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Are multiple births at greater risk for RSV-related hospitalisation compared with singletons?
  1. Rafat Mosalli1,2,
  2. Amirah Al Matrafi3,
  3. Sarah Alqarni3,
  4. Wed Khayyat3,
  5. Bosco Paes4
  1. 1 Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia
  2. 2 Department of Pediatrics, International Medical Center, Jeddah, Saudi Arabia
  3. 3 Umm Al-Qura University College of Medicine, Makkah, Saudi Arabia
  4. 4 Department of Pediatrics (Neonatal Division), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
  1. Correspondence to Dr Rafat Mosalli, Department of Pediatrics, Umm Al-Qura University, Makkah 21421, Saudi Arabia; rmmosalli{at}

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Case scenario

Twins 34 weeks gestational age are being discharged from the neonatal unit for regular follow-up by their general practitioner. One of the twins required nasal continuous positive airway pressure for 3 days for mild respiratory distress syndrome. The mother asks, are my twins at high risk for respiratory syncytial virus (RSV) infection and related hospitalisation?

Structured clinical question

Are multiple births (population) at greater risk for RSV-related hospitalisation (outcome) compared with singletons (control)?


An advanced modality search was conducted across available databases including PubMed, Google Scholar, Ovid Medline, Cochrane Library and Web of Science using the following keywords and Medical Subject Headings (MeSH) terms: Respiratory syncytial virus OR RSV AND Twins OR Triplets OR Multiple gestation OR Multiple birth. All relevant articles that comprised multiple birth neonates aged less than 2 years that were hospitalised with RSV infection were reviewed. Included articles were checked for references to additional relevant studies. Animal-based, non–English-language case reports, and studies prior to 1980 were excluded. The search yielded 466 articles, and after exclusions and consensus, a total of 15 articles were retained for analysis and the characteristics of 12 key studies1–12 are shown in table 1.

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Table 1

Summary of included studies (n=12)


RSV is one of the most common causes of viral-related hospitalisation (RSVH) and mortality in the world, resulting in 31% hospital admissions among children aged less than 5 years, and an estimated 118 200 in and out of hospital deaths.13 It is estimated that 22% of global lower respiratory tract infection (LRTI) in children is due to RSV and 44% of RSVH occurs in those less than 2 months of age, with the highest mortality reported in children of very low birth weight <1500 g, and those who are immunocompromised or are infected with HIV.14 Well-established risk factors associated with RSV LRTI and RSVH include …

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  • Contributors RM: confirmed and added to the literature review, first draft and revision of manuscript. AAM, SA, WK: conducted and consolidated the PRISMA article search and framed the table. BP: conception, literature review, manuscript composition, final revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BP has been compensated as a speaker by AbbVie Corporation in the past.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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