Respiratory Syncytial Virus-Associated Acute Lower Respiratory Infections in Children With Bronchopulmonary Dysplasia: Systematic Review and Meta-Analysis

Abstract

Background Respiratory syncytial virus (RSV) is among the most important causes of acute lower respiratory tract infection (ALRI) in young children. We assessed the severity of RSV-ALRI in children less than 5 years old with bronchopulmonary dysplasia (BPD). Methods We searched for studies using EMBASE, Global Health, and MEDLINE. We assessed hospitalization risk, intensive care unit (ICU) admission, need for oxygen supplementation and mechanical ventilation, and in-hospital case fatality (hCFR) among children with BPD compared with those without (non-BPD). We compared the (1) length of hospital stay (LOS) and (2) duration of oxygen supplementation and mechanical ventilation between the groups. Results Twenty-nine studies fulfilled our inclusion criteria. The case definition for BPD varied substantially in the included studies. Risks were higher among children with BPD compared with non-BPD: RSV hospitalization (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7–4.2; P < .001), ICU admission (OR, 2.9; 95% CI, 2.3–3.5; P < .001), need for oxygen supplementation (OR, 4.2; 95% CI, .5–33.7; P = .175) and mechanical ventilation (OR, 8.2; 95% CI, 7.6–8.9; P < .001), and hCFR (OR, 12.8; 95% CI, 9.4–17.3; P < .001). Median LOS (range) was 7.2 days (4–23) (BPD) compared with 2.5 days (1–30) (non-BPD). Median duration of oxygen supplementation (range) was 5.5 days (0–21) (BPD) compared with 2.0 days (0–26) (non-BPD). The duration of mechanical ventilation was more often longer (>6 days) in those with BPD compared with non-BPD (OR, 11.9; 95% CI, 1.4–100; P = .02). Conclusions The risk of severe RSV disease is considerably higher among children with BPD. There is an urgent need to establish standardized BPD case definitions, review the RSV prophylaxis guidelines, and encourage more specific studies on RSV infection in BPD patients, including vaccine development and RSV-specific treatment.

IFI27 may predict and evaluate the severity of respiratory syncytial virus infection in preterm infants

“…RSV infection remains a major cause of LRTIs and hospital visits during infancy and childhood globally. Preterm infants are much more vulnerable to RSV attack and RSV related LRTIs can be much more severe and even fatal for preterm infants [ 19 ]. However, the specific mechanism of RSV infection is poorly understood.…”

IFI27 may predict and evaluate the severity of respiratory syncytial virus infection in preterm infants

“…RSV infection remains a major cause of LRTIs and hospital visits during infancy and childhood globally. Preterm infants are much more vulnerable to RSV attack and RSV related LRTIs can be much more severe and even fatal for preterm infants (19). However, the speci c mechanism of RSV infection is poorly understood.…”

Respiratory Tract Microecology and Bronchopulmonary Dysplasia in Preterm Infants

“…Both respiratory syncytial virus and rhinovirus colonization lead to severe lower respiratory tract infections that damage lung tissue and lead to chronic lung disease ( 53 ). A study conducted by ( 54 ) found that the rate of respiratory syncytial virus infection was significantly higher in infants with BPD than in infants without BPD ( 55 ). Mourani et al ( 9 ) also believed that early colonization of or exposure to neonatal respiratory pathogens can affect the development of neonatal lung immune function and increase the risk of early or late infection, which may be associated with the subsequent development of BPD.…”