The Full Burden of RSV-related Pediatric Intensive Care Unit Admissions During Infancy: A Prospective National Study (BRICK Study)

Background: Worldwide, respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections during infancy. Approximately 5% of hospitalized infants require pediatric intensive care unit (PICU) admission. Our objective was to capture a complete overview of the PICU admission, including the yet unseen burden, to understand the full clinical impact of new preventive interventions. Methods: A nationwide, prospective, observational, multicenter study was performed in the Netherlands. Patients included infants <12 months with laboratory-confirmed RSV-related PICU admission. Collected data were clinical characteristics, unwanted and detrimental events during admission and parental signs of post-traumatic stress disorder (PTSD) after admission. Results: Of 423 patients, most were term born (n=335, 79.2%) and had no comorbidities (n=292, 69.0%). Median age was 46 (interquartile range, 25.0-89.0) days. Invasive mechanical ventilation was used in 258 (61.1%) patients. In total, 51 unwanted events were observed in 48 (11.3%) patients. Events occurred more frequently in patients receiving invasive mechanical ventilation compared to patients receiving other types of respiratory support (91.9% versus 52.4%; P < 0.001). Three (0.7%) patients died, all with severe comorbidities. Follow-up showed signs of PTSD in 35/120 (29.2%) of the parents. Conclusions: The burden of severe RSV disease is broader than the PICU admission alone. During admission, 11% of infants experienced unwanted, detrimental events, and one-third of parents showed signs or symptoms of PTSD. Because 75% of infants were <3 months of age, the introduction of RSV immunization into the Dutch immunization program could have the potential to significantly decrease this yet unseen RSV burden too.