Burden, Risk Factors, and Outcomes of RSV Infection in Pediatric ICUs Across Türkiye: RSVP Study

Background Respiratory syncytial virus (RSV) is one of the leading causes of requiring a pediatric intensive care unit (PICU). This study aimed to characterize the clinical features, complications, co-infections, and risk factors associated with RSV-related morbidity and mortality in a large PICU cohort over five years. Methods This is a retrospective multicenter study to evaluate patients with RSV infection admitted to the PICUs in Türkiye between 2020 and 2024, including the COVID-19 pandemic. Results Medical records of 646 children (360 boys, 286 girls, 70% younger than 12 months; 70.6% previously healthy) have been evaluated. Underlying disease was identified in 190 children (29.4%), and congenital heart disease in 58 (9%). Complications included pleural effusion (n = 8), pneumothorax (n = 8), central nervous system involvement (n = 19), apnea (n = 10), and myocarditis (n = 5). Respiratory co-pathogens were detected in 169 patients (26.2%). During PICU admission, 165 patients (25.5%) required IMV. The mortality rate was 5.4% due to RSV infection. Logistic regression revealed that the presence of an underlying disease significantly increased mortality risk (OR 3.15, p < 0.01) and this association remained significant in infants under one year (OR 3.57, p < 0.01). Conclusion Most children admitted to the PICU due to RSV infection were under one year of age and previously healthy, while mortality was associated with underlying conditions. Monitoring RSV cases in the PICU can be used as a probe for determining the burden of disease and economic cost in the country and for potential treatment and prevention strategies.