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1. RSV-related ALRI incidence was significantly higher among preterm infants than term infants.

2. This pattern for RSV hospitalizations remained true until infants’ second year of life.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Infants born prematurely face an increased risk for severe respiratory infections, particularly from respiratory syncytial virus (RSV). Until now, few studies have successfully assessed the global burden and risk factors associated with RSV-related acute lower respiratory infections (ALRIs) in preterm infants. This systematic review and meta-analysis aimed to quantify RSV-associated ALRI incidence and severity outcomes among premature infants. The primary outcome was the incidence of RSV-associated ALRIs, while a key secondary outcome was RSV-associated hospital admissions. According to study results, pre-term birth was linked to a disproportionately high burden of RSV-related disease compared to term infants. Although this study was well done, it was limited by the reliance on aggregated data and variability in study methodologies.

Click to read the study in The Lancet

Relevant Reading: Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants

In-depth [systematic review and meta-analysis]: 3302 studies published in MEDLINE, Embase, and Global Health between Jan 1, 1995, and Dec 31, 2021, were assessed for eligibility. Included were patients born <37 weeks gestational age (wGA) with RSV-associated ALRI incidence and risk factors. 64 studies were included in the analysis. The primary outcome of RSV-associated ALRI incidence and hospitalization was significantly higher among preterm infants than for infants born at any gestational age (rate ratio [RR] 1.69-3.87). This was also the case for RSV-related hospitalizations among early preterm infants (<32 wGA) in their second year of life (RR 2.26, 95% uncertainty range [UR] 1.27-3.98). Furthermore, late preterm infants (32 to <37 wGA) had higher RSV-associated ALRI hospitalization rate in the first 6 months (RR 1.93, 95% UR 1.11-3.26). Findings from this study suggest that preterm infants bear a significant burden of RSV-associated disease, emphasizing the need for preventive measures to reduce morbidity and mortality in this vulnerable population.

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