Prematurity is a significant predictor of worse outcomes in viral bronchiolitis: A comparative study in infancy

Abstract

Background: The rate of admissions to hospital with bronchiolitis has increased over the past years. The reasons for this are likely to be multifactorial including improved survival of preterm infants. Aim: To assess the severity of viral bronchiolitis in preterm compared with term infants admitted at a tertiary hospital in Cairo, Egypt, based on the outcome. Materials and Methods: This prospective study was conducted throughout a 3-year period from September 2011 to October 2014. It included 153 infants, 74 healthy preterm and 79 healthy term infants, admitted with clinical diagnosis of bronchiolitis at a tertiary hospital in Cairo, Egypt. Bronchiolitis severity score (BSS) was recorded, and nasopharyngeal swabs were obtained from each patient at the time of presentation. Viruses were identified using reverse transcription PCR. The clinical course and patient's outcome were recorded. Results: This study recorded a significantly more severe BSS for preterm compared with term infants. The preterm group had an increased mean length of hospital stay and oxygen therapy and were more likely to need ICU admission and mechanical ventilation compared with the term group. The mean ±SD BSS for infections with human metapneumovirus, respiratory syncytial virus, parainfluenza 3 was more significantly severe in preterm compared with term infants. Bacterial co-infection was significantly correlated with severity scoring in both groups.. Conclusion: Prematurity significantly affects the severity of bronchiolitis, and this underscores the importance of early categorization of these infants as a high-risk group on their first visit. Physician should be aware that their illness runs a more severe course, even if they have no underlying disorders.

Factors Contributing to Symptom Duration and Viral Reduction in Outpatient Children With Respiratory Syncytial Virus Infection

“…The bronchiolitis severity score, including wheezing and retraction, was significantly higher in preterm infants than in term infants, in studies of children with RSV bronchiolitis. 24 Adjusted forced expiratory volume in a second was lower in the preterm born group than in the term born group even in the adolescent period. 25 Our data, therefore, suggested gestational period to influence the disease outcome most probably.…”

Impact of pulmonary hypertension and congenital heart disease with hemodynamic repercussion on the severity of acute respiratory infections in children under 5 years of age at a pediatric referral center in Colombia, South America

“…Children younger than 12 months and children with a history of prematurity are at greater risk due to immunological immaturity and incomplete development of their lung function, making these patients more susceptible to the harmful effect of respiratory pathogens. 25 Dai Kimura, et al 10 showed a higher frequency of pulmonary hypertension during respiratory syncytial virus infection with: CHD, paediatric chronic lung disease, prematurity, and Down syndrome, having a significant association with ICU admission (OR: 6.4; 95% CI 2.2-18.8, p = 0.0007), intubation (OR: 4.7; 95% CI 1.8-12.3, p = 0.002), high frequency ventilation (OR: 8.4; 95% CI 2.95-23.98, p < 0.0001), and prolonged hospitalisation in ICU (OR: 4.9; 95% CI 2.0-11.7, p = 0.0004). These findings are consistent with those in our study, in which both pulmonary hypertension and pulmonary hypertension plus respiratory syncytial virus infection were risk factors for ICU admission (p = 0.004 and p = 0.007, respectively), although this was not true for the outcome variable "prolonged hospitalisation in ICU (10 or more days)" (p = 0.154).…”