Epidemiological and clinical characteristics of respiratory syncytial virus infection in hospitalized neonates in Suzhou.

Background: Respiratory syncytial virus (RSV) poses a significant global health burden, particularly among neonates and preterm infants due to their immunologic immaturity, with limited regional epidemiological data. We aimed to explore the epidemiology of acute lower respiratory tract infections (ALRTI) related to RSV infections in hospitalized neonates and the risk factors associated with severe infections. Methods: A total of 7,420 hospitalized ALRTI neonates admitted to the Children's Hospital of Soochow University from January 2013 to December 2023 were included in this retrospective study. Their epidemiological and clinical data were collected and analyzed. The general data and laboratory test data between the two groups were compared. Severe RSV infection was defined as requiring oxygen therapy, ICU admission, or mechanical ventilation. Results: There were 875 (11.79%) neonates with positive RSV infection, with 459 males (52.46%) and 416 females (47.54%) and a median age of 19 days. The detection rate of RSV was the highest in winter [24.83% (583/2,299)]. Moreover, 191 RSV cases (21.83%) were severe cases. Logistic regression analysis showed that preterm birth [odds ratio (OR) =2.325, 95% confidence interval (95% CI): 1.112-4.859], high-sensitivity C-reactive protein (hsCRP) ≥8 mg/L (OR =2.580, 95% CI: 1.527-4.359), mixed infection (OR =1.493, 95% CI: 1.038-2.146), and combined underlying disease (OR =3.679, 95% CI: 2.247-6.023) were the independent risk factors for hospitalized neonatal RSV infection among ALRTI neonates. Conclusions: RSV is one of the most common causes of ALRTI in hospitalized neonates. RSV affects neonates and carries the greatest impact in late preterm neonates with seasonal peaks in the autumn and winter months. Early identification of risk factors (as prematurity or elevated levels of hsCRP, mixed infections, or preexisting conditions or risk factors) can help make timely interventions and enable targeted preventive approaches to alleviate the burden.