OBJECTIVES:   To examine the characteristics of patients admitted to PICU with RSV infection following provincial approval of RSV prophylaxis in June 2002. Secondly, to determine if patients had received palivizumab and document incurred morbidities. METHODS: A retrospective, hospital medical records review of all PICU admissions for RSV infection from January 1, 2003 to December 31, 2009. RSV infection was identified by ICD codes and cases were confirmed by RSV IFA test, culture, or PCR. Data was collected on baseline demographics, underlying disease, criteria for hospitalization, type of respiratory illness and management, complications and palivizumab prophylaxis. Group 1 patients (≤2 years) were compared to Group 2 (>2 -18 years). RESULTS: A total of 181 patients were admitted with RSV infection over 7 years. Group 1 (n=152); Group 2 (n= 29) had a mean admission age in months (SD); 3.7 (5.7) versus 59.9 (37.7). Majority (79.6%) Group 1 versus only 20.7% Group 2 (p<0.001) had no underlying disease. 97.4% versus 93.1% were admitted with respiratory distress and most had bronchiolitis; 88.8% versus 55.2 % (p<0.001), decreased oxygen saturation; 77% versus 75.9% and inability to maintain intake; 75.7% versus 44.8% (p<0.01). Fifty percent versus 41.3% required mechanical ventilation and 81.6% versus 69.0% received antibiotics. Median days (range) in PICU was 5 (1 -73) versus 2 (1-36). Median length of hospital stay days (range) was 9 (1-113) versus 7 (1-64) (p<0.05). The overall RSV positive, PICU hospitalization rate was 5.7%.  There were few complications: respiratory (2.8%); concurrent bacterial sepsis (5.5%). Only 3.3% children had received prophylaxis. 1 death was attributed to RSV infection. CONCLUSIONS: Majority of admissions comprised infants ≤ 2 years of age. 63.3% were ≥ 36 weeks gestation without underlying disease and in total 88.4% would not qualify for prophylaxis. Current Canadian RSV prophylaxis guidelines have significantly impacted PICU admission rates in high-risk infants.