Identifying Preterm Infants at Risk of RSV Hospitalisation -EMJ

Identifying Preterm Infants at Risk of Respiratory Syncytial Virus Hospitalisation

NOVEL research presented at the 8th Respiratory Syncytial Virus Network (ResViNET) Conference, held from the 13th–16th February 2024 in Mumbai, India, identified a risk scoring tool (RST) for classifying moderate-to-late preterm infants at greatest risk of respiratory syncytial virus (RSV) hospitalisation.  

Lead author Bosco Paes, McMaster University, Ontario, Canada, and colleagues, reviewed eight published RSTs/predictive models for several attributes: robustness and applicability of source data, simplicity and accuracy, validation and applicability, and cost-effectiveness.  

The team found that most RSTs/models were developed from large, prospective, observational studies specifically designed to identify risk factors for RSV hospitalisation in moderate-to-late preterm infants. The International RST (IRST) had the largest dataset, encompassing data from six studies across 28 countries (n=13,475). Paes and team identified 15 distinct risk factors across all eight RSTs, the most common being age relative to the RSV season (8/8), followed by siblings and/or daycare attendance (7/8), maternal and/or household smoking (4/8), lack of breastfeeding (4/8), and familial atopy (4/8). While other RSTs/models comprised 4–8 risk factors, the IRST only had 3, making it a simpler tool.  It also had the second-highest predictive accuracy. The proportion of preterm infants identified as high-risk for RSV hospitalisation ranged from 11–42%, with the IRST ascribing 24% of infants as high-risk. Validations were reported for 6/8 RSTs/models, and the IRST was proven accurate using data from Ireland, Colombia, and Brazil. The IRST also proved to guide prophylaxis cost-effectively in North America, Europe, Asia, and Latin America.  

Study results point to the IRST as a robust, simple, applicable, and cost-effective tool for ensuring that the most vulnerable moderate-to-late preterm infants receive prophylaxis against severe RSV infection. 

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