title: Epidemiology and risk factors for severe respiratory syncytial virus infections requiring pediatric intensive care admission in Hong Kong children.
abstract: OBJECTIVE
  Respiratory syncytial virus (RSV) is a common cause of lower respiratory tract infection in young children. However, there are limited data on severe RSV infection requiring pediatric intensive care unit (PICU) admission. This retrospective study described features of RSV-associated PICU admissions in Hong Kong and investigated factors for mortality and duration of PICU stay.
  
  
  METHODS
  Children with laboratory-confirmed RSV infection and admitted to the PICUs of all eight government hospitals in Hong Kong between January 2009 and June 2011 were identified from computerized auditing systems and PICU databases. RSV in respiratory samples was detected by direct immunofluorescence and/or viral culture. The relationships between mortality and PICU duration and demographic and clinical factors were analyzed.
  
  
  RESULTS
  A total of 118 (2.4 %) PICU admissions were identified among 4,912 RSV-positive pediatric cases in all hospitals. Sixty-five (55.6 %) patients were infants. PICU admissions were higher between October and March. Eight (6.8 %) patients died, but only two were infants. RSV-associated mortality was related to prior sick contact, presence of older siblings, neurodevelopmental conditions, chromosomal and genetic diseases, and bacterial co-infections, but none was significant following logistic regression analyses (odds ratio 9.36, 95 % confidence interval 0.91-96.03 for prior sick contact, p = 0.060). Chronic lung disease was the only risk factor for the duration of PICU admission (β = 0.218, p = 0.017).
  
  
  CONCLUSIONS
  The majority of RSV-infected children do not require PICU support. There is winter seasonality for RSV-associated PICU admission in Hong Kong. Prior sick contact is the only risk factor for RSV-associated mortality, whereas the presence of chronic lung disease is associated with longer PICU stay. The current risk-based approach of RSV prophylaxis may not be effective in reducing severe RSV infections.
authors.affiliation: Department of Pediatrics, The Chinese University of Hong Kong, Room 84043, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, tfleung@cuhk.edu.hk.
authors.forename: T F
authors.initials: TF
authors.lastname: Leung
authors.forename: D S Y
authors.initials: DS
authors.lastname: Lam
authors.forename: T Y
authors.initials: TY
authors.lastname: Miu
authors.forename: K L
authors.initials: KL
authors.lastname: Hon
authors.forename: C S K
authors.initials: CS
authors.lastname: Chau
authors.forename: S W
authors.initials: SW
authors.lastname: Ku
authors.forename: R S Y
authors.initials: RS
authors.lastname: Lee
authors.forename: P Y
authors.initials: PY
authors.lastname: Chow
authors.forename: W K
authors.initials: WK
authors.lastname: Chiu
authors.forename: D K K
authors.initials: DK
authors.lastname: Ng
mesh_terms: D002675:Child, Preschool; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors