Predictors and incidence of hospitalization due to respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRTI) in non-prophylaxed moderate-to-late preterm infants in Bosnia and Herzegovina

Abstract

Prematurity is a risk factor for respiratory syncytial virus (RSV)-associated lower respiratory tract infections (LRTIs), due to immature humoral and cell-mediated immune system in preterm newborns, as well as their incomplete lung development. Palivizumab, a humanized monoclonal antibody against the F glycoprotein of RSV, is licensed for the prevention of severe RSV LRTI in children at high risk for the disease. This study is a part of a larger observational, retrospective-prospective epidemiological study (PONI) conducted at 72 sites across 23 countries in the northern temperate zone. The aim of our non-interventional study was to identify common predictors and factors associated with RSV LRTI hospitalization in non-prophylaxed, moderate-to-late preterm infants, born between 33 weeks and 0 days and 35 weeks and 6 days of gestation, and less than 6 months prior to or during the RSV season in Bosnia and Herzegovina (B&H). A total of 160 moderate-to-late preterm infants were included from four sites in B&H (Sarajevo, Tuzla, Mostar, and Banja Luka). We identified several significant intrinsic and extrinsic factors to be associated with the risk of RSV LRTI hospitalization in the preterm infants, including: comorbidities after birth, shorter hospital stay, admission to NICU/PICU while in the maternity ward, household smoking, low maternal age, breast feeding, number of family members, and history of family/paternal atopy. Overall, our results indicated that the risk of RSV LRTI in preterm newborns can be associated with different environmental and social/cultural factors, and further research is needed to comprehensively evaluate these associations.

Detection of influenza virus in air samples of patient rooms

“…The lack of RSV detection in the air samples might be attributed to the small number of RSV-patients included in this study. Furthermore, the respiratory symptoms in RSV-infected patients usually appear around 3 days prior to hospital admission [ 62 , 63 ]. Therefore, the lack of sampling on day one of admission from RSV-patients’ room might have also reduced our ability to detect the virus in the air.…”

Are multiple births at greater risk for RSV-related hospitalisation compared with singletons?

“…22 Two studies found a significantly reduced risk of RSVH in late preterm multiple births 8 9 while three reports showed no difference in the proportion of multiple births compared with non-multiple births that were hospitalised with RSV. [23][24][25] Haerskjold et al 9 found that children of multiple birth born between 33-35 weeks and 36 wGA were associated with a decreased risk of RSVH (adjusted HR 0.56, 95% CI 0.40 to 0.78, p=0.001) and a similar trend of reduced RSVH risk was documented by Ambrose et al (HR 0.48; p=0.043). 8 The postulated rationale for the decreased risk was attributed to differences in provider or parental behaviour in the care of twins 8 and that preterm twins of advanced gestational age are otherwise healthy compared with their counterparts of lower gestational age.…”

“…22 Although rare, there have been reports of neuropsychiatric adverse events (AEs) in children including depression, anxiety, psychosis and suicidal ideation. 23…”

Respiratory infections in children born preterm in low and middle‐income countries: A systematic review

“…In addition, 10 studies were carried out prospectively, while 2 were carried out retrospectively. Of the 12 studies, 2 each were from Brazil, 15,16 Turkey, 17,18 Argentina, 19,20 and one each from Nepal, 21 Peru, 22 South Africa, 23 Bosnia and Herzegovina, 24 Iran, 25 and Mexico. 26 The majority of studies were conducted in the last decade except for one study conducted in 2002.…”