The Impact of Nirsevimab on the Transport of Critically Ill Children
Por:
Alejandre-Galobardes C, Pazos E, Gonzalez-Alvarez P, Girona M, Millán-García del Real N, Rodriguez M, Covas A, Aina Martínez Planas and Esteban-Torne E
Publicada:
14 feb 2026
Ahead of Print:
14 feb 2026
Resumen:
Purpose: Respiratory syncytial virus-positive bronchiolitis continues to be the main diagnosis prompting transportation in children younger than one year of age. It represents approximately 15-20% of all services performed by a specialized pediatric transport team. In October 2023, an immunization program with nirsevimab, a monoclonal antibody against RSV, was started in Spain. The purpose of the present study is to describe how nirsevimab affects the rates of bronchiolitis managed by a pediatric team specialized in critical patient transport. Secondary objectives included describing and comparing the clinical aspects of the two cohorts-pre-nirsevimab (pre-n) and post-nirsevimab (post-n)-to quantify how immunization has modified the clinical phenotype of bronchiolitis. Methods: This is a descriptive and observational study. Patients with bronchiolitis transported by a specialized pediatric transport team between September 2021 and August 2025 were included. Demographic, clinical, and microbiological data were collected. The pre-n and post-n periods were compared. Results: From a total of 2347 interfacility transports conducted by the unit between 2021 and 2025, 463 (19.7%) involved bronchiolitis patients, all of whom were recruited: 307 in the pre-n period and 156 in the post-n. The median age was 2.5 months (IQR 1.3-5.7), and 55% were male. There was a significant decrease in bronchiolitis cases that required specialized transport between the two periods: 28.2% (307/1089) pre-n vs. 12.4% (156/1258) post-n (p < 0.001). RSV detection also declined (74.3% vs. 47.4%, p < 0.001), while other viruses increased significantly in the post-n period, including rhinovirus, metapneumovirus and bocavirus. Age at admission showed statistically significant differences across the two periods (2.2 vs. 3.4 months, p < 0.001). There were no differences in severity between the two periods in terms of respiratory and inotropic support and length of stay. No mortality was reported. Conclusions: Universal nirsevimab immunization was associated with a marked reduction in pediatric transports for bronchiolitis, particularly RSV-related cases, without modifying disease severity among those requiring transfer.
Filiaciones:
Alejandre-Galobardes C:
Pediatric Transport Team, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
:
Pediatric Transport Team, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Gonzalez-Alvarez P:
Pediatric Transport Team, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Girona M:
Pediatric Transport Team, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, 08950 Barcelona, Spain
Millán-García del Real N:
Pediatric Transport Team, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Rodriguez M:
Pediatric Transport Team, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Covas A:
Pediatric Transport Team, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Aina Martínez Planas:
Pediatric Transport Team, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Esteban-Torne E:
Pediatric Transport Team, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
Green Submitted, gold
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