Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 26 , ISSUE 11 ( November, 2022 ) > List of Articles

Pediatric Critical Care

Clinico-demographic Profile and Predictors of Intensive Care Need in Children with Respiratory Syncytial Virus-associated Acute Lower Respiratory Illness during Its Recent Outbreak alongside Ongoing COVID-19 Pandemic: An Eastern Indian Perspective

Arindam Ghosh, Saba Annigeri, Sunil Kumar Hemram, Pranab Kumar Dey, Sangita Mazumder

Keywords : Children, Coronavirus disease-2019, Eastern India, Pediatric intensive care unit, Predictors, Respiratory syncytial virus

Citation Information : Ghosh A, Annigeri S, Hemram SK, Dey PK, Mazumder S. Clinico-demographic Profile and Predictors of Intensive Care Need in Children with Respiratory Syncytial Virus-associated Acute Lower Respiratory Illness during Its Recent Outbreak alongside Ongoing COVID-19 Pandemic: An Eastern Indian Perspective. Indian J Crit Care Med 2022; 26 (11):1210-1217.

DOI: 10.5005/jp-journals-10071-24350

License: CC BY-NC 4.0

Published Online: 31-10-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Introduction: The objective was to delineate the clinico–epidemiological characteristics of hospitalized children with respiratory syncytial virus (RSV)-associated acute lower respiratory tract infection (RSV-ALRI) during its recent outbreak and to find out the independent predictors of pediatric intensive care unit (PICU) admission. Materials and methods: Children aged between 1 month and 12 years who tested positive for RSV were included. Multivariate analysis was performed to identify the independent predictors and predictive scores were developed from the β-coefficients. Receiver operating characteristic curve (ROC) was generated and the area under the curve (AUC) was calculated to assess the overall precision. The performance of sum scores in predicting PICU need, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR+ and LR) were calculated for each cutoff value. Results: The proportion of RSV positivity was 72.58%. A total of 127 children were included with a median [interquartile range (IQR)] age of 6 (2–12) months, of whom 61.42% were males and 33.07% had underlying comorbidity. Tachypnea, cough, rhinorrhea, and fever were predominant clinical presentations while hypoxia and extrapulmonary manifestations were present in 30.71% and 14.96% of children, respectively. About 30% required PICU admission, and 24.41% developed complications. Premature birth, age below 1 year, presence of underlying CHD, and hypoxia were independent predictors. The AUC [95% confidence interval (CI)] was 0.869 (0.843−0.935). Sum score below 4 had 97.3% sensitivity and 97.1% NPV whereas sum score above 6 had 98.9% specificity, 89.7% PPV, 81.3% NPV, 46.2 LR+, and 0.83 LR to predict PICU needs. Conclusion: Awareness of these independent predictors and application of the novel scoring system will be beneficial for busy clinicians in planning the level of care needed, thereby optimizing PICU resource utilization.

PDF Share
  1. Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: A systematic review and meta-analysis. Lancet 2010;375(9725):1545–1555. DOI:10.1016/S0140-6736(10)60206-1.
  2. Britton PN, Hu N, Saravanos G, Shrapnel J, Davis J, Snelling T, et al. COVID-19 public health measures and respiratory syncytial virus. Lancet Child Adolesc Health 2020;4(11):e42–e43. DOI: 10.1016/S2352-4642(20)30307-2.
  3. Wagatsuma K, Koolhof IS, Shobugawa Y, Saito R. Decreased human respiratory syncytial virus activity during the COVID-19 pandemic in Japan: An ecological time-series analysis. BMC Infect Dis 2021;21(1):734. DOI: 10.1186/s12879-021-06461-5.
  4. Ujiie M, Tsuzuki S, Nakamoto T, Iwamoto N, et al. Resurgence of respiratory syncytial virus infections during COVID-19 pandemic, Tokyo, Japan. Emerg Infect Dis 2021;27(11):2969–2970. DOI:10.3201/eid2711.211565.
  5. Agha R, Avner JR. Delayed seasonal RSV surge observed during the COVID-19 pandemic. Pediatrics 2021;148(3):e2021052089. DOI: 10.1542/peds.2021-052089.
  6. Government of West Bengal. Increased incidence of ARI/ILI in paediatric age group. Surveillance guidelines. Available at: Assessed on: 14 October 2021.
  7. Fitzner J, Qasmieh S, Mounts AW, Alexander B, Besselaar T, Briand S, et al. Revision of clinical case definitions: Influenza-like illness and severe acute respiratory infection. Bull World Health Organ 2018;96(2):122–128. DOI: 10.2471/BLT.17.194514.
  8. Wang JN, Wu JM, Chen YJ. Validity of the updated pediatric risk of mortality score (PRISM III) in predicting the probability of mortality in a pediatric intensive care unit. Acta Paediatr Taiwan 2001;42(6): 333–337. PMID: 11811220.
  9. Matics TJ, Sanchez–Pinto LN. Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the sepsis-3 definitions in critically ill Children. JAMA Pediatr 2017;171(10):e172352. DOI: 10.1001/jamapediatrics.2017.2352.
  10. Khilnani P, Ramachandran B, Shaikh F, Sharma R, Sachdev A, Deopujari S, et al. Consensus guidelines for pediatric intensive care units in India, 2020. Indian Pediatr 2020;57(11):1049–1054. DOI: 10.1007/s13312-020-2034-0.
  11. Taylor A, Whittaker E. The changing epidemiology of respiratory viruses in children during the COVID-19 pandemic: A canary in a COVID time. Pediatr Infect Dis J 2022;41(2):e46–e48. DOI: 10.1097/INF.0000000000003396.
  12. Fricke LM, Glöckner S, Dreier M, Lange B. Impact of non-pharmaceutical interventions targeted at COVID-19 pandemic on influenza burden: A systematic review. J Infect 2021;82(1):1–35. DOI: 10.1016/j.jinf.2020.11.039.
  13. Cohen R, Ashman M, Taha MK, Varon E, Angoulvant F, Levy C, et al. Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap? Infect Dis Now 2021;51(5):418–423. DOI: 10.1016/j.idnow.2021.05.004.
  14. Ghia C, Rambhad G. Disease burden due to respiratory syncytial virus in Indian pediatric population: A literature review. Clin Med Insights Pediatr 2021;15:11795565211029250. DOI: 10.1177/11795565 211029250.
  15. Singh C, Angurana SK, Bora I, Jain N, Kaur K, Sarkar S. Clinico demographic profiling of the respiratory syncytial virus (RSV) infected children admitted in tertiary care hospital in North India. J Family Med Prim Care 2021;10(5):1975–1580. DOI: 10.4103/jfmpc.jfmpc_2406_20.
  16. Broor S, Parveen S, Maheshwari M. Respiratory syncytial virus infections in India: Epidemiology and need for vaccine. Indian J Med Microbiol 2018;36(4):458–464. DOI: 10.4103/ijmm.IJMM_19_5.
  17. Eisenhut M. Extrapulmonary manifestations of severe respiratory syncytial virus infection: A systematic review. Crit Care 2006;10(4):R107. DOI: 10.1186/cc4984.
  18. Zhang Q, Guo Z, Langley JM, Bai Z. Respiratory syncytial virus-associated intensive care unit admission in children in Southern China. BMC Res Notes 2013;6:447. DOI: 10.1186/1756-0500-6-447.
  19. Bem RA, Bont LJ, van Woensel JBM. Life-threatening bronchiolitis in children: Eight decades of critical care. Lancet Respir Med 2020;8(2):142–144. DOI: 10.1016/S2213-2600(19)30445-X.
  20. Vásquez–Hoyos P, Diaz–Rubio F, Monteverde–Fernandez N, Jaramillo–Bustamante JC, Carvajal C, Serra A, et al. Reduced PICU respiratory admissions during COVID-19. Arch Dis Child 2020; archdischild-2020-320469. DOI: 10.1136/archdischild-2020-320469. Online ahead of print.
  21. Hatter L, Eathorne A, Hills T, Bruce P, Beasley R. Respiratory syncytial virus: paying the immunity debt with interest. Lancet Child Adolesc Health 2021;5(12):e44–e45. DOI: 10.1016/S2352-4642(21)00333-3.
  22. Saravanos GL, King CL, Deng L, Deng L, Dinsmore N, Ramos I, et al. Respiratory syncytial virus-associated neurologic complications in children: A systematic review and aggregated case Series. J Pediatr 2021;239:39–49.e9. DOI: 10.1016/j.jpeds.2021.06.045.
  23. Checchia PA, Appel HJ, Kahn S, Smith FA, Shulman ST, Pahl E, et al. Myocardial injury in children with respiratory syncytial virus infection. Pediatr Crit Care Med 2000;1(2):146–150. DOI: 10.1097/00130478-200010000-00010.
  24. Bohmwald K, Espinoza JA, Rey–Jurado E, Gómez RS, González PA, Bueno SM, et al. Human respiratory syncytial virus: Infection and pathology. Semin Respir Crit Care Med 2016;37(4):522–537. DOI: 10.1055/s-0036-1584799.
  25. Shi T, Vennard S, Mahdy S, Nair H. Risk factors for RSV associated acute lower respiratory infection and mortality in young children: A systematic review and meta-analysis. J Infect Dis 2021;226 (Suppl. 1):jiaa751. DOI: 10.1093/infdis/jiaa751.
  26. Rodriguez DA, Rodriguez–Martinez CE, Cardenas AC, Quilaguy IE, Mayorga LY, Falla LM, et al. Predictors of severity and mortality in children hospitalized with respiratory syncytial virus infection in a tropical region. Pediatr Pulmonol 2014;49(3):269–276. DOI: 10.1002/ppul.22781.
  27. Scheltema NM, Gentile A, Lucion F, Nokes DJ, Munywoki PK, Madhi SA, et al. Global respiratory syncytial virus-associated mortality in young children (RSV GOLD): A retrospective case series. Lancet Global Health 2017;5(10):e984–e991. DOI: 10.1016/S2214-109X(17)30344-3.
  28. Chaw PS, Wong SWL, Cunningham S, Campbell H, Mikolajczyk R, Nair H, et al. Acute lower respiratory infections associated with respiratory syncytial virus in children with underlying congenital heart disease: Systematic review and meta-analysis. J Infect Dis 2020;222(Suppl. 7):S613–S619. DOI: 10.1093/infdis/jiz150.
  29. Garegnani L, Styrmisdóttir L, Roson Rodriguez PR, Liquitay CME, Esteban I, Franco JV. Palivizumab for preventing severe respiratory syncytial virus (RSV) infection in children. Cochrane Database Syst Rev 2021;11(11):CD013757. DOI: 10.1002/14651858.CD013757.pub2.
  30. Salah ET, Algasim SH, Mhamoud AS, Husian NEOSA. Prevalence of hypoxemia in under-five children with pneumonia in an emergency pediatrics hospital in Sudan. Indian J Crit Care Med 2015;19(4): 203–207. DOI: 10.4103/0972-5229.154549.
  31. Subhi R, Adamson M, Campbell H, Weber M, Smith K, Duke T, et al. The prevalence of hypoxaemia among ill children in developing countries: A systematic review. Lancet Infect Dis 2009;9(4):219–227. DOI: 10.1016/S1473-3099(09)70071-4.
  32. Piedimonte G, Perez MK. Respiratory syncytial virus infection and bronchiolitis. Pediatr Rev 2014;35(12):519–530. DOI: 10.1542/pir.35-12-519.
  33. Pongpan S, Wisitwong A, Tawichasri C, Patumanond J, Namwongprom S. Development of dengue infection severity score. ISRN Pediatr 2013;2013:845876. DOI: 10.1155/2013/845876.
  34. Sriwongpan P, Krittigamas P, Tantipong H, Patumanond J, Tawichasri C, Namwongprom S. Clinical risk-scoring algorithm to forecast scrub typhus severity. Risk Manag Healthc Policy 2013;7:11–17. DOI: 10.2147/RMHP.S55305.
  35. Gunalan A, Sistla S, Sastry AS, Venkateswaran R. Concordance between the National Healthcare Safety Network (NHSN) surveillance criteria and clinical pulmonary infection score (CPIS) criteria for diagnosis of ventilator-associated pneumonia (VAP). Indian J Crit Care Med 2021;25(3):296–298. DOI:10.5005/jp-journals-10071-23753.
  36. Altschul DJ, Unda SR, Benton J, Ramos RDLG, Cezayirli P, Mehler M, et al. A novel severity score to predict inpatient mortality in COVID-19 patients. Sci Rep 2020;10(1):16726. DOI: 10.1038/s41598-020-73962-9.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.