Hospitalizations Due to Bronchiolitis in Chronic Patients in The Era of RSV Immunoprophylaxis- A Pilot Study

Background: Bronchiolitis is the most common respiratory disorder causing hospitalization in infants; respiratory syncytial virus (RSV) is the primary culprit. In Israel, RSV prophylaxis is indicated for preterm infants and for certain chronic heart or lung diseases.

Aim: To evaluate hospitalizations due to bronchiolitis in children with chronic diseases compared to healthy children.

Methods: A retrospective analysis of patients

Results: Out of 1124 hospitalizations due to RSV bronchiolitis during the study period, 244 (22%) were children with chronic diseases. Although 20 (1.8%) were indicated for RSV prophylaxis, only 8 were vaccinated (6 of whom with chronic diseases). Length of hospitalization was longer in children with chronic diseases comparted to healthy children (median 4 days (3-7) vs. 3 days (2-5), p<0.001). Rate of re-admissions was significantly higher (5.6% vs. 0.9%, p<0.001) as well as PICU admissions (9% vs. 4.5%, p=0.007). Out of 21 hospitalized children with Down’s syndrome (1.9% of all admissions), 5 were in PICU – 8% (5/62) of PICU admissions. Respiratory tract malformations were present in 2% (23) of admissions, 3 of them were transferred to ICU.

Conclusion: Children with chronic diseases admitted with RSV bronchiolitis are prone to longer hospitalization and ICU admission. Children with Down’s syndrome or respiratory tract malformations might benefit from RSV prophylaxis.