Citations 2
Infants Admitted to US Intensive Care Units for RSV Infection During the 2022 Seasonal Peak
Halasa, Natasha , Zambrano, Laura D. , Stewart, Laura S , Newhams, Margaret M. , Levy, Emily R. , Carroll, Christopher L. , Fitzgerald, Julie C. , Bline, Katherine , Cullimore, Melissa L. , Loftis, Laura L. , Jeyapalan, Asumthia , Schwarz, Adam J. , Zinter, Matt S. , Irby, Katherine , Kuebler, Joseph D. , Babbitt, Christopher , Gaspers, Mary Glas , Nofziger, Ryan A. , Kong, Michele , Coates, Bria M. , Schuster, Jennifer E. , Gertz, Shira J. , Mack, Elizabeth H. , White, Benjamin R. , Harvey, Helen , Butler, Andrew , Bradford, Tamara T. , Rowan, Courtney M. , Staat, Mary Allen , Aguiar, Cassyanne L. , Randolph, Adrienne G. , Campbell, Angela P. , Investigators, RSV-PIC, Tomcany, Merry, Price, Heather E. , Sanders, Ronald C., Dixon, Lexie, Kücükak, Suden, McNamara, Elizabeth R, Chen, Sabrina R., Listerud, Eve, Vargas-Shiraishi, Ofelia, Oberle, Betty, Zorensky, Frances, Mansour, Rachel, Jumarang, Jaycee , Johnston, Marla , Bush, Jenny L., Dickey, Shawn, Sullivan, Melissa, Kietzman, Abigail , Colston, Candice , Murdock, Meghan, Kelley, Heather M., Wright-Sexton, Laura, Martin, Maygan, Malloch, Lacy , Patterson, Kayla, Sanders, Cameron , Rohlfs, Chelsea , Rice, Marilyn, Howard, Miranda, Murphy, M. Gail, Soma, Vijaya L, Job, Megan , Mennie, Colleen, Simkhada, Kamala, Drapeau, Noelle M., Hayek, Haya , Maranto, Molly, Waters, Aubrie, Flowers, Maggie, Havlin, Kevin , Furlong-Dillard, Jamie , Porter, Melissa , Nason, Jennifer, Ray, Madison, Gossett, Kristen, Crandall, Hillary , Heller, Evan G, Foley, Jennifer, Rasal, Rajashri, Marlow, Christine, Senthil, Anurithi, Myers, Kimberly, Tudor, Betsy, Garcia, Nereyda, Treister, Natalie, Sun, Kathleen, Villarreal-Chico, Denise, Kainaroi, Sophia, Levy, Emily R , Randolph, Adrienne G , Kong, Michele , Staat, Mary A , Gertz, Shira J , Bline, Katherine E , Amarin, Justin Z. , Shein, Steven L. , Michaels, Marian G , Montgomery, Vicki , Pannaraj, Pia S. , Cvijanovich, Natalie Z , Maddux, Aline B. , Bembea, Melania M. , Zerr, Danielle M. , Hobbs, Charlotte V. , Dapul, Heda , Wellnitz, Kari , Hymes, Saul , Investigators, RSV-PIC, Michelson, Kelly Nicole , Typpo, Katri , Harwayne‐Gidansky, Ilana , Bush, Jenny, Hill, Shannon, Kelley, Heather, Martin, Lora , Rice, Marilyn, Howard, Miranda, Murphy, Makayla, Ratner, Adam J. , Behl, Supriya , Betters, Kristina Ann , Maranto, Molly , Nason, Jennifer, Marlow, Christine, Myers, Kimberly, Adler, Amanda , Garcia, Nereyda, McQuillen, Patrick S. , Williams, John V.
JAMA Network Open | August 15, 2023 | Volume: 6 | Issue: 8 | Pages: e2328950
10.1001/jamanetworkopen.2023.28950
ImportanceRespiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections (LRTIs) and infant hospitalization worldwide.ObjectiveTo evaluate the characteristics and outcomes of RSV-related critical illness in US infants during peak 2022 RSV transmission.Design, Setting, and ParticipantsThis cross-sectional study used a public health prospective surveillance registry in 39 pediatric hospitals across 27 US states. Participants were infants admitted for 24 or more hours between October 17 and December 16, 2022, to a unit providing intensive care due to laboratory-confirmed RSV infection.ExposureRespiratory syncytial virus.Main Outcomes and MeasuresData were captured on demographics, clinical characteristics, signs and symptoms, laboratory values, severity measures, and clinical outcomes, including receipt of noninvasive respiratory support, invasive mechanical ventilation, vasopressors or extracorporeal membrane oxygenation, and death. Mixed-effects multivariable log-binomial regression models were used to assess associations between intubation status and demographic factors, gestational age, and underlying conditions, including hospital as a random effect to account for between-site heterogeneity.ResultsThe first 15 to 20 consecutive eligible infants from each site were included for a target sample size of 600. Among the 600 infants, the median (IQR) age was 2.6 (1.4-6.0) months; 361 (60.2%) were male, 169 (28.9%) were born prematurely, and 487 (81.2%) had no underlying medical conditions. Primary reasons for admission included LRTI (594 infants [99.0%]) and apnea or bradycardia (77 infants [12.8%]). Overall, 143 infants (23.8%) received invasive mechanical ventilation (median [IQR], 6.0 [4.0-10.0] days). The highest level of respiratory support for nonintubated infants was high-flow nasal cannula (243 infants [40.5%]), followed by bilevel positive airway pressure (150 infants [25.0%]) and continuous positive airway pressure (52 infants [8.7%]). Infants younger than 3 months, those born prematurely (gestational age <37 weeks), or those publicly insured were at higher risk for intubation. Four infants (0.7%) received extracorporeal membrane oxygenation, and 2 died. The median (IQR) length of hospitalization for survivors was 5 (4-10) days.Conclusions and RelevanceIn this cross-sectional study, most US infants who required intensive care for RSV LRTIs were young, healthy, and born at term. These findings highlight the need for RSV preventive interventions targeting all infants to reduce the burden of severe RSV illness.
Association of Early Steroid Administration With Outcomes of Children Hospitalized for COVID-19 Without Multisystem Inflammatory Syndrome in Children
Nadiger, Meghana , McGarvey, Jeremy , Harthan, Aaron A. , Lombardo, Mónica, Perkins, Nicholas , Sayed, Imran A., Bhalala, Utpal , Raju, Umamaheswara, Miller, Aaron S., Boman, Karen , Arteaga, Grace M. , Bansal, Vikas , Tekin, Aysun , Kumar, Vishakha K. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Kovačević, Tanja , Markić, Joško , Ardalic, Tatjana Capitovic , Polić, Branka , Ivić, Ivo, Carev, Dominko , Glavinić, Robert, Vadgaonkar, Girish, Ediga, Rekha, Basety, Shilpa, Dammareddy, Shwetha, Kasumalla, Phani Sreeharsha, Manduva, Janaki, Kolakani, Naresh, Sripathi, Shreeja , Chaitanya, Sheetal, Papani, Sridhar, Kamuram, Mahesh, Mohan, Surapaneni Krishna, Jyothisree, Ekambaram, Petrolwala, Mukur, Ladva, Bharat, Kodate, Akira, Suzuki, Reina , Moriki, Koyo, Hassan-Hanga, Fatimah , Gezawa, Abubakar Shehu, Kabara, Halima M. S., Amole, Taiwo Gboluwaga , Kabir, Halima , Haliru, Dalha Gwarzo, Ibrahim, Abdullahi S., Asghar, Muhammad Sohaib , Syed, Mashaal , Naqvi, Syed Anosh Ali, Yasmin, Farah , Ahmed, Iftekhar , Ishaque, Sidra , Saleem, Ali Faisal , Alarifi, Mohammed I, Macarambon, Jara Mia, Bukhari, Ahmad Abdullah, Albahrani, Hussain A., Aldossary, Kaltham M., Malki, Walid, Kouzoukas, Brenna, Jacobs, Nekaiya, Ganbote, Tejashree, Valentine, Beryl, Sreerama, Pavan, Havalad, Vinod, Barry, Suzanne, Woll, Christopher , Wu, Gregory F. , Carrole, Erin, Burke, Kathryn , Irby, Katherine , Sanders, Ronald C., Hefley, Glenda, Christie, Amy B. , Adiga, Rajani, Campbell, Beth Salvagio , Wilson, Cathleen, Rivers, Patrick , Brinks, Jonathan, Mongoh, Mokenge Ndiva, Gilson, Boris, Danesh, Valerie , Dubrocq, Gueorgui , Davis, Amber, Hammers, Marissa J, McGahey, Ill M, Farris, Amanda C., Priest, Elisa L. , Korsmo, Robyn, Fares, Lorie, Skiles, Kathy, Shor, Susan M, Burns, Kenya, Dowell, Corrie A., Gonzales, Gabriela “ Hope”, Flores, Melody, Newman, Lindsay, Wilk, Debora A., Ettlinger, Jason, Bomar, Jaccallene, Darji, Himani, Arroliga, Alejandro C. , Khandhar, Paras B., Kring, Elizabeth, Anderson, Edwin L., Nagy, Rosemary, Inja, Ravali R., Nawathe, Pooja , Tsing, Jennifer, Carr, Karen, Chaudhary, Anila , Guglielmino, Kathleen, Strom, Larisa, Chiotos, Kathleen, Lee, Giyoung , Burnett, Ryan H., Sydney, Guy I. , Traynor, Danielle M., Ahmed, Farzin, Deonarine, Christopher, Jones, Ashley, Shaikh, Mohammad-Ali , Preston, David A. , Chin, Jeanette, Milligan, Patrick S., Koglin, Joy M., Gibson, Regina, Johnson, Lana, Preston, Felicia, Scott, Crimson, Nungester, Bethany, Menter, Sarah, Wasilewski, A., Kaul, Viren , Austin, Praise, Rogner, Jaimie, Russo, Anthony J. , Ontai, Sidney , Contreras, Brian, Obinwanko, Uzoma, Amamasi, Nneka, Sharafi, Amir, Kaufman, Margit, Lobel, G, Gandhi, Nisha, AbdelAty, Amr M. , Shaji, Elizabeth, Lim, Kiana, Marte, Juan M., Sosa, Dani Ashley, Roth, Prerana , Litwin, Alain H. , Pariyadath, Anand, Moschella, Phillip , Llano, Trayson, Salas, Alan, Daube, Ariel , Korn, Michelle, Rajagopalan, Logi, Santos, Laura Jurema dos , Crandall, Christine , Stojanovski, Sasko, Michienzi, Kelly, Amer, Marwa , Dahhan, Talal, Kseibi, Eiad, Butt, Abid, Khurshid, Syed Moazzum, Rabee, Muath, Abujazar, Mohammed, Alghunaim, Razan, Abualkhair, Maal, AlFirm, Abeer Turki, Oulds, Franscene, Nandavar, Akshay, Wen, Andy , DaCar, Allie, Reilkoff, Ronald A., Eichen, Sarah, Goertzen, Lexie, Rajala, Scott, Feussom, Ghislaine, Domecq, Juan Pablo , Sharma, Mayank , Qamar, Shahraz , Morales, Diana J. Valencia , Khan, Syed Anjum , Jain, Nitesh , Wang, Christine, Kotekal, Dhatri, Sendi, Prithvi , Aulakh, Bhagat , Bandy, Jennifer A., Kreps, Lisa M., Bollinger, Dawn R., Nadiger, Meghana, Schauf, Victoria, Rich, Deana, Anderson, Harry L., Rajkumar, Dixy, Abunayla, Ali, Heiter, Jerrilyn, Zaren, Howard A. , Smith, Stephanie J., Lewis, Grant C., Seames, Lauren, Farlow, Cheryl, Miller, Judy, Broadstreet, Gloria, Terrill, Cindy, Montgomery, Brock, Reyes, Sydney A, Reyes, Summer M, Plattner, Alex, Martinez, Anthony , Allison, Micheal, Mittal, Aniket, Ruíz, Rafael Azuar , Skaanland, Aleta, Amzuta, Ioana, Shah, Amish , Modi, Ritu, Al-Khalisy, Hassan, Masuta, Pardeep , Schafer, Melissa , Wratney, Angela, Jones, Tracy L., Ayers, Shonda C., Harrell, Amy B., Brown, Brent R., Malone, Kassidy, Sinko, Lauren A, Hrarrell, Amy B, Settle, Lisa, Sears, Taylor J., Kuehne, Joshua, Garcia, Melinda, Beebe, Morgan, Herrera, Heather , Belden, Katherine A. , Baram, Michael , Weber, Devin , DePaola, Rosalie, Xia, Yuwei , Carter, Hudson, Tolley, A. E., Ferranti, Mary, House, Scott, Aldana, Isabella, Stulce, Casey , Chong, Grace , Ghavam, Ahmeneh , Baslanti, Tezcan Ozrazgat, Omalay, George, Hashemighouchani, Haleh , Cupka, Julie S , Hubbard, Janice, Nazir, Usman, Rampon, Garrett , Riggle, Jake, Dismang, Nathan, Sullivan, Janice, Morris, Sarah, Nason, Jennifer, Rahman, Rania Abdul, Mulrow, Mary, Gál, Tamás, Mahashabde, Manasi, Vagonis, Alexandra , Uber, Rebecca, Mahmud, Haseeb , Leightle, Stefan, Zhang, Zoe, Vissichelli, Nicole C. , O'Meara, A M Iqbal, Rocawich, Katie, Harris, Lynnette , Cusson, Bruce, Reeves, Brandon, Fanelli, Jessica, Disher, Nataya, Samant, Anusha, DeGroot, Chritian, Youshock, Evan, Ligon, R. Miller, McCartney, Katherine, Garcia, Julio, Iloabachie, Chidi, Flores, Kelsey, VanEenenaam, David P., Sands, Lauren , Sweatt, Nia, Fowler, Jacob , Fram, Madeline, Howard, Easton, Johnson, Kathleen N. , Udoh, Imoh, Nosow, Lillian, Howard, Lucy Winesett, Pham, Quan Duc Minh, Irfanullah, Aman, Ong, Tiffany, Enwezor, Chukwunyelu Henry, Dabagian, Hannah, Bansal, Vikas , Asghar, Muhammad S , Tekin, Aysun , Tripathi, Sandeep , Lombardo, Monica, Gharpure, Varsha , Chiotos, Kathleen , Bjornstad, Erica C. , Dapul, Heda , Montgomery, Vicki , Deo, Neha , Gajic, Ognjen , Kashyap, Rahul , Walkey, Allan J. , Group, Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS): COVID-19 Registry Investigator, Itagaki, Yuki , Galadanci, Hadiza , Kabara, Halima Salisu, Syed, Mashaal, Almazyad, Mohammed , Asfina, Kazi Nur , Cooper, Paul R. , Burke, Kathryn, Mohammed, Mustafa, Ashley, Dennis W. , Mosier, Jarrod , Lutrick, Karen , Dubrocq, Gueorgui , Nagy, Rosemary, Inja, Ravali R., Pedraza, Isabel , Carr, Karen, Gist, Katja M. , Chiotos, Kathleen, Blatz, Allison M. , Cheruku, Sreekanth , Preston, David, Gupta, Sandeep , Abdelaty, Amr, Rennert, Lior , Ramírez, Michelle , Verma, Sourabh , Stojanovski, Sasko D., Johnson, Kristin, Bawazeer, Mohammed Abdullah , Gupta, Manoj , Heneghan, Julia A. , Tang, Ben, Lal, Amos , O’Horo, John C. , Singh, Romil , Koritala, Thoyaja , Tarabichi, Yasir , Perzynski, Adam T. , Wang, Christine, Totapally, Balagangadhar , Nadiger, Meghana, Wall, Chris, Menon, Shina , McGuire, John K. , Anderson, Harry L., Miller, Judy, Lin, John C. H. , Montgomery, Brock, Ruiz, Rafael, Ross, Robert, Gupta, Neha , Brown, Brent , Tolley, Aaron, Tofil, Nancy M. , Mayampurath, Anoop , Bihorac, Azra , Ruppert, Matthew M. , McGonagill, Patrick W. , Galet, Colette , Wang, David , Allan, Lauren , Badheka, Aditya V. , Chegondi, Madhuradhar , Sullivan, Janice, Nason, Jennifer, Akhter, Murtaza , Kashiouris, Markos , Gal, Tamas, Karam, Oliver , Carvalho, Heloisa De, Khanna, Ashish K. , Garcia, Julio, Robinson, Samuel, Enwezor, Chukwunyelu Henry , Mendoza, Rafael
JAMA Pediatrics | October 3, 2022 | Volume: 176 | Issue: 12 | Pages: 1208
10.1001/jamapediatrics.2022.3611
ImportanceThere is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).ObjectiveTo determine whether the use of steroids within 2 days of admission for non–MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.Design, Setting, and ParticipantsThis cohort study analyzed data retrospectively for children (<18 years) who required hospitalization for non–MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.ExposureAdministration of steroids within 2 days of admission.Main Outcomes and MeasuresLength of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.ResultsA total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score–matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.Conclusions and RelevanceSteroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.