Introduction and aims Viral respiratory tracts infections (VRTIs) can be subclinical or clinical and present in clustered outbreaks on the NICU. Little data are available on the impact such infections have on health service resources such as length of stay and associated costs. This study aimed to explore these in the NICU population.

Methods A retrospective case-control study (1:2, matched for gestation and centre), at two UK tertiary NICUs, of all inpatients with PCR confirmed VRTIs (cases) over a 6 year period. Length of stay, level of care and associated costs were compared.

Results 169 controls and 86 cases were identified with similar gestations (median 29 weeks, IQR 26–34). There were no significant differences between groups for antenatal steroids, birth weight, maternal smoking or death, although fewer cases had blood culture positive sepsis (11/86 vs 65/169, p < 0.0001). Cases spent significantly longer (71 vs 37 days) in the NICU than controls which was most notable at the higher levels of care (see Table). Based on UK National Health Service (NHS) tariffs this results in added costs of £25,162 per patient. With an average of 14 cases a year in our population (birth rate 10,500/year) this equates to £356,472/year of additional costs. With extrapolation across the UK NHS this could equate to between £7 M and £249 M.

Conclusion There are significant resource implications both in terms of capacity and economic costs associated with RVTIs on the NICU. Strategies aimed at reducing the burden of these infections could have significant cost savings.