Which child is at highest risk for hospitalization due to RSV?

• A. A 16-month-old with a tracheostomy.
• B. A 2-month-old born at 32 weeks.
• C. A 3-year-old with a congenital heart defect.
• D. A 4-year-old born at 30 weeks.

Answer: (B)

The highest risk for hospitalization from RSV occurs in very young infants, especially those born prematurely. A baby at 2 months who was born at 32 weeks has both factors: infancy and prematurity. Premature infants have smaller, less mature airways and immature immune defenses, and they receive fewer maternal antibodies because they miss part of the late-gestation antibody transfer. These factors together make RSV infections more likely to become severe enough to require hospitalization.

The other scenarios involve risk factors but not at the same vulnerable age. A 16‑month‑old with a tracheostomy has airway issues, but age moves them out of the period of highest RSV risk. A 3‑year‑old with congenital heart disease has chronic risk, but the illness tends to be less severe than in the youngest preterm infant. A 4‑year‑old born at 30 weeks is preterm, but age again reduces the likelihood of severe RSV compared with a 2‑month-old preemie.