# Readmission Following Respiratory Syncytial Virus Hospitalization among Children <5 Years of Age

## TL;DR

Young children hospitalized with RSV are more likely to be readmitted for respiratory issues than those with influenza or human metapneumovirus.

## Contribution

The study shows RSV hospitalization is linked to a fourfold higher risk of respiratory readmission compared to other viruses.

## Key findings

- RSV hospitalization was associated with a 3.62 hazard ratio for respiratory readmission compared to influenza.
- RSV readmission rates increased to 16.8% at 1.5 years, higher than 6%-7% for influenza and hMPV.
- Readmission rates for all causes ranged from 5% to 30% over 1.5 years post-discharge.

## Abstract

Hospitalization with lower respiratory infection (LRI) by Respiratory Syncytial Virus (RSV) and other respiratory viruses is common in young children. However, the likelihood of readmission following RSV LRI compared to other common respiratory viral infections is unknown.

This prospective study included children <5 years and hospitalized with laboratory-confirmed RSV LRI at two hospitals in Salt Lake City, Utah, from October 31, 2019 to April 30, 2022. For comparison, we retrospectively identified children <5 years, hospitalized during the same period with Influenza virus (IV) or human metapneumovirus (hMPV) LRI. Readmissions were tracked for 1.5 years post-discharge. We calculated the incidence proportion of readmissions and estimated hazard ratios using Cox proportional hazards model with Covariate Balancing Propensity Score.

Among children hospitalized with RSV, IV, and hMPV LRI, all-cause hospital readmission was common, with 30-day readmission proportions ranging between 5% and 9% and increasing to between 19% and 30%, 1.5 years post-discharge. Respiratory-related readmission varied by virus, with RSV having higher proportions, increasing to 16.8% 1.5 years post-discharge, compared to 6%-7% with IV and hMPV. After adjusting for confounders, RSV hospitalization was associated with an increased hazard of respiratory-related readmission within 1.5 years after hospitalization compared to IV (HR 3.62, 95% CI, 1.13-11.64) or hMPV (HR 3.56, 95% CI, 1.14-11.06).

Respiratory-related readmission proportion was higher and progressive over time among children <5 years with an index RSV admission compared to IV and hMPV. This underscores the critical need for prevention of RSV infection in infants and young children through RSV immunization strategies.

Children < 5 years hospitalized with RSV face a fourfold higher risk of being readmitted for respiratory issues within 1.5 years compared to those hospitalized with influenza or human metapneumovirus. This emphasizes the need for widespread RSV immunoprophylaxis.