Respiratory syncytial virus infection in children with congenital heart disease: global data and interim results of Korean RSV-CHD survey

Abstract

Respiratory syncytial virus (RSV) is a main cause of hospitalization for bronchiolitis and pneumonia in infants worldwide. Children with hemodynamically significant congenital heart disease (HS-CHD), as well as premature infants are at high risk for severe RSV diseases. Mortality rates for CHD patients hospitalized with RSV have been reported as about 24 times higher compared with those without RSV infection. Recently with advances in intensive care, mortality rates in CHD patients combined with RSV have decreased below 2%. The requirements of intensive care and mechanical ventilation for CHD patients with RSV infection were still higher than those without RSV infection or with non-CHD children. RSV infection has frequently threatened CHD infants with congestive heart failure, cyanosis, or with pulmonary hypertension. As a progressive RSV pneumonitis in those infants develops, the impairment of oxygen uptake, the breathing workload gradually increases and eventually causes to significant pulmonary hypertension, even after the operation. Preventing RSV infection as much as possible is very important, especially in infants with HS-CHD. A humanized monoclonal antibody, palivizumab, has effective in preventing severe RSV disease in high-risk infants, and progressive advances in supportive care including pulmonary vasodilator have dramatically decreased the mortality (<1%). Depending on the global trend, Korean Health Insurance guidelines have approved the use of palivizumab in children <1 year of age with HS-CHD since 2009. Korean data are collected for RSV prophylaxis in infants with CHD.

Clinical and epidemiologic profile of lower respiratory tract infections associated with human bocavirus

“…However, such strategy might have contributed to a lower severity of our cases when compared with other studies in which cases with underlying diseases were not excluded. [31][32][33] HBoV detection followed a seasonal distribution, similar to that classically described for RSV. 21,34 Conversely, in other populations, occurrence of the virus did not appear to be associated with any particular time of year.…”

“…The objective of the exclusion of patients with underlying diseases was to make the sample more homogeneous regarding clinical manifestations associated only with viral etiology. However, such strategy might have contributed to a lower severity of our cases when compared with other studies in which cases with underlying diseases were not excluded …”

Pediatric Pulmonary Hypertension

“…628,629 Because respiratory viral and bacterial infections are common throughout childhood and adversely affect outcomes of children with PH, we make similar recommendations for the use of respiratory syncytial virus, influenza, and pneumococcal vaccines as defined in these other settings. [629][630][631] In addition, involvement of an experienced PH team during even routine surgical and dental procedures can reduce complications related to anesthesia in children with PH. 78,79,632 Recommendations concerning the potential harm of pregnancy in young women with PH, 633 caution with intense exercise, 134,634 and the availability and use of supplemental oxygen for airplane travel, 635 as well as the growing awareness that family issues are especially critical for childhood disease, 636 are also highlighted.…”

Respiratory Syncytial Virus Infections among Children with Congenital Heart Disease

“…Spontaneous breathing of infants is characterized by a functional residual capacity that is less than the closing capacity, which leads to areas of mechanical collapse of the alveoli. As a result the infant itself is more susceptible to develop ventilation/perfusion mismatch and is at higher risk for respiratory problems just from anatomy and pathophysiology irrespective of congenital heart disease [3].…”