Prospective study of healthcare utilisation and respiratory morbidity due to RSV infection in prematurely born infants

Abstract

Background: A study was undertaken to determine the impact of respiratory syncytial virus (RSV) infection, both in hospital and the community, on healthcare utilisation and respiratory morbidity in prematurely born infants and to identify risk factors for symptomatic RSV infection. Methods: A hospital and community follow up study was undertaken of 126 infants born before 32 weeks of gestational age. Healthcare utilisation (hospital admissions and general practitioner attendances) in the first year, respiratory morbidity at follow up (wheeze and cough documented by parent completed diary cards), and RSV positive lower respiratory tract infections (LRTIs) were documented. Nasopharyngeal aspirates were obtained for immunofluorescence and culture for RSV whenever the infants had an LRTI, either in the community or in hospital. Results: Forty two infants had an RSV positive LRTI (RSV group), 50 had an RSV negative LRTI (RSV negative LRTI group), and 32 infants had no LRTI (no LRTI group). Compared with the RSV negative LRTI and the no LRTI groups, the RSV group required more admissions (p = 0.392, p,0.001) and days in hospital (p = 0.049, p = 0.006) and had more cough (p = 0.05, p = 0.038) and wheeze (p = 0.003, p = 0.003) at follow up. Significant risk factors for symptomatic RSV LRTI were number of siblings (p = 0.035) and maternal smoking in pregnancy (p = 0.005), for cough were number of siblings (p = 0.002) and RSV LRTI (p = 0.02), and for wheeze was RSV LRTI (p = 0.019). Conclusion: RSV infection, even if hospital admission is not required, is associated with increased subsequent respiratory morbidity in prematurely born infants.

Modified Recommendations for Use of Palivizumab for Prevention of Respiratory Syncytial Virus Infections

“…Therefore, although current recommendations were designed to be consistent with the US Food and Drug Administration approval for marketing of palivizumab for the prevention of serious RSV lower respiratory track disease, they specifically target infants in this group with consistently identified risk factors for RSV hospitalization during the period of greatest risk, which is the first 3 months of life. [21][22][23][24][25][26][27][28] Palivizumab prophylaxis should be limited to infants in this group at greatest risk of hospitalization attributable to RSV, namely infants younger than 3 months of age at the start of the RSV season and infants born during the RSV season who are likely to have an increased risk of exposure to RSV. Epidemiologic data suggest that RSV infection is more likely to occur and more likely to lead to hospitalization for infants in this gestational-age group when at least 1 of the following 2 risk factors is present: Prophylaxis may be considered for infants from 32 through less than 35 weeks' gestation (defined as 32 weeks 0 days through 34 weeks 6 days) who are born less than 3 months before the onset or during the RSV season and for whom at least 1 of the 2 risk factors is present.…”

Rhinovirus infection and healthcare utilisation in prematurely born infants

“…Respiratory syncytial virus (RSV) lower respiratory tract infections (LRTIs) are associated with increased chronic respiratory morbidity and healthcare utilisation in prematurely born infants who did [1] or did not [2,3] develop bronchopulmonary dysplasia (BPD). Amongst those who had had BPD, healthcare utilisation and the related cost of care were increased up to 7 years of age and lung function was lower than that of controls at 10 years of age [1].…”

Respiratory morbidity of preterm infants of less than 33 weeks gestation without bronchopulmonary dysplasia: a 12-month follow-up of the CASTOR study cohort

“…To our knowledge, only one previous prospective study evaluated post-RSV respiratory morbidity and that was in a smaller cohort of 126 preterm infants <32 weeks GA followed up to only age 1 year of [32].…”

“…Chronic respiratory morbidity is common after premature birth; in premature infants, the immaturity of the immune system confers an increased risk for severe respiratory viral infections and airway obstruction in the first 2 years of life [28][29][30][31][32]. Prematurity with respiratory morbidity, such as respiratory distress syndrome, can result in long-term lung damage and bronchial hyperreactivity, which predisposes to subsequent viral-induced wheezing later on in life [33].…”