Severe Infant RSV Linked to Lower Parental HRQoL

Key Takeaways

• Among parents or caregivers of children younger than 24 months hospitalized for RSV across Germany, France, Italy, and Sweden during the 2022–2023 season, higher infant disease severity was associated with worse parent-reported burden during the acute phase.
• Parents of children with higher RSV severity reported significantly lower HRQoL during the acute hospitalization period.
• Higher severity was also associated with significantly lower overall family impact and family functioning scores in adjusted analyses.
• The negative HRQoL pattern appeared stronger when adequate mental health support had not been offered, and parent-reported burden improved by follow-up with no significant severity association detected then.

Respiratory syncytial virus (RSV) hospitalization in infancy can extend beyond respiratory support and length of stay to affect parental well-being, daily routines, and family functioning. Whether a more severe infant course tracks with worse parent-reported health-related quality of life (HRQoL) remains an important family-centered question, particularly when burden is measured during hospitalization and again after early recovery. Across 4 European countries, families were surveyed during the acute admission period and again after short follow-up to examine how infant illness severity related to parent-reported burden over time.

In the ResQ Family European observational study of infant RSV severity and parental HRQoL, investigators conducted a multi-country observational analysis during the 2022–2023 RSV season in Germany, France, Italy, and Sweden. Parents or caregivers of children younger than 24 months hospitalized for RSV completed an online baseline survey during or shortly after hospitalization, with recruitment within 4 weeks of hospitalization; 138 participants had complete baseline data and 59 had follow-up data. Infant severity was summarized with a composite index ranging from 0 to 8, assigning 1 point each for hospital stay of 5 days or more, supplemental oxygen, apnoea monitoring, and confirmed apnoea episodes, and 2 points each for intensive care unit (ICU) admission and for the need of mechanical ventilation (invasive or non-invasive respiratory support); scores of 3 or more were classified as high severity and scores below 3 as low severity. Parental outcomes were measured with the Pediatrics Quality of Life Family Impact Module 2.0 (PedsQL FIM) Total Score, Parent HRQoL Summary Score, and Family Functioning Summary Score, with higher scores indicating better status, and adjusted multivariable linear regression models accounted for prespecified parent, child, household, and country covariates in complete-case analyses with multiple imputation as a sensitivity check. Follow-up was initiated about 6 weeks after baseline, with a median interval of 44 days and a mean of 59 days.

The cohort had a median severity index score of 5.0, ranging from 1 to 8, with 26 children in the low-severity group and 112 in the high-severity group. Full-sample acute-phase mean PedsQL FIM scores were 55.6 for Total, 52.5 for Parent HRQoL Summary, and 59.4 for Family Functioning Summary. The study showed that high versus low severity was associated with a 12.1-point lower Parent HRQoL Summary Score (95% CI −21.2 to −3.03; P=0.010), a 10.3-point lower Total Score (95% CI −18.6 to −1.90; P=0.017), and a 10.5-point lower Family Functioning Summary Score (95% CI −20.5 to −0.47; P=0.04). Unadjusted acute-phase comparisons also showed lower total and parent HRQoL scores in the high-severity group. The authors reported that the HRQoL association appeared stronger among parents who had not been offered adequate mental health support, and significant correlations across all three summary scores were also seen within groups with higher health literacy or better RSV-related understanding. Acute-phase total, parent HRQoL, and family functioning scores were significantly lower than follow-up scores, while repeated models found no significant association between initial severity and follow-up PedsQL FIM scores; responders and nonresponders did not differ significantly at baseline, and sensitivity analyses were directionally consistent.

Because the analysis was observational, lacked a control group, and assessed the acute phase in a cross-sectional way, it cannot establish causality or the direction of every reported association. Generalizability is also shaped by pragmatic online and social-media recruitment, parental self-report, smaller subgroup and follow-up samples, variability in follow-up timing, and a severity index informed by prior work but not externally validated. Residual confounding and attrition bias cannot be excluded, and although a small number of longer-recall responses were examined in sensitivity analyses, the overall direction and magnitude of findings did not materially change. The authors presented the mental health support and health literacy signals as exploratory associations rather than evidence of tested interventions.

The investigators concluded that a more severe infant RSV hospitalization was associated with worse parent-reported HRQoL and family functioning during the acute phase. Parent-reported burden improved over the following weeks, and no significant severity association was detected at follow-up. The findings frame infant RSV hospitalization as a family-centered burden as well as a pediatric respiratory event.

Clinician Questions

How was infant RSV severity defined in the ResQ Family analysis?

In the ResQ Family analysis, infant RSV severity was defined by a composite 0-to-8 score that assigned 1 point each for hospital stay of 5 days or more, supplemental oxygen, apnoea monitoring, and confirmed apnoea episodes, and 2 points each for ICU admission and mechanical ventilation; high severity was 3 points or more and low severity was fewer than 3 points.

Which parent-reported outcomes were measured after infant RSV hospitalization?

Parent-reported outcomes after infant RSV hospitalization were measured with the PedsQL FIM 2.0 Total Score, Parent HRQoL Summary Score, and Family Functioning Summary Score, each ranging from 0 to 100 with higher scores indicating better status, and these were collected during or shortly after hospitalization and again at follow-up.

Was higher infant RSV severity still associated with worse parental PedsQL scores at follow-up?

Parental total, HRQoL, and family functioning scores after infant RSV hospitalization were significantly lower during the acute phase than at follow-up about 6 weeks later, but repeated multivariable models found no significant evidence that initial RSV severity was associated with PedsQL FIM scores at follow-up.

Did mental health support appear to modify the parental HRQoL burden of severe infant RSV?

The authors reported an exploratory pattern in which the negative association between severe infant RSV and parental HRQoL appeared stronger among parents who had not been offered adequate mental health support during hospitalization, and they described this as a stratified association rather than a tested intervention effect.