MV. DISCUSSION: The Pediatric Acute Lung Injury Consensus Conference (PALICC) developed pediatric-specific definitions for ARDS and recommendations regarding treatment. Recommendations regarding management of patients with one lung who develop ARDS are lacking. One lung ventilation is a standard approach to facilitate surgical exposure for pulmonary and other thoracic surgeries, however it is not known whether ventilation strategies suggested by the anesthesia literature is applicable to PARDS. CONCLUSIONS: Our case presented challenges in providing adequate ventilation and oxygenation while minimizing further lung injury in a patient with one lung PARDS. Further study is needed to elucidate the optimum mechanical ventilation strategy. DISCLOSURE: Nothing to declare. KEYWORD: One Lung ARDS

Epidemiology, Microbiology and Severity of Bronchiolitis in the First Post-Lockdown Cold Season in Three Different Geographical Areas in Italy: A Prospective, Observational Study.

The aim of this study was to understand the epidemiology, disease severity, and microbiology of bronchiolitis in Italy during the 2021–2022 cold season, outside of lockdowns. Before COVID-19, the usual bronchiolitis season in Italy would begin in November and end in April, peaking in February. We performed a prospective observational study in four referral pediatric centers located in different geographical areas in Italy (two in the north, one in the center and one in the south). From 1 July 2021 to 31 January 2022, we collected all new clinical diagnoses of bronchiolitis in children younger than two years of age recording demographic, clinical and microbiological data. A total of 657 children with a clinical diagnosis of bronchiolitis were enrolled; 56% children were admitted and 5.9% required PICU admission. The first cases were detected during the summer, peaking in November 2021 and declining into December 2021 with only a few cases detected in January 2022. RSV was the commonest etiological agent, while SARS-CoV-2 was rarely detected and only since the end of December 2021. Disease severity was similar in children with RSV vs. non-RSV bronchiolitis, and in those with a single infectious agent detected compared with children with co-infections. The 2021–2022 bronchiolitis season in Italy started and peaked earlier than the usual pre-pandemic seasons, but had a shorter duration. Importantly, the current bronchiolitis season was not more severe when data were compared with Italian published data, and SARS-CoV-2 was rarely a cause of bronchiolitis in children younger than 24 months of age.

IRIS: Infection with RespIratory Syncytial Virus in infants—a prospective observational cohort study

BackgroundRespiratory syncytial virus (RSV) is the most common cause of acute lower respiratory tract infection in infants. Globally, RSV is responsible for approximately 3.2 million hospital admissions and about 60,000 in-hospital deaths per year.MethodsInfection with RespIratory Syncytial Virus (IRIS) is an observational, multi-centre study enrolling infants with severe RSV infection and healthy controls. Inclusion criteria are age between 0 and 36 months and hospitalisation due to RSV infection at three German sites. Exclusion criteria are premature birth, congenital or acquired bronchopulmonary or cardiac diseases, and immunodeficiency. Healthy control probands are enrolled via recruitment of patients undergoing routine surgical procedures. Blood and respiratory specimens are collected upon admission, and RSV and other pathogens are analysed by multiplex polymerase chain reaction. Different biomaterials, including plasma, nasal lining fluid, blood cells, DNA, and RNA specimens, are sampled in a dedicated biobank. Detailed information on demographic characteristics and medical history is recorded, and comprehensive clinical data, including vital signs, medication, and interventions.DiscussionThe IRIS study aims to discover host and viral factors controlling RSV disease courses in infants. The approach including multi-omics characterisation in clinically well-characterized children with RSV bronchiolitis seeks to improve our understanding of the immune response against this virus. It may disclose novel diagnostic and treatment approaches for respiratory infections in infants.Trial registration: ClinicalTrials.gov, NCT04925310. Registered 01 October 2021—Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04925310?cond=NCT04925310&draw=2&rank=1

Changes in Ventilation Practices for Bronchiolitis in the Hospital Ward and Need for ICU Transfer over the Last Decade.

There is limited evidence of the potential benefits of the use of high-flow nasal cannula (HFNC) for the management of bronchiolitis in the ward. Our aim is to describe the ventilation trends for bronchiolitis in our hospital along with the introduction of an HFNC ward protocol and to determine the need for respiratory support escalation and transfer to an intensive care unit (ICU). A retrospective analytical observational study of children < 12 months old requiring admission for a first RSV bronchiolitis episode in a single centre from January 2009 to December 2018. The sample was divided into four groups according to the type of respiratory support that would ensure the clinical stability of the infants on admission. A total of 502 infants were recruited. The total number and percentage of patients admitted in the ward grew progressively over time. Simultaneously, there was an increase in HFNC and, paradoxically, an increase in ICU transfers. The risk of failure was higher for those who required HFNC or CPAP for clinical stabilisation in the first 12 h after admission. Moreover, the risk of failure was also higher in children with standard oxygen therapy promptly escalated to HFNC, especially if they had atelectasis/viral pneumonia, coinfections or a history of prematurity. Despite the limitations of a retrospective analysis, our study reflects usual clinical practice and no correlation was found between the usage of HFNC and a shorter length of hospital stay or less time spent on oxygen therapy.