Risk factors for severe respiratory syncytial virus infection during the first year of life: development and validation of a clinical prediction model

Vartiainen, Pekka; Jukarainen, Sakari; Rhedin, Samuel Arthur; Prinz, Alexandra; Hartonen, Tuomo; Vabalas, Andrius; Viippola, Essi; Rodosthenous, Rodosthenis S; Koskelainen, Sara; Liu, Aoxing; Lundholm, Cecilia; Smew, Awad I; Osvald, Emma Caffrey; Helle, Emmi; Perola, Markus; Almqvist, Catarina; Heinonen, Santtu; Ganna, Andrea

doi:10.1016/s2589-7500(23)00175-9

Cited by 13 publications

(1 citation statement)

References 29 publications

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“…Policy decisions regarding use and uptake may vary across the world depending on cost effectiveness and resource allocation, among other factors [ 34 ]. Balancing the cost and population health impact of these prevention products is important [ 23 ], and there is a clear need for tools to identify infants who are at high risk for severe RSV outcomes for whom these products may have the most benefit. This is especially important in times of limited availability, which was the case for the 2023 through 2024 RSV season in the United States [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Personalized Infant Risk Prediction for Severe Respiratory Syncytial Virus Lower Respiratory Tract Infection Requiring Intensive Care Unit Admission

Snyder,

Achten,

Gebretsadik

et al. 2024

Open Forum Infectious Diseases

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Background Currently, there are no available tools to identify infants at the highest risk of significant morbidity and mortality from respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) who would benefit most from RSV prevention products. The objective was to develop and internally validate a personalized risk prediction tool for use among all newborns that uses readily available birth/postnatal data to predict RSV LRTI requiring intensive care unit (ICU) admission. Methods We conducted a population-based birth cohort study of infants born 1995-2007, insured by the Tennessee Medicaid Program, and who did not receive RSV immunoprophylaxis during the first year of life. The primary outcome was severe RSV LRTI requiring ICU admission during the first year of life. We built a multivariable logistic regression model including demographic and clinical variables available at or shortly after birth to predict the primary outcome. Results In a population-based sample of 429,365 infants, 713 (0.2%) had severe RSV LRTI requiring ICU admission. The median age of admission was 66 days (interquartile range 37-120). Our tool, including 19 variables, demonstrated good predictive accuracy (AUC 0.78, 95% CI 0.77, 0.80) and identified infants who did not qualify for palivizumab, based on American Academy of Pediatrics guidelines, but had higher predicted risk levels than infants who qualified (27% of non-eligible infants with >0.16% predicted probabilities [lower quartile for eligible infants]). Conclusions We developed a personalized tool that identified infants at increased risk for severe RSV LRTI requiring ICU admission, expected to benefit most from immunoprophylaxis.

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Section: Discussionmentioning

confidence: 99%

Personalized Infant Risk Prediction for Severe Respiratory Syncytial Virus Lower Respiratory Tract Infection Requiring Intensive Care Unit Admission

Snyder,

Achten,

Gebretsadik

et al. 2024

Open Forum Infectious Diseases

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Monoclonal antibody therapies in respiratory syncytial virus prophylaxis—An umbrella review

Kuitunen,

Backman,

Gärdström

et al. 2024

Pediatric Pulmonology

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The aim was to gather an overview of the evidence of monoclonal antibody therapies in respiratory syncytial virus (RSV) prophylaxis in children. For this umbrella review of previous meta‐analyses, we searched PubMed, Scopus, and Web of Science databases in August 2023. We included systematic reviews with meta‐analyses of randomized controlled trials. One author extracted the data, and another author validated the data. We extracted all analyses focusing on clinical outcomes and comparing prophylaxis to placebo. Risk of bias in systematic reviews (ROBIS) tool was used to analyze the risk of bias in the included reviews. AMSTAR‐2 was used to evaluate the quality of the included reviews. After screening of 323 abstracts and 22 full reports, a total of seven systematic reviews with meta‐analyses were included. The risk of bias was rated to be low in four and high in three of these. Three reviews were of moderate quality, one low, and three very low quality according to AMSTAR‐2 classification. Six of the meta‐analyses were direct comparisons, and one was a network meta‐analysis. Five of the reviews focused on palivizumab, one in nirsevimab, and one included all monoclonal antibodies. Six reviews focused on preterm neonates and consisted of 42 comparisons to placebo of which 21 showed efficacy, and 21 had no evidence of a difference. The positive effect was seen in all reviews against RSV infection and RSV hospitalization in palivizumab and nirsevimab groups compared to placebo. None of the mortality comparisons showed efficacy. One meta‐analysis focused on cystic fibrosis patients and had eight comparisons, but it was underpowered to detect any results. The overall evidence from previous meta‐analyses shows that monoclonal antibodies are effective in preventing RSV infections and RSV hospitalizations in preterm infants. However, no effect on mortality was seen in these studies. Evidence certainty has been ranked mainly from low to moderate.

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Risk factors for severe disease in pediatric respiratory syncytial virus infections

Mendoza-Cano,

Trujillo,

Huerta

et al. 2024

Public Health

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Risk factors for severe respiratory syncytial virus infection during the first year of life: development and validation of a clinical prediction model

Cited by 13 publications

References 29 publications

Personalized Infant Risk Prediction for Severe Respiratory Syncytial Virus Lower Respiratory Tract Infection Requiring Intensive Care Unit Admission

Personalized Infant Risk Prediction for Severe Respiratory Syncytial Virus Lower Respiratory Tract Infection Requiring Intensive Care Unit Admission

Monoclonal antibody therapies in respiratory syncytial virus prophylaxis—An umbrella review

Risk factors for severe disease in pediatric respiratory syncytial virus infections

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