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Anderson EJ, Carbonell-Estrany X, Blanken M, Lanari M, Sheridan-Pereira M, Rodgers-Gray B, Fullarton J, Rouffiac E, Vo P, Notario G, Campbell F, Paes B. Burden of Severe Respiratory Syncytial Virus Disease Among 33-35 Weeks' Gestational Age Infants Born During Multiple Respiratory Syncytial Virus Seasons. Pediatr Infect Dis J 2017; 36:160-167. [PMID: 27755464 PMCID: PMC5242218 DOI: 10.1097/inf.0000000000001377] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Moderate-late preterm infants, 33-35 weeks' gestational age (wGA), are at increased risk for respiratory syncytial virus hospitalization (RSVH). The objective of this study is to quantify the burden of RSVH in moderate-late preterm infants. METHODS A pooled analysis was conducted on RSVH from 7 prospective, observational studies in the Northern Hemisphere from 2000 to 2014. Infants' 33-35 wGA without comorbidity born during the respiratory syncytial virus season who did not receive respiratory syncytial virus immunoprophylaxis were enrolled. Data for the first confirmed RSVH during the season (+1 month) were analyzed. Incidence and hospitalization rate per 100 patient-seasons, intensive care unit admission and length of stay (LOS), oxygen support, mechanical ventilation and overall hospital LOS were assessed. RESULTS The pooled analysis comprised 7,820 infants; 267 experienced a confirmed RSVH at a median age of 8.4 weeks. The crude pooled RSVH incidence rate was 3.41% and the rate per 100 patient-seasons was 4.52. Median hospital LOS was 5.7 days. A total of 22.2% of infants required intensive care unit admission for a median LOS of 8.3 days. A total of 70.4% received supplemental oxygen support for a median of 4.9 days, and 12.7% required mechanical ventilation for a median of 4.8 days. CONCLUSIONS The burden of RSVH in moderate-late, 33-35 weeks' wGA preterm infants without comorbidities born during the viral season in Northern Hemisphere countries is substantial. Severe cases required prolonged and invasive supportive therapy.
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Affiliation(s)
- Evan J. Anderson
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Xavier Carbonell-Estrany
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Maarten Blanken
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Marcello Lanari
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Margaret Sheridan-Pereira
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Barry Rodgers-Gray
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - John Fullarton
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Elisabeth Rouffiac
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Pamela Vo
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Gerard Notario
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Fiona Campbell
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
| | - Bosco Paes
- From the Departments of Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA; Neonatology Service, Hospital Clinic, Institut d’Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain; Division of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands; Pediatrics and Neonatology Unit, Imola Hospital, Imola, Italy; Department of Paediatrics, Trinity College and Coombe Women and Infants University Hospital, Dublin, Ireland; Strategen Limited, Basingstoke, United Kingdom; Global Pharmaceutical Research and Development, AbbVie Inc, North Chicago, IL; and Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
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Green RJ. Viral Lower Respiratory Tract Infections. VIRAL INFECTIONS IN CHILDREN, VOLUME II 2017. [PMCID: PMC7122336 DOI: 10.1007/978-3-319-54093-1_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Lower respiratory tract infections in children are often viral in origin. Unfortunately in this time of significant antimicrobial resistance of infectious organisms, especially bacteria, there is still a tendency for clinicians to manage a child who coughs with antibiotics. In addition, the World Health Organization (WHO) has defined “pneumonia” as a condition that only occurs in children who have “fast breathing or chest wall indrawing”. That would delineate upper respiratory tract infections from those in the lower airway. However, in addition to pneumonia another important entity exists in the lower respiratory tract that is almost always viral in origin. This condition is acute viral bronchiolitis. The concept of “acute lower respiratory tract infection” (ALRTI) has emerged and it is becoming increasing evident from a number of studies that the infectious base of both acute pneumonia (AP) and acute bronchiolitis in children has a mixed etiology of microorganisms. Therefore, whilst certain clinical phenotypes do not require antibiotics the actual microbial etiology is much less distinct.
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Affiliation(s)
- Robin J. Green
- Department of Paediatrics and Child Health, University of Pretoria, School of Medicine, Pretoria, ZA, South Africa
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Oliveira-Santos M, Santos JA, Soares J, Dias A, Quaresma M. Influence of meteorological conditions on RSV infection in Portugal. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2016; 60:1807-1817. [PMID: 27059367 DOI: 10.1007/s00484-016-1168-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/29/2016] [Accepted: 04/03/2016] [Indexed: 06/05/2023]
Abstract
Acute viral bronchiolitis is a common cause for infant hospital admissions. Of all etiological agents, respiratory syncytial virus (RSV) is commonly the most frequent. The present study assesses relationships between atmospheric factors and RSV infections in under 3-year-old patients admitted to the Inpatient Paediatric Service of Vila Real (North of Portugal). For this purpose, (1) clinical files of children admitted with a diagnosis of acute bronchiolitis from September 2005 to December 2015 (>10 years) were scrutinised and (2) local daily temperature/precipitation series, as well as six weather types controlling meteorological conditions in Portugal, were used. Fifty-five percent of all 770 admitted children were effectively infected with a given virus, whilst 48 % (367) were RSV+, i.e. 87 % of virus-infected children were RSV+. The bulk of incidence is verified in the first year of age (82 %, 302), slightly higher in males. RSV outbreaks are typically from December to March, but important inter-annual variability is found in both magnitude and shape. Although no clear connections were found between monthly temperatures/precipitation and RSV outbreaks apart from seasonality, a linkage to wintertime cold spells is apparent on a daily basis. Anomalously low minimum temperatures from the day of admittance back to 10 days before are observed. This relationship is supported by anomalously high occurrences of the E and AA weather types over the same period, which usually trigger dry and cold weather. These findings highlight some predictability in the RSV occurrences, revealing potential for modelling and risk assessments.
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Affiliation(s)
- M Oliveira-Santos
- Department of Psychiatry and Mental Health, Centro Hospitalar de Trás-os-Montes e Alto Douro EPE, CHTMAD, Vila Real, Portugal.
| | - J A Santos
- Centre for the Research and Technology of Agro-environmental and Biological Sciences, CITAB, Universidade de Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - J Soares
- Paediatric Department, Centro Hospitalar de Trás-os-Montes e Alto Douro EPE, CHTMAD, Vila Real, Portugal
| | - A Dias
- Paediatric Department, Centro Hospitalar de Trás-os-Montes e Alto Douro EPE, CHTMAD, Vila Real, Portugal
| | - M Quaresma
- Paediatric Department, Centro Hospitalar de Trás-os-Montes e Alto Douro EPE, CHTMAD, Vila Real, Portugal
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Characterizing the risk of respiratory syncytial virus in infants with older siblings: a population-based birth cohort study. Epidemiol Infect 2016; 145:266-271. [PMID: 27821195 DOI: 10.1017/s0950268816002545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
From a population-based birth cohort of 245 249 children born in Western Australia during 1996-2005, we used linkage of laboratory and birth record datasets to obtain data including all respiratory syncytial virus (RSV) detections during infancy from a subcohort of 87 981 singleton children born in the Perth metropolitan area from 2000 to 2004. Using log binomial regression, we found that the risk of infant RSV detection increases with the number of older siblings, with those having ⩾3 older siblings experiencing almost three times the risk (relative risk 2·83, 95% confidence interval 2·46-3·26) of firstborn children. We estimate that 45% of the RSV detections in our subcohort were attributable to infection from an older sibling. The sibling effect was significantly higher for those infants who were younger during the season of peak risk (winter) than those who were older. Although older siblings were present in our cohort, they had very few RSV detections which could be temporally linked to an infant's infection. We conclude that RSV infection in older children leads to less severe symptoms but is nevertheless an important source of infant infection. Our results lend support to a vaccination strategy which includes family members in order to provide maximum protection for newborn babies.
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Intensive Care Unit Admission and Death Rates of Infants Admitted With Respiratory Syncytial Virus Lower Respiratory Tract Infection in Mexico. Pediatr Infect Dis J 2016; 35:1199-1203. [PMID: 27276178 DOI: 10.1097/inf.0000000000001262] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the most common etiology for acute respiratory infection hospital admissions in young children. Case fatality rates for hospitalized patients range between 0% and 3.4%. Recent reports indicate that deaths associated with RSV are uncommon in developed countries. However, the role of this virus as a current cause of mortality in other countries requires further examination. METHODS Children with RSV infection admitted between May 2003 and December 2014 to a level 2 specialty hospital in Mexico were included in this analysis. Underlying risk factors, admission to the intensive care unit (ICU) and condition on discharge were assessed to determine the ICU admission and death rates associated to RSV infection. RESULTS We analyzed data of 1153 patients with RSV infection in whom information regarding underlying illnesses and discharge status was available. Sixty patients (5.2 %) were admitted to the ICU and 12 (1.04 %) died. Relevant underlying conditions were present in 320 (27.7%) patients. Infants with underlying respiratory disorders (excluding asthma) and a history of prematurity had high ICU admission rates (17.1% and 13.8%, respectively). Mortality rates were highest for infants with respiratory disease (excluding asthma) (7.3%), cardiovascular diseases (5.9%) and neurologic disorders (5.3%). The ICU admission and death rates were higher in infants <6 months of age than in other age groups. CONCLUSIONS The ICU admission rate and mortality rate in Mexican infants hospitalized with RSV infection were 5.2% and 1%, respectively. Mortality rates were high in infants with respiratory, cardiovascular and neurologic disorders.
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Pignotti MS, Carmela Leo M, Pugi A, De Masi S, Biermann KP, Galli L, Vitali Rosati G, Buonocore G, Mugelli A, Dani C, Lucenteforte E, Bellini F, Donzelli G. Consensus conference on the appropriateness of palivizumab prophylaxis in respiratory syncytial virus disease. Pediatr Pulmonol 2016; 51:1088-1096. [PMID: 27618642 DOI: 10.1002/ppul.23561] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/22/2016] [Accepted: 08/10/2016] [Indexed: 11/11/2022]
Abstract
Respiratory syncytial virus infection represents a clinical burden among young children under 24 months. Palivizumab is the only drug licensed in Italy for the prevention of serious lower respiratory tract disease requiring hospitalization caused by respiratory syncytial virus in children at high risk. However recommendations for palivizumab prophylaxis are heterogeneous. Not all the published documents agree about the clinical indications of palivizumab; this could lead to different clinical practices and concerns about the appropriateness of prophylaxis. These issues and the lack of evidence about palivizumab prophylaxis efficacy in specific medical conditions brought on the idea of a consensus conference on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications. The goal was to perform a review of the evidence regarding the efficacy and the safety of palivizumab and give recommendations in order to harmonize its use. A structured and validated method to conduct the consensus process was adopted. The consensus conference recommends palivizumab prophylaxis in infants born before 29 weeks and younger than 12 months at the start of the epidemic season. According to evidence from literature and experts' opinion, palivizumab prophylaxis is not recommended in preterm infants of gestational age ≥29 weeks, without co-morbidity (i.e., cardiac, bronchopulmonary diseases). The experts identified some clinical rare conditions for which the decision of prophylaxis should be entrusted to the specialists. The evaluation of the appropriateness of palivizumab prophylaxis in the single patient should be documented by the specialists. Pediatr Pulmonol. 2016;51:1088-1096. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Alessandra Pugi
- Meyer Children's Hospital, Viale Pieraccini 24, Florence, Italy
| | | | | | - Luisa Galli
- Meyer Children's Hospital, Viale Pieraccini 24, Florence, Italy
| | | | | | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Carlo Dani
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
| | - Ersilia Lucenteforte
- Department of Neurosciences, Psychology, Drug Research and Children's Health, University of Florence, Florence, Italy
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Caffarelli C, Santamaria F, Di Mauro D, Mastrorilli C, Mirra V, Bernasconi S. Progress in pediatrics in 2015: choices in allergy, endocrinology, gastroenterology, genetics, haematology, infectious diseases, neonatology, nephrology, neurology, nutrition, oncology and pulmonology. Ital J Pediatr 2016; 42:75. [PMID: 27566421 PMCID: PMC5002164 DOI: 10.1186/s13052-016-0288-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 08/10/2016] [Indexed: 12/29/2022] Open
Abstract
This review focuses key advances in different pediatric fields that were published in Italian Journal of Pediatrics and in international journals in 2015. Weaning studies continue to show promise for preventing food allergy. New diagnostic tools are available for identifying the allergic origin of allergic-like symptoms. Advances have been reported in obesity, short stature and autoimmune endocrine disorders. New molecules are offered to reduce weight gain and insulin-resistance in obese children. Regional investigations may provide suggestions for preventing short stature. Epidemiological studies have evidenced the high incidence of Graves' disease and Hashimoto's thyroiditis in patients with Down syndrome. Documentation of novel risk factors for celiac disease are of use to develop strategies for prevention in the population at-risk. Diagnostic criteria for non-celiac gluten sensitivity have been reported. Negative effect on nervous system development of the supernumerary X chromosome in Klinefelter syndrome has emerged. Improvements have been made in understanding rare diseases such as Rubinstein-Taybi syndrome. Eltrombopag is an effective therapy for immune trombocytopenia. Children with sickle-cell anemia are at risk for nocturnal enuresis. Invasive diseases caused by Streptococcus pyogenes are still common despite of vaccination. No difference in frequency of antibiotic prescriptions for acute otitis media between before the publication of the national guideline and after has been found. The importance of timing of iron administration in low birth weight infants, the effect of probiotics for preventing necrotising enterocolitis and perspectives for managing jaundice and cholestasis in neonates have been highlighted. New strategies have been developed to reduce the risk for relapse in nephrotic syndrome including prednisolone during upper respiratory infection. Insights into the pathophysiology of cerebral palsy, arterial ischemic stroke and acute encephalitis may drive advances in treatment. Recommendations on breastfeeding and complementary feeding have been updated. Novel treatments for rhabdomyosarcoma should be considered for paediatric patients. Control of risk factors for bronchiolitis and administration of pavilizumab for preventing respiratory syncytial virus infection may reduce hospitalization. Identification of risk factors for hospitalization in children with wheezing can improve the management of this disease. Deletions or mutations in genes encoding proteins for surfactant function may cause diffuse lung disease.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Dora Di Mauro
- Clinica Pediatrica, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Carla Mastrorilli
- Clinica Pediatrica, Department of Clinical and Experimental Medicine, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Virginia Mirra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Sergio Bernasconi
- Pediatrics Honorary Member University Faculty, G D’Annunzio University of Chieti-Pescara, Chieti, Italy
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Roggeri DP, Roggeri A, Rossi E, Cataudella S, Martini N. Impact of hospitalizations for bronchiolitis in preterm infants on long-term health care costs in Italy: a retrospective case-control study. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:407-12. [PMID: 27536151 PMCID: PMC4976809 DOI: 10.2147/ceor.s111535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Bronchiolitis is an acute inflammatory injury of the bronchioles, and is the most frequent cause of hospitalization for lower respiratory tract infections in preterm infants. This was a retrospective, observational, case-control study conducted in Italy, based on administrative database analysis. The aim of this study was to evaluate differences in health care costs of preterm infants with and without early hospitalization for bronchiolitis. Patients and methods Preterm infants born in the period between January 1, 2009 and December 31, 2010 and hospitalized for bronchiolitis in the first year of life were selected from the ARNO Observatory database and observed for the first 4 years of life. These preterm infants were compared (paired 1–3) with preterm infants who were not hospitalized for bronchiolitis in the first year of life and with similar characteristics. Only direct health care costs reimbursed by the Italian National Health Service were considered for this study (drugs, hospitalizations, and diagnostic/therapeutic procedures). Results Of 40,823 newborns in the accrual period, 863 were preterm with no evidence of prophylaxis, and 22 preterm infants were hospitalized for bronchiolitis (cases) and paired with 62 controls. Overall, cases had 74% higher average cost per infant in the first 4 years of life than controls (18,624€ versus 10,189€, respectively). The major cost drivers were hospitalizations, accounting for >90% in both the populations. The increase in total yearly health care cost between cases and controls remained substantial even in the fourth year of life for all cost items. A relevant increase in hospitalizations and drug consumption linked to respiratory tract diseases was noted in infants hospitalized for bronchiolitis during the entire follow-up period. Conclusion Preterm infants hospitalized for bronchiolitis in the first year of life were associated with increased resource consumption and costs throughout the entire period of observation; even in the fourth year, the difference versus paired controls was relevant.
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Balekian DS, Linnemann RW, Castro VM, Perlis R, Thadhani R, Camargo CA. Pre-birth cohort study of atopic dermatitis and severe bronchiolitis during infancy. Pediatr Allergy Immunol 2016; 27:413-8. [PMID: 26766307 PMCID: PMC10983116 DOI: 10.1111/pai.12532] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infants hospitalized for bronchiolitis (i.e. severe bronchiolitis) are at increased risk of childhood asthma. There are many known risk factors for severe bronchiolitis, including cardiac and pulmonary diseases. Less is known about the association between atopic diseases and risk of severe bronchiolitis. We sought to further examine risk factors for severe bronchiolitis, focusing on atopic dermatitis (AD). METHODS We conducted a nested cohort study within the Massachusetts General Hospital Obstetric Maternal Study (MOMS), a prospective cohort of pregnant women enrolled during 1998-2006. Children of mothers enrolled in MOMS were included in the analysis if they received care within our health system (n = 5407). Potential risk factors for bronchiolitis and hospitalization data were extracted from the children's electronic health records; we also examined pregnancy and perinatal risk factors collected from the underlying MOMS data. RESULTS During the first year of life, 125 infants (2.3%) had severe bronchiolitis. Eighteen of these patients had AD; 11 (61%) were diagnosed with AD prior to bronchiolitis hospitalization. In unadjusted analyses, AD was associated with severe bronchiolitis (χ(2) 14.6; p < 0.001). In multivariable analyses adjusting for nine known risk factors for severe bronchiolitis, including demographics, birth season, disposition at birth, cardiac disease, maternal parity, and delivery mode, AD was associated with increased odds of severe bronchiolitis (odds ratio 2.72, 95% confidence interval 1.60-4.63). CONCLUSIONS Atopic dermatitis is significantly associated with severe bronchiolitis in infancy. The mechanism of the AD-bronchiolitis association is unclear and merits further study; this research may shed light on the pathogenesis of asthma.
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Affiliation(s)
- Diana S. Balekian
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Rachel W. Linnemann
- Harvard Medical School, Boston, MA, USA
- Division of Pediatric Pulmonology, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Victor M. Castro
- Research Information Systems and Computing, Partners HealthCare System, Boston, MA, USA
- Department of Neurology, Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA, USA
| | - Roy Perlis
- Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Ravi Thadhani
- Harvard Medical School, Boston, MA, USA
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Carlos A. Camargo
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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Silvestri M, Marando F, Costanzo AM, di Luzio Paparatti U, Rossi GA. Respiratory Syncytial Virus-associated hospitalization in premature infants who did not receive palivizumab prophylaxis in Italy: a retrospective analysis from the Osservatorio Study. Ital J Pediatr 2016; 42:40. [PMID: 27112952 PMCID: PMC4845497 DOI: 10.1186/s13052-016-0252-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to different social and epidemiological factors, the eligibility criteria to receive palivizumab prophylaxis may be different between countries, especially in "otherwise healthy" late preterm infants. METHODS We analyzed an Italian database of young children referred to emergency departments for acute lower respiratory tract infection (ALRI) during the RSV season over a four year period, when the use of palivizumab as prophylaxis for RSV disease was not widespread in premature infants. The demographic and environmental characteristics and the RSV positivity (RSV(+)) in hospitalized and not-hospitalized patients were compared. In the data analysis we divided children according to their chronologic age (age) and their week gestational age (wGA). RESULTS Out of the 100 children evaluated, 68 were infants (≤12 month-age): 7.5 and 20.6 % were in the <29 and 29- < 32 wGA groups respectively, and 72.0 % in the 32- < 35 wGA group. Positive hospitalized-to-not-hospitalized ratios were found in all three wGA groups, progressively decreasing (from 4.0 to 1.2), with increasing wGA (p = 0.35). The percentage of hospitalized infants that were also RSV(+) was also progressively decreasing (from 40.0 to 28.6 % and 18.4 %) with increasing wGA (p = 0.43). In the >12 month-age group (N = 32), there was positive hospitalized-to-not-hospitalized ratio only in the <29 wGA group with a low RSV(+) frequency (<29 %) in all wGA groups. In the ≤12 month-age group, 41 infants were evaluated with a ≤6 month-age and 27 with a >6-12 month-age. A positive hospitalized-to-not-hospitalized ratios was found in all wGA groups in ≤6 month-age infants, despite a low RSV(+) frequency in the 29- < 32 and 32- < 35 wGA group. In the >6-12 month-age group, all infants with a <29 and 29- < 32 wGA were hospitalized with a relatively high RSV(+) frequency whilst the 32- < 35 wGA group showed a negative hospitalized-to-not-hospitalized ratio with a lower RSV(+) frequency. CONCLUSIONS The hospitalized-to-not-hospitalized ratios and RSV(+) frequency in the first 12 months of age in infants born prematurely confirm the vulnerability of these children for clinically important RSV infection, most notably in the <32 wGA category.
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Affiliation(s)
- Michela Silvestri
- />Pediatric Pulmonology and Allergy Unit and Cystic Fibrosis Center, Istituto Giannina Gaslini, Genoa, Italy
| | - Francesca Marando
- />AbbVie, Medical Department, Campoverde di Aprilia (LT), Campoverde di Aprilia (Latina), Italy
| | - Anna Maria Costanzo
- />AbbVie, Medical Department, Campoverde di Aprilia (LT), Campoverde di Aprilia (Latina), Italy
| | | | - Giovanni A. Rossi
- />Pediatric Pulmonology and Allergy Unit and Cystic Fibrosis Center, Istituto Giannina Gaslini, Genoa, Italy
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Jeong Y, Hwang JH, Kwon JY, Shin J, Kwon JH, Han K, Seo WH, Choung JT. Prediction of the severity and length of hospital stay in infants with acute bronchiolitis using the severity score. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.6.429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yeongsang Jeong
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Ji Hyen Hwang
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Ji Yoon Kwon
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jeonghee Shin
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jung Hyun Kwon
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won Hee Seo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Ji Tae Choung
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
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Lanari M, Vandini S, Adorni F, Prinelli F, Di Santo S, Silvestri M, Musicco M. Prenatal tobacco smoke exposure increases hospitalizations for bronchiolitis in infants. Respir Res 2015; 16:152. [PMID: 26695759 PMCID: PMC4699376 DOI: 10.1186/s12931-015-0312-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 12/09/2015] [Indexed: 11/29/2022] Open
Abstract
Background Tobacco smoke exposure (TSE) is a worldwide health problem and it is considered a risk factor for pregnant women’s and children’s health, particularly for respiratory morbidity during the first year of life. Few significant birth cohort studies on the effect of prenatal TSE via passive and active maternal smoking on the development of severe bronchiolitis in early childhood have been carried out worldwide. Methods From November 2009 to December 2012, newborns born at ≥33 weeks of gestational age (wGA) were recruited in a longitudinal multi-center cohort study in Italy to investigate the effects of prenatal and postnatal TSE, among other risk factors, on bronchiolitis hospitalization and/or death during the first year of life. Results Two thousand two hundred ten newborns enrolled at birth were followed-up during their first year of life. Of these, 120 (5.4 %) were hospitalized for bronchiolitis. No enrolled infants died during the study period. Prenatal passive TSE and maternal active smoking of more than 15 cigarettes/daily are associated to a significant increase of the risk of offspring children hospitalization for bronchiolitis, with an adjHR of 3.5 (CI 1.5–8.1) and of 1.7 (CI 1.1–2.6) respectively. Conclusions These results confirm the detrimental effects of passive TSE and active heavy smoke during pregnancy for infants’ respiratory health, since the exposure significantly increases the risk of hospitalization for bronchiolitis in the first year of life. Electronic supplementary material The online version of this article (doi:10.1186/s12931-015-0312-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marcello Lanari
- Pediatrics and Neonatology Unit, Imola Hospital, Via Montericco, 4, Imola, Italy.
| | - Silvia Vandini
- Neonatology Unit, S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11 40138, Bologna, Italy.
| | - Fulvio Adorni
- Epidemiology and Biostatistics Unit, Institute of Biomedical Technologies, National Research Council Milan, Via Fratelli Cervi 93, Segrate, MI, Italy.
| | - Federica Prinelli
- Epidemiology and Biostatistics Unit, Institute of Biomedical Technologies, National Research Council Milan, Via Fratelli Cervi 93, Segrate, MI, Italy.
| | - Simona Di Santo
- Epidemiology and Biostatistics Unit, Institute of Biomedical Technologies, National Research Council Milan, Via Fratelli Cervi 93, Segrate, MI, Italy. .,Department of Neuroscience, Foundation IRCCS Santa Lucia, Via Ardeatina 306, Rome, Italy.
| | - Michela Silvestri
- Pediatric Pulmonology and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy.
| | - Massimo Musicco
- Epidemiology and Biostatistics Unit, Institute of Biomedical Technologies, National Research Council Milan, Via Fratelli Cervi 93, Segrate, MI, Italy. .,Department of Neuroscience, Foundation IRCCS Santa Lucia, Via Ardeatina 306, Rome, Italy.
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63
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Bollani L, Baraldi E, Chirico G, Dotta A, Lanari M, Del Vecchio A, Manzoni P, Boldrini A, Paolillo P, Di Fabio S, Orfeo L, Stronati M, Romagnoli C. Revised recommendations concerning palivizumab prophylaxis for respiratory syncytial virus (RSV). Ital J Pediatr 2015; 41:97. [PMID: 26670908 PMCID: PMC4681171 DOI: 10.1186/s13052-015-0203-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/25/2015] [Indexed: 11/12/2022] Open
Abstract
Respiratory Syncytial Virus infections are one of the leading causes of severe respiratory diseases that require hospitalization and, in some cases, intensive care. Once resolved, there may be respiratory sequelae of varying severity. The lack of effective treatments for bronchiolitis and the lack of vaccines for RSV accentuate the role of prevention in decreasing the impact of this disease. Prevention of bronchiolitis strongly relies on the adoption of environment and the hygienic behavior measures; an additional prophylactic effect may be offered, in selected cases, by Palivizumab, a humanized monoclonal antibody produced by recombinant DNA technology, able to prevent RSV infection by blocking viral replication.After many years the Italian Society of Neonatology, on the basis of the most recent scientific knowledge, has decided to revise recommendations for the use of palivizumab in the prevention of RSV infection.
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Affiliation(s)
- Lina Bollani
- Unità di Neonatologia, Patologia Neonatale e Terapia Intensiva, Policlinico S. Matteo, Pavia, Italy.
| | - Eugenio Baraldi
- U.O.C. Terapia Intensiva e patologia neonatale, A.O. Padova, Padova, Italy.
| | - Gaetano Chirico
- U.O. C. Neonatologia e Terapia Intensiva neonatale, A.O. Spedali civili, Brescia, Italy.
| | - Andrea Dotta
- U.O.C. Terapia intensiva neonatale, Ospedale pediatrico Bambino Gesù, Roma, Italy.
| | - Marcello Lanari
- U.O. Pediatria E Neonatologia , Ospedale Nuovo S. Maria della Scaletta, Imola, Italy.
| | - Antonello Del Vecchio
- U.O. Utin e Neonatologia, Azienda Ospedaliera di Venere e Giovanni XXIII, Bari, Italy.
| | - Paolo Manzoni
- U.O. Neonatologia e TIN ospedaliera, Azienda Ospedaliera OIRM-S. Anna, Torino, Italy.
| | - Antonio Boldrini
- U.O. Nido, Patologia Neonatale e Terapia Intensiva Neonatale, Ospedale Santa Chiara, Pisa, Italy.
| | | | - Sandra Di Fabio
- U.O. Neonatologia, Presidio Ospedaliero S. Salvatore, L'Aquila, Italy.
| | - Luigi Orfeo
- U.O. Nido, Patologia Neonatale e Terapia Intensiva Neonatale, Azienda Ospedaliera G. Rummo, Benevento, Italy.
| | - Mauro Stronati
- Unità di Neonatologia, Patologia Neonatale e Terapia Intensiva, Ospedale Policlinico S. Matteo, Pavia, Italy.
| | - Costantino Romagnoli
- U.O.C. Neonatologia, Policlinico Universitario A. Gemelli, Roma, Italy.
- Division of Neonatology, Department of Pediatrics, Catholic University S.H., Largo A. Gemelli,8, Rome, 00168, Italy.
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Abraha HY, Lanctôt KL, Paes B. Risk of respiratory syncytial virus infection in preterm infants: reviewing the need for prevention. Expert Rev Respir Med 2015; 9:779-99. [PMID: 26457970 DOI: 10.1586/17476348.2015.1098536] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Premature infants are at substantial risk for a spectrum of morbidities that are gestational age dependent. Respiratory syncytial virus (RSV) infection is most common in the first two years of life with the highest burden in children aged <6 months. Preterm infants ≤35 weeks' gestation are handicapped by incomplete immunological and pulmonary maturation and immature premorbid lung function with the added risk of bronchopulmonary dysplasia. Superimposed RSV infection incites marked neutrophilic airway inflammation and innate immunological responses that further compromise normal airway modeling. This review addresses the epidemiology and burden of RSV disease, focusing on the preterm population. Risk factors that determine RSV-disease severity and hospitalization and the impact on healthcare resource utilization and potential long-term respiratory sequelae are discussed. The importance of disease prevention and the evidence-based rationale for prophylaxis with palivizumab is explored, while awaiting the development of a universal vaccine.
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Affiliation(s)
- Haben Y Abraha
- a Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre , University of Toronto , Toronto , Ontario , Canada
| | - Krista L Lanctôt
- a Medical Outcomes and Research in Economics (MORE®) Research Group, Sunnybrook Health Sciences Centre , University of Toronto , Toronto , Ontario , Canada
| | - Bosco Paes
- b Division of Neonatology, Department of Pediatrics , McMaster University , Hamilton , Ontario , Canada
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