The Impact of Human Rhinovirus Infection in Pediatric Patients Undergoing Heart Surgery

Abstract

Human rhinovirus (HRV), the most common cause of upper respiratory infection in children, can present as bronchiolitis, pneumonia, or asthma exacerbations. The impact of HRV in infants and toddlers with congenital heart disease is poorly defined. A case-control study was performed to compare the clinical course for 19 young children with respiratory symptoms who tested positive for rhinovirus after heart surgery with that of 56 matched control subjects. The control subjects were matched by surgical repair, age, weight, and time of the year. Patients with known HRVs before surgery and control subjects with respiratory symptoms or positive test results for viruses were excluded from the study. Human rhinovirus infection was associated with more than a tenfold increase in the odds of noninvasive ventilation after extubation (odds ratio [OR] 11.45; 95 % confidence interval [CI] 3.97-38.67), a 12-fold increase in the probability of extubation failure (OR 12.84; 95 % CI 2.93-56.29), and increased use of pulmonary medications including bronchodilator and nitric oxide (p < 0.001). As a result, the hospital length of stay (HLOS) was two times longer than for the control subjects (p < 0.001), and the cardiac intensive care unit (CICU) length of stay (CICU LOS) was three times longer (p < 0.0001). The intubation time was significantly longer (p < 0.001), and the CICU respiratory charges were significantly greater (p = 0.001) for the infected patients. Human rhinovirus increases resource use and prolongs postoperative recovery after pediatric heart surgery. Surgery timing should be delayed for patients with rhinovirus if possible.

Impact of respiratory viruses in the neonatal intensive care unit

“…However, some infants did experience substantial morbidity; seven infants progressed from non-invasive to invasive respiratory support, one of whom progressed to ECMO. Others have reported that increases in respiratory support associated with respiratory viruses were associated with an increased length of hospitalization [19][20][21].…”

Epidemiology of viral respiratory infections in children undergoing heart surgery

“…Legend: ASD, atrial septal defect; VSD, ventricular septal defect. mechanical ventilation, more extubation failures, frequent use of bronchodilators, and longer hospital stay [11]. In another study, children submitted to open-heart surgery that had VRI experienced longer hospital and PICU length-of-stay, compared with matched controls [12].…”

“…We speculate that our results were negative because of: (a) limited power, given the small sample size, and (b) detection of viruses in asymptomatic children, since the ones with symptoms of VRI were rescheduled. In the study by Delgado-Corcoran et al [11], children were considered infected when they had symptoms of VRI, while in the study by Spaeder et al [12], infection was defined as the presence of viruses in nasopharyngeal or endotracheal specimens. Although there is evidence that a symptomatic VRI will negatively impact outcomes [12], it is not clear whether asymptomatic presence of a virus in the respiratory system will affect the outcomes.…”

“…Some authors recommend screening for rhinovirus among patients scheduled for congenital heart surgery, especially infants and toddlers with respiratory symptoms, and that surgery should be postponed if positive; they, however, acknowledge that cost-effectiveness is unknown [11]. Simsic et al adopted preoperative testing for respiratory virus by PCR before cardiac surgery for all patients with single-ventricle and, if the test is positive, surgery is rescheduled for 6 weeks, pending a negative follow-up viral PCR [15].…”

Acute viral bronchiolitis in South Africa: Intensive care management for severe disease

“…[7,8] In a case controlled study of children after cardiac surgery, human rhinovirus infect ion was associated with a twelvefold increase in the probability of extubation failure, a threefold increase in duration of PICU stay, and a twofold increase in length of hospital stay. [9] It has been suggested that when human rhinovirus is detected by polymerase chain reaction (PCR) in symptomatic individuals, it is likely to represent true infection. [10] hMPV has been reported in up to 19% of hospitalised SA children with respiratory tract infections (RTIs).…”