OP005 Topic: AS15–Lung: Respiratory Support/Acute Respiratory Failure/Other: THE POST-PANDEMIC RSV SURGE: TRENDS IN PEDIATRIC HOSPITALIZATIONS AND RESPIRATORY SUPPORT MODALITIES

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Aims & Objectives: Pediatric RSV hospitalizations dramatically decreased globally during the COVID-19 pandemic and resurged in 2022-23 after lifting pandemic precautions. This study examined how demographics, respiratory support mode utilization, and clinical outcomes in pediatric RSV differed in the 2022-23 RSV surge compared to pre-pandemic. Methods: A cross-sectional study of 48 U.S. children’s hospitals in the Pediatric Health Information System (PHIS) database was performed including 288,816 patients < 5 years old with RSV from July 1, 2017 to June 30, 2023. RSV seasons were defined July 1 to June 30 each year. 2022-23 RSV surge data was compared to pre-pandemic averages. Results: RSV hospital presentations increased 2.4-fold in 2022-23 (94,347 vs. 39,698) with 86.7% more hospitalizations (50,619 vs. 27,114) and 43.5% more ICU admissions (13,696 vs. 9,546) than pre-pandemic (p<0.001). In 2022-23, children were older (median 11.3 vs. 6.8 months; p<0.001) with fewer comorbidities (17.6% vs. 21.8%; p<0.001) than pre-pandemic. Advanced respiratory support use increased 70.1% in 2022-23 (9,094 vs. 5,340; p<0.001) and those requiring high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV) were older than pre-pandemic (median, HFNC = 6.9 vs. 4.6 months, NIV = 6 vs. 4.3 months). Comorbid conditions were less frequent during the surge across all respiratory support modalities. Conclusions: The post-pandemic pediatric RSV surge resulted in unprecedented hospital volumes and advanced respiratory support utilization in older children with fewer comorbidities. These findings highlight post-pandemic trends in advanced respiratory support utilization for pediatric RSV that can inform guidelines as new RSV vaccines become more widely available. Keywords: Respiratory syncytial virus, Post-pandemic RSV surge, Viral bronchiolitis, Respiratory support modes

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