Clinical characteristics and risk factors for intubation of critically ill children with respiratory syncytial virus (RSV) infection: A descriptive analysis from the Kuwait PICUs registry

BACKGROUND: Respiratory syncytial virus (RSV) is a major cause of pediatric lower respiratory tract critical infection. Using a national pediatric intensive care units (PICUs) registry, we aimed to describe the clinical and management characteristics of RSV-positive PICU admissions, and identify factors associated with the need for invasive mechanical ventilation. METHODS: We conducted a national-level retrospective study of all children aged 0-14 years admitted to a PICU with laboratory-confirmed RSV infection between September 2023 and June 2025. Data extracted from the Kuwait PICUs Registry included demographics, comorbidities, respiratory support, length of stay, antimicrobial use, and viral coinfections. Descriptive analysis and multivariate logistic regression were performed to identify factors associated with intubation. RESULTS: Among 1144 RSV-positive admissions representing 19.8% of all PICU admissions, the median age was 91.5 days (IQR 41-304), with 49.4% aged < 3 months, 59.3% were male, and nine died (0.8%). Most patients (86.5%) were previously healthy. Overall, 22.4% required intubation, with genetic disorders (aOR 9.31, 95%CI 4.61-18.79), chronic respiratory disease (aOR 2.93, 95%CI 1.24-6.92), other comorbidities (aOR 4.97, 95%CI 2.45-10.10), viral coinfection (aOR 2.15, 95%CI 1.45-3.17), and younger age independently associated with intubation. The 2024/2025 season had higher admission and intubation rates compared to the 2023/2024 season. Antimicrobial use was frequent despite low bacterial coinfection rates. CONCLUSION: Severe RSV infection predominantly affects previously healthy young infants, with a substantial proportion requiring intubation. Younger age, comorbidities, and viral coinfection are key risk factors. These findings highlight the significant burden of RSV-disease in PICUs.