Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997-2012

Respiratory syncytial virus (RSV) causes significant pediatric morbidity and is the most common cause of bronchiolitis. Bronchiolitis hospitalizations declined among US infants from 2000‒2009; however, rates in infants at high risk for RSV have not been described. This study examined RSV and unspeci...

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Bibliographic Details
Published in:PloS one 2016-04, Vol.11 (4), p.e0152208
Main Authors: Doucette, Abigail, Jiang, Xiaohui, Fryzek, Jon, Coalson, Jenna, McLaurin, Kimmie, Ambrose, Christopher S
Format: Article
Language:English
Subjects:
Analysis
Biology and Life Sciences
Births
Bronchiolitis
Bronchiolitis - epidemiology
Bronchiolitis - therapy
Bronchopneumonia
Cardiovascular disease
Child health
Codes
Congenital diseases
Coronary artery disease
Databases, Factual
Down syndrome
Down's syndrome
Emergency medical care
Female
Health aspects
Health risks
Heart diseases
Hospitalization
Hospitalization - statistics & numerical data
Hospitals
Humans
Immunodeficiency
Immunoprophylaxis
Infant
Infants
Infections
Laboratories
Lung diseases
Male
Mechanical ventilation
Medicine and Health Sciences
Morbidity
Mortality
Pediatrics
People and Places
Pneumonia
Respiratory syncytial virus
Respiratory Syncytial Virus Infections - epidemiology
Respiratory Syncytial Virus Infections - therapy
Respiratory tract
Respiratory tract diseases
Risk
Risk factors
Risk groups
Statistical analysis
Statistics
Surgery
Systematic review
Trends
United States - epidemiology
Ventilation
Viruses
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Summary:Respiratory syncytial virus (RSV) causes significant pediatric morbidity and is the most common cause of bronchiolitis. Bronchiolitis hospitalizations declined among US infants from 2000‒2009; however, rates in infants at high risk for RSV have not been described. This study examined RSV and unspecified bronchiolitis (UB) hospitalization rates from 1997‒2012 among US high-risk infants. The Kids' Inpatient Database (KID) infant annual RSV (ICD-9 079.6, 466.11, 480.1) and UB (ICD-9 466.19, 466.1) hospitalization rates were estimated using weighted counts. Denominators were based on birth hospitalizations with conditions associated with high-risk for RSV: chronic perinatal respiratory disease (chronic lung disease [CLD]); congenital airway anomalies (CAA); congenital heart disease (CHD); Down syndrome (DS); and other genetic, metabolic, musculoskeletal, and immunodeficiency conditions. Preterm infants could not be identified. Hospitalizations were characterized by mechanical ventilation, inpatient mortality, length of stay, and total cost (2015$). Poisson and linear regression were used to test statistical significance of trends. RSV and UB hospitalization rates were substantially elevated for infants with higher-risk CHD, CLD, CAA and DS without CHD compared with all infants. RSV rates declined by 47.0% in CLD and 49.7% in higher-risk CHD infants; no other declines in high-risk groups were observed. UB rates increased in all high-risk groups except for a 22.5% decrease among higher-risk CHD. Among high-risk infants, mechanical ventilation increased through 2012 to 20.4% and 13.5% of RSV and UB hospitalizations; geometric mean cost increased to $31,742 and $25,962, respectively, and RSV mortality declined to 0.9%. Among high-risk infants between 1997 and 2012, RSV hospitalization rates declined among CLD and higher-risk CHD infants, coincident with widespread RSV immunoprophylaxis use in these populations. UB hospitalization rates increased in all high-risk groups except higher-risk CHD, suggesting improvement in the health status of higher-risk CHD infants, potentially due to enhanced surgical interventions. Mechanical ventilation use and RSV and UB hospitalization costs increased while RSV mortality declined.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0152208