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Manzoni P, Viora E, Lanari M, Iantomasi R, Montuori EA, Rodgers-Gray B, Waghorne N, Masturzo B. Maternal Risk Factors for Respiratory Syncytial Virus Lower Respiratory Tract Infection in Otherwise Healthy Preterm and Term Infants: A Systematic Review and Meta-analysis. Pediatr Infect Dis J 2024; 43:763-771. [PMID: 38754000 DOI: 10.1097/inf.0000000000004387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND/OBJECTIVE To date, there is no published, formal assessment of all maternal risk factors for respiratory syncytial virus lower respiratory tract infection (RSV-LRTI) in infants. A systematic literature review and meta-analysis were undertaken to ascertain: What maternal risk factors are associated with an increased risk of RSV-LRTI in infants? METHODS The systematic literature review used explicit methods to identify, select and analyze relevant data. PubMed, Embase and the Cochrane Library were searched (November 2022) using terms regarding: (1) RSV/LRTI; (2) risk factors; (3) pregnant/postpartum population. Bayesian meta-analysis compared RSV hospitalization (RSVH) risk in infants born to mothers with or without certain risk factors. RESULTS A total of 2353 citations were assessed and 20 were included in the final review (10 individual studies; 10 pooled analyses). In 10 studies examining infants (<1 year) without comorbidities (primary outcome), 10 maternal risk factors were associated with RSV-LRTI/RSVH in multivariate analyses. Meta-analysis revealed smoking while pregnant increased infant RSVH risk by 2.01 (95% credible interval: 1.52-2.64) times, while breast-feeding was protective (0.73, 95% credible interval: 0.58-0.90). Risk scoring tools have reported that maternal risk factors contribute between 9% and 21% of an infant's total risk score for RSVH. CONCLUSIONS A greater understanding of maternal risk factors and their relative contribution to infant RSV-LRTI will enable more accurate assessments of the impact of preventive strategies.
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Affiliation(s)
- Paolo Manzoni
- From the Department of Maternal-Infant Medicine, "Degli Infermi" Hospital, University of Torino School of Medicine, Ponderano, Biella, Italy
| | - Elsa Viora
- Obstetrics and Gynecology Department, Città della Salute e della Scienza S. Anna Hospital, Torino, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliera Universitaria di Bologna, Bologna, Italy
| | | | | | | | | | - Bianca Masturzo
- Obstetrics and Gynecology Unit, Department of Maternal-Infant Medicine, "Degli Infermi" Hospital, Ponderano, Biella, Italy
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2
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Paes B, Lanari M, Rodgers-Gray B, Fullarton J, Carbonell-Estrany X. Opinion: The optimal use of risk factors to guide palivizumab prophylaxis against severe respiratory syncytial virus infection in moderate-to-late preterm infants. Front Pediatr 2024; 12:1343960. [PMID: 38283631 PMCID: PMC10811053 DOI: 10.3389/fped.2024.1343960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Affiliation(s)
- Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, ON, Canada
| | - Marcello Lanari
- Paediatric Emergency Unit, IRCCS-Policlinico Ospedaliero-Universitario di Bologna, Bologna, Italy
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Singh S, Maheshwari A, Namazova I, Benjamin JT, Wang Y. Respiratory Syncytial Virus Infections in Neonates: A Persisting Problem. NEWBORN (CLARKSVILLE, MD.) 2023; 2:222-234. [PMID: 38348152 PMCID: PMC10860331 DOI: 10.5005/jp-journals-11002-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections in young infants. It is an enveloped, single-stranded, nonsegmented, negative-strand RNA virus, a member of the family Pneumoviridae. Globally, RSV is responsible for 2.3% of deaths among neonates 0-27 days of age. Respiratory syncytial virus infection is most common in children aged below 24 months. Neonates present with cough and fever. Respiratory syncytial virus-associated wheezing is seen in 20% infants during the first year of life of which 2-3% require hospitalization. Reverse transcriptase polymerase chain reaction (RT-PCR) gives fast results and has higher sensitivity compared with culture and rapid antigen tests and are not affected by passively administered antibody to RSV. Therapy for RSV infection of the LRT is mainly supportive, and preventive measures like good hygiene and isolation are the mainstay of management. Standard precautions, hand hygiene, breastfeeding and contact isolation should be followed for RSV-infected newborns. Recent AAP guidelines do not recommend pavilizumab prophylaxis for preterm infants born at 29-35 weeks without chronic lung disease, hemodynamically significant congenital heart disease and coexisting conditions. RSV can lead to long-term sequelae such as wheezing and asthma, associated with increased healthcare costs and reduced quality of life.
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Affiliation(s)
- Srijan Singh
- Neonatologist, Kailash Hospital, Noida, Uttar Pradesh, India
- Global Newborn Society (https://www.globalnewbornsociety.org/)
| | - Akhil Maheshwari
- Global Newborn Society (https://www.globalnewbornsociety.org/)
- Department of Pediatrics, Louisiana State University, Shreveport, Louisiana, United States of America
| | - Ilhama Namazova
- Global Newborn Society (https://www.globalnewbornsociety.org/)
- Department of Pediatrics, Azerbaijan Tibb Universiteti, Baku, Azerbaijan
| | - John T Benjamin
- Global Newborn Society (https://www.globalnewbornsociety.org/)
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Yuping Wang
- Department of Obstetrics and Gynaecology, Louisiana State University, Shreveport, Louisiana, United States of America
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4
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Mosalli R, Al Matrafi A, Alqarni S, Khayyat W, Paes B. Are multiple births at greater risk for RSV-related hospitalisation compared with singletons? Arch Dis Child 2022; 107:193-197. [PMID: 34728463 DOI: 10.1136/archdischild-2021-322856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/13/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Rafat Mosalli
- Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia .,Department of Pediatrics, International Medical Center, Jeddah, Saudi Arabia
| | | | - Sarah Alqarni
- Umm Al-Qura University College of Medicine, Makkah, Saudi Arabia
| | - Wed Khayyat
- Umm Al-Qura University College of Medicine, Makkah, Saudi Arabia
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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5
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Gebremedhin AT, Hogan AB, Blyth CC, Glass K, Moore HC. Developing a prediction model to estimate the true burden of respiratory syncytial virus (RSV) in hospitalised children in Western Australia. Sci Rep 2022; 12:332. [PMID: 35013434 PMCID: PMC8748465 DOI: 10.1038/s41598-021-04080-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 12/14/2021] [Indexed: 12/23/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a leading cause of childhood morbidity, however there is no systematic testing in children hospitalised with respiratory symptoms. Therefore, current RSV incidence likely underestimates the true burden. We used probabilistically linked perinatal, hospital, and laboratory records of 321,825 children born in Western Australia (WA), 2000-2012. We generated a predictive model for RSV positivity in hospitalised children aged < 5 years. We applied the model to all hospitalisations in our population-based cohort to determine the true RSV incidence, and under-ascertainment fraction. The model's predictive performance was determined using cross-validated area under the receiver operating characteristic (AUROC) curve. From 321,825 hospitalisations, 37,784 were tested for RSV (22.8% positive). Predictors of RSV positivity included younger admission age, male sex, non-Aboriginal ethnicity, a diagnosis of bronchiolitis and longer hospital stay. Our model showed good predictive accuracy (AUROC: 0.87). The respective sensitivity, specificity, positive predictive value and negative predictive values were 58.4%, 92.2%, 68.6% and 88.3%. The predicted incidence rates of hospitalised RSV for children aged < 3 months was 43.7/1000 child-years (95% CI 42.1-45.4) compared with 31.7/1000 child-years (95% CI 30.3-33.1) from laboratory-confirmed RSV admissions. Findings from our study suggest that the true burden of RSV may be 30-57% higher than current estimates.
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Affiliation(s)
- Amanuel Tesfay Gebremedhin
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia.
| | - Alexandra B Hogan
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia
- School of Medicine, The University of Western Australia, Perth, WA, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
- PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Perth, WA, Australia
| | - Kathryn Glass
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, 6872, Australia
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6
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Butt M, Elliott L, Guy F, Symington A, Paes B. Comparison of the Canadian vs. the international risk scoring tool for respiratory syncytial virus prophylaxis in moderate-to-late preterm infants. Front Pediatr 2022; 10:997349. [PMID: 36683806 PMCID: PMC9851620 DOI: 10.3389/fped.2022.997349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
AIM The study objective was to compare the Pediatric Investigators Collaborative Network on Infections in Canada risk scoring tool (CRST) that determines need for respiratory syncytial virus (RSV) prophylaxis in infants 33-35 weeks gestational age during the RSV season, with the newly developed international risk scoring tool (IRST). METHODS Children 33-35 weeks gestational age born during the 2018-2021 RSV seasons were prospectively identified following birth and scored with the validated CRST and IRST, that comprises seven and three variables respectively, into low- moderate- and high-risk groups that predict RSV-related hospitalization. Correlations between total scores on the two tools, and cut-off scores for the low-, moderate- and high-risk categories were conducted using the Spearman rank correlation. RESULTS Over a period of 3 RSV seasons, 556 infants were scored. Total risk scores on the CRST and the IRST were moderately correlated (rs = 0.64, p < 0.001). A significant relationship between the risk category rank on the CRST and the risk category rank on the IRST (rs = 0.53; p < 0.001) was found. The proportion of infants categorized as moderate risk for RSV hospitalization by the CRST and IRST were 19.6% (n = 109) and 28.1% (n = 156), respectively. CONCLUSION The IRST may provide a time-efficient scoring alternative to the CRST with three vs. seven variables, and it selects a larger number of infants who are at moderate risk for RSV hospitalization for prophylaxis. A cost-utility analysis is necessary to justify country-specific use of the IRST, while in Canada a cost comparison is necessary between the IRST vs. the currently approved CRST prior to adoption.
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Affiliation(s)
- Michelle Butt
- School of Nursing, McMaster University, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - LouAnn Elliott
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Fiona Guy
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Amanda Symington
- Department of Pediatrics, St. Catharines General Hospital, Niagara Health, St. Catharines, ON, Canada
| | - Bosco Paes
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
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7
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Rodríguez-Álvarez D, Rodríguez-De Tembleque C, Cendejas-Bueno E, Pérez-Costa E, Díez-Sebastian J, De la Oliva P. Severity of bronchiolitis in infants is associated with their parents' tobacco habit. Eur J Pediatr 2021; 180:2563-2569. [PMID: 34002301 DOI: 10.1007/s00431-021-04099-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/25/2021] [Accepted: 05/02/2021] [Indexed: 12/29/2022]
Abstract
The aim of this study was to investigate the effect of tobacco smoke exposure among severely pediatric ICU patients. A prospective epidemiological observational study was conducted among children with bronchiolitis younger than 2 years of age admitted to the Pediatric Intensive Care Unit of Children's University Hospital La Paz during the October 2017 to March 2018 outbreak. On admission, parents were asked whether they smoked. In children who required invasive mechanical ventilation, endotracheal aspirate was collected at the time of intubation. A total of 102 patients with bronchiolitis were studied. Among these, 14 (47%) of 30 infants whose parents smoked required invasive mechanical ventilation vs. 14 (19%) of 72 whose parents were nonsmokers (p = 0.007). Among patients on invasive mechanical ventilation, 10 (71%) of 14 infants with secondhand smoke exposure presented pulmonary bacterial superinfection vs. 3 (21%) of 14 in the unexposed (p = 0.012).Conclusion: Secondhand smoke exposure is an additional high risk for pulmonary bacterial superinfection and invasive mechanical ventilation in infants with severe acute bronchiolitis What is known: •Environmental tobacco smoke exposure is known to be an important risk factor for childhood lower respiratory tract infections. •Tobacco smoke makes structural changes in the respiratory tract and reduces the immune response. What in new: •Secondhand smoke exposure showed to be associated with the increased need and duration of invasive mechanical ventilation, and pediatric intensive care length of stay. •Tobacco smoke exposure is an additional risk factor for the presence of bacteria in the endotracheal aspirate.
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Affiliation(s)
| | | | | | - Elena Pérez-Costa
- Paediatric Intensive Care Unit, Children's University Hospital La Paz, Madrid, Spain
| | | | - Pedro De la Oliva
- Paediatric Intensive Care Unit, Children's University Hospital La Paz, Madrid, Spain.
- Department of Paediatrics, Autonomous University of Madrid Medical School, Madrid, Spain.
- Department of Pediatrics. Universidad Autónoma de Madrid, Head of Paediatric Intensive Care Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain.
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8
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Paes B, Fullarton JR, Rodgers-Gray BS, Carbonell-Estrany X. Adoption in Canada of an international risk scoring tool to predict respiratory syncytial virus hospitalization in moderate-to-late preterm infants. Curr Med Res Opin 2021; 37:1149-1153. [PMID: 33813989 DOI: 10.1080/03007995.2021.1911974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The advisory board to the Ontario Ministry of Health considered adopting the new three-variable international risk scoring tool (IRST) to guide prophylaxis against respiratory syncytial virus hospitalization (RSVH) in moderate-to-late preterm infants born 32-35 weeks' gestational age (wGA). Canada currently uses a nationally validated, seven-variable RST, to predict RSVH in 33-35 wGA infants. We explored the potential implications of switching from the Canadian to the IRST. METHODS Predictive accuracy (area under the receiver operating characteristic curve [AUROC]) of the two RSTs and correlations (Spearman rank) and number needed to treat (NNT) between cut-off scores for low-, moderate- and high-risk subjects were assessed. RESULTS The RSTs contain many of the same risk factors (birth proximity to the RSV season, smoking, siblings, daycare), with the Canadian RST also including sex, small for GA and familial eczema. Predictive accuracy was similar (AUROC, IRST: 0.773 [sensitivity: 68.9%; specificity: 73.0%] vs Canadian: 0.762 [68.2%; 71.9%]). Significant correlations between cut-off scores (p < .001) and risk categories (p < .001) were apparent, although the correlation coefficients were weak for both (scores: 0.217; categories: 0.055). While the proportion of high-risk infants was similar (IRST: 0.7% vs Canadian: 0.6%), the NNT was lower for the Canadian RST (7.5 vs 14.3), and more infants were assigned moderate risk by the IRST (19.9% vs 9.8%). CONCLUSIONS The IRST can be considered simpler (fewer risk factors) than the Canadian RST and its adoption may reduce the number of RSVHs among moderate-to-late preterm infants; however, the cost-effective implications for RSV prophylaxis warrant further investigation.
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Affiliation(s)
- Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | | | | | - Xavier Carbonell-Estrany
- Neonatology Service, Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain
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9
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Papenburg J, Defoy I, Massé E, Caouette G, Lebel MH. Impact of the Withdrawal of Palivizumab Immunoprophylaxis on the Incidence of Respiratory Syncytial Virus (RSV) Hospitalizations Among Infants Born at 33 to 35 Weeks' Gestational Age in the Province of Quebec, Canada: The RSV-Quebec Study. J Pediatric Infect Dis Soc 2021; 10:237-244. [PMID: 32530035 PMCID: PMC8023310 DOI: 10.1093/jpids/piaa046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 04/28/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Infants born at 33-35 completed weeks' gestational age (wGA) aged <6 months at the start of or born during respiratory syncytial virus (RSV) season and classified as moderate/high risk of severe RSV disease were included in a palivizumab RSV prophylaxis program in the province of Quebec, Canada, until 2014-2015. We assessed the impact of withdrawal of this indication on lower respiratory tract infection (LRTI)/RSV hospitalizations (H) in this population. METHODS We conducted a 4-year, retrospective, cohort study in 25 Quebec hospitals (2 seasons with and 2 without palivizumab prophylaxis for moderate- to high-risk infants). Our primary outcome was LRTI/RSV-H incidence. We compared LRTI/RSV-H incidence before (2013-2015; seasons 1 + 2 [S1/2]) and after (2015-2017; S3/4) the change in indication. RESULTS We identified 6457 33-35 wGA births. LRTI/RSV-H occurred in 105/3353 infants (3.13%) in S1/2 and 130/3104 (4.19%) in S3/4. Among LRTI/RSV-H, 86.4% were laboratory-confirmed RSV-H. Adjusting for sex, wGA, and birth month, S3/4 was significantly associated with increased LRTI/RSV-H incidence (adjusted odds ratio [aOR], 1.36; 95% confidence interval [CI], 1.04-1.76) but not with laboratory-confirmed RSV-H (aOR, 1.19; 95% CI, 0.90-1.58). Mean duration of LRTI/RSV-H was 5.6 days; 22.6% required intensive care unit admission. Comparing S3/4 with S1/2, infant percentage with LRTI/RSV-H classified as moderate/high risk increased from 27.8% to 41.9% (P = .11). CONCLUSIONS In a province-wide study, we observed a significant increase in LRTI/RSV-H incidence among infants born at 33-35 wGA in the 2 years after withdrawal of RSV prophylaxis.
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Affiliation(s)
- Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Edith Massé
- Division of Neonatology, Department of Pediatrics, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie-CHUS, Sherbrooke, Quebec, Canada
| | - Georges Caouette
- Division of Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - Marc H Lebel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Centre hospitalier universitaire (CHU) Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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Ofman G, Pradarelli B, Caballero MT, Bianchi A, Grimaldi LA, Sancilio A, Duenas K, Rodriguez A, Ferrero F, Ferretti A, Coviello S, Ferolla FM, Acosta PL, Bergel E, Libster R, Polack FP. Respiratory Failure and Death in Vulnerable Premature Children With Lower Respiratory Tract Illness. J Infect Dis 2021; 222:1129-1137. [PMID: 32006428 PMCID: PMC7459133 DOI: 10.1093/infdis/jiaa046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/24/2020] [Indexed: 01/14/2023] Open
Abstract
Background Efforts to better understand the risk factors associated with respiratory failure (RF) and fatal lower respiratory tract infection (LRTI) in premature children in developing countries are necessary to elaborate evidenced-based preventive interventions. We aim to characterize the burden of respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) LRTI in premature children and determine risk factors for RF and fatal illness in a vulnerable population. Methods This is a prospective, population-based, cross-sectional study. Subjects with severe LRTI were enrolled during respiratory season. Risk factors for RF and death in premature infants were investigated. Results A total of 664 premature children participated. Infant’s hospitalization rate due to LRTI was 82.6/1000 (95% confidence interval [CI], 68.6–96.7/1000). Infant’s RSV and hMPV rates were 40.9/1000 (95% CI, 36.3–45.6/1000) and 6.6/1000 (95% CI, 3.9–9.2/1000), respectively. The RF rate was 8.2/1000 (95% CI, 4.9–11.5/1000). The LRTI mortality was 2.2/1000 (95% CI, 0.7–3.7/1000); for RSV, the rate was 0.8/1000 (95% CI, 0–1.7/1000) with a case-fatality ratio of 1.8%. Never breastfeeding, malnutrition, younger than 6 months, congenital heart disease, and lower hematocrit were risk factors for RF. Experiencing pneumonia, pneumothorax, sepsis, or apnea were clinical determinants of poor outcomes. Conclusions Premature children under 2 years old in vulnerable environments experience RF and death more often than term counterparts. Modifiable risk factors associated with poor outcomes should prompt evidence-based interventions.
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Affiliation(s)
| | | | - Mauricio T Caballero
- Fundación INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Andrea Sancilio
- Hospital Interzonal General de Agudos "Evita" de Lanus, Buenos Aires, Argentina
| | - Karina Duenas
- Hospital Interzonal General de Agudos "Evita" de Lanus, Buenos Aires, Argentina
| | - Andrea Rodriguez
- Hospital Zonal General de Agudos Descentralizado "Evita Pueblo" de Berazategui, Buenos Aires, Argentina
| | - Fernando Ferrero
- Hospital General de Niños "Pedro de Elizalde", Buenos Aires, Argentina
| | | | | | | | | | | | - Romina Libster
- Fundación INFANT, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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11
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Gao J, Zhu X, Wu M, Jiang L, Wang F, He S. IFI27 may predict and evaluate the severity of respiratory syncytial virus infection in preterm infants. Hereditas 2021; 158:3. [PMID: 33388093 PMCID: PMC7778825 DOI: 10.1186/s41065-020-00167-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Preterm infants are a special population that vulnerable to respiratory syncytial virus (RSV) infection and the lower respiratory tract infections (LRTIs) caused by RSV could be severe and even life-threating. The purpose of the present study was to identify candidate genes of preterm infants who are susceptible to RSV infection and provide a new insight into the pathogenesis of RSV infection. Methods Three datasets (GSE77087, GSE69606 and GSE41374) containing 183 blood samples of RSV infected patients and 33 blood samples of healthy controls from Gene Expression Omnibus (GEO) database were downloaded and the differentially expressed genes (DEGs) were screened out. The function and pathway enrichments were analyzed through Database for Annotation, Visualization and Integrated Discovery (DAVID) website. The protein-protein interaction (PPI) network for DEGs was constructed through Search Tool for the Retrieval of Interacting Genes (STRING). The module analysis was performed by Cytoscape software and hub genes were identified. Clinical verification was employed to verify the expression level of top five hub genes among 72 infants including 50 RSV infected patients and 22 non-RSV-infected patients hospitalized in our center. Further, the RSV infected infants with high-expression IFI27 and those with low-expression IFI27 were compared (defined as higher or lower than the median mRNA level). Finally, the gene set enrichment analysis (GSEA) focusing on IFI27 was carried out. Results Totally, 4028 DEGs were screened out and among which, 131 most significant DEGs were selected. Subsequently, 13 hub genes were identified, and function and pathway enrichments of hub genes mainly were: response to virus, defense response to virus, regulation of viral genome replication and regulation of viral life cycle. Furthermore, IFI27 was confirmed to be the most significantly expressed in clinical verification. Gene sets associated with calcium signaling pathway, arachidonic acid metabolism, extracellular matrix receptor interaction and so on were significantly enriched when IFI27 was highly expressed. Moreover, high-expression IFI27 was associated with more severe cases (p = 0.041), more requirements of mechanical ventilation (p = 0.034), more frequent hospitalization (p < 0.001) and longer cumulative hospital stay (p = 0.012). Conclusion IFI27 might serve to predict RSV infection and evaluate the severity of RSV infection in preterm infants. Supplementary Information The online version contains supplementary material available at 10.1186/s41065-020-00167-5.
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Affiliation(s)
- Junyan Gao
- Department of Pediatrics, Affiliated Hospital of Yangzhou University, NO.368 Hanjiang Middle Road, Yangzhou, 225000, Jiangsu, China
| | - Xueping Zhu
- Department of Neonatology, Children's Hospital of Soochow University, NO.92 Zhongnan Street, Industrial Park, Suzhou, 215025, Jiangsu, China
| | - Mingfu Wu
- Department of Pediatrics, Affiliated Hospital of Yangzhou University, NO.368 Hanjiang Middle Road, Yangzhou, 225000, Jiangsu, China
| | - Lijun Jiang
- Department of Pediatrics, Affiliated Hospital of Yangzhou University, NO.368 Hanjiang Middle Road, Yangzhou, 225000, Jiangsu, China
| | - Fudong Wang
- Department of Pediatrics, Affiliated Hospital of Yangzhou University, NO.368 Hanjiang Middle Road, Yangzhou, 225000, Jiangsu, China
| | - Shan He
- Department of Neonatology, Children's Hospital of Soochow University, NO.92 Zhongnan Street, Industrial Park, Suzhou, 215025, Jiangsu, China. .,Department of Pediatrics, The First People's Hospital of Yunnan Province, NO.152 Jinbi Road, Kunming, 650031, Yunnan, China.
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12
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Burden of respiratory syncytial virus hospitalisation among infants born at 32-35 weeks' gestational age in the Northern Hemisphere: pooled analysis of seven studies. Epidemiol Infect 2020; 148:e170. [PMID: 32799945 PMCID: PMC7439292 DOI: 10.1017/s0950268820001661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To provide comprehensive information on the epidemiology and burden of respiratory syncytial virus hospitalisation (RSVH) in preterm infants, a pooled analysis was undertaken of seven multicentre, prospective, observational studies from across the Northern Hemisphere (2000–2014). Data from all 320–356 weeks' gestational age (wGA) infants without comorbidity were analysed. RSVH occurred in 534/14 504 (3.7%) infants; equating to a rate of 5.65 per 100 patient-seasons, with the rate in individual wGA groups dependent upon exposure time (P = 0.032). Most RSVHs (60.1%) occurred in December–January. Median age at RSVH was 88 days (interquartile range (IQR): 54–159). Respiratory support was required by 82.0% of infants: oxygen in 70.4% (median 4 (IQR: 2–6) days); non-invasive ventilation in 19.3% (median 3 (IQR: 2–5) days); and mechanical ventilation in 10.2% (median 5 (IQR: 3–7) days). Intensive care unit admission was required by 17.9% of infants (median 6 days (IQR: 2–8) days). Median overall hospital length of stay (LOS) was 5 (IQR: 3–8) days. Hospital resource use was similar across wGA groups except for overall LOS, which was shortest in those born 35 wGA (median 3 vs. 4–6 days for 32–34 wGA; P < 0.001). Strategies to reduce the burden of RSVH in otherwise healthy 32–35 wGA infants are indicated.
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Drazdienė N, Tamelienė R, Kviluna D, Saik P, Saik E, Zaikauskienė J. Hospitalisation of late preterm infants due to lower respiratory tract infections in Lithuania, Latvia, and Estonia: incidence, disease severity, and risk factors. Acta Med Litu 2018; 25:76-85. [PMID: 30210241 PMCID: PMC6130930 DOI: 10.6001/actamedica.v25i2.3760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background. By two years of age, almost all children experience at least one episode of respiratory syncytial virus (RSV) infection, the most common viral cause of hospitalisation due to lower respiratory tract infection (LRTI). We present data on LRTI hospitalisations (with a special focus on RSV), the course of illness, and LRTI hospitalisation risk factors in Lithuania, Latvia, and Estonia. Materials and methods. The analysed data were part of a large multinational study conducted in 23 countries (PONI). LRTI-related hospitalisations were observed during one RSV season for late premature infants (born between 33 weeks and 0 days and 35 weeks and 6 days of gestation) ≤6 months of age, who did not receive RSV prophylaxis. The potential risk factors and demographics were recorded at study enrolment and at the end of the RSV season. The primary endpoint was hospitalisation due to RSV LRTI; the secondary endpoints included severity, the course and the outcome of LRTI hospitalisations. Results. Out of the 291 infants enrolled in three Baltic states, 19 were hospitalised due to LRTI (6.5%). RSV testing was performed for 14 hospitalised infants; five infants had a positive test for RSV (1.7%). The majority of the hospitalised infants (94.7%) had mild or moderate respiratory illness. Male sex, O2 dependency after birth, younger maternal age, and furred pets at home were significantly associated with an increased risk for LRTI hospitalisation. Conclusions. During one RSV season, the incidence of LRTI hospitalisations among late preterm infants was 6.5% and the incidence of RSV LRTI hospitalisations was 1.7%.
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Affiliation(s)
- Nijolė Drazdienė
- Clinic of Children's Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rasa Tamelienė
- Department of Neonatology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Daiga Kviluna
- Neonatology Clinic, University Children's Hospital, Riga, Latvia
| | - Pille Saik
- Department of Neonatology, Women's Clinic, West Tallinn Central Hospital, Tallinn, Estonia
| | - Ervin Saik
- Department of Neonatology, Women's Clinic, West Tallinn Central Hospital, Tallinn, Estonia
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Blanken MO, Paes B, Anderson EJ, Lanari M, Sheridan‐Pereira M, Buchan S, Fullarton JR, Grubb E, Notario G, Rodgers‐Gray BS, Carbonell‐Estrany X. Risk scoring tool to predict respiratory syncytial virus hospitalisation in premature infants. Pediatr Pulmonol 2018; 53:605-612. [PMID: 29405612 PMCID: PMC6099524 DOI: 10.1002/ppul.23960] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/14/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective was to develop a risk scoring tool which predicts respiratory syncytial virus hospitalisation (RSVH) in moderate-late preterm infants (32-35 weeks' gestational age) in the Northern Hemisphere. METHODS Risk factors for RSVH were pooled from six observational studies of infants born 32 weeks and 0 days to 35 weeks and 6 days without comorbidity from 2000 to 2014. Of 13 475 infants, 484 had RSVH in the first year of life. Logistic regression was used to identify the most predictive risk factors, based on area under the receiver operating characteristic curve (AUROC). The model was validated internally by 100-fold bootstrapping and externally with data from a seventh observational study. The model coefficients were converted into rounded multipliers, stratified into risk groups, and number needed to treat (NNT) calculated. RESULTS The risk factors identified in the model included (i) proximity of birth to the RSV season; (ii) second-hand smoke exposure; and (iii) siblings and/or daycare. The AUROC was 0.773 (sensitivity: 68.9%; specificity: 73.0%). The mean AUROC from internal bootstrapping was 0.773. For external validation with data from Ireland, the AUROC was 0.707 using Irish coefficients and 0.681 using source model coefficients. Cut-off scores for RSVH were ≤19 for low- (1.0%), 20-45 for moderate- (3.3%), and 50-56 (9.5%) for high-risk infants. The high-risk group captured 62.0% of RSVHs within 23.6% of the total population (NNT 15.3). CONCLUSIONS This risk scoring tool has good predictive accuracy and can improve targeting for RSVH prevention in moderate-late preterm infants.
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Affiliation(s)
- Maarten O. Blanken
- Division of Pediatric Immunology and Infectious DiseasesUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Bosco Paes
- Neonatal Division, Department of PediatricsMcMaster UniversityHamiltonCanada
| | - Evan J. Anderson
- Departments of Pediatrics and MedicineEmory University School of MedicineAtlantaGeorgia
| | - Marcello Lanari
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Margaret Sheridan‐Pereira
- Department of Paediatrics and Newborn Medicine, Coombe Women and Infants University Hospital and Department of PaediatricsTrinity CollegeDublinIreland
| | | | | | - ElizaBeth Grubb
- Health Economics and Outcomes ResearchAbbVie IncNorth ChicagoIllinois
| | - Gerard Notario
- Formerly Global Pharmaceutical Research and DevelopmentAbbVie IncNorth ChicagoIllinois
| | | | - Xavier Carbonell‐Estrany
- Neonatology Service, Hospital ClinicInstitut d'Investigacions Biomediques August Pi Suñer (IDIBAPS)BarcelonaSpain
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Chabra S. Precise Gestational Age Definitions Needed for Palivizumab Prophylaxis in Preterm Infants. Am J Respir Crit Care Med 2018; 197:680. [DOI: 10.1164/rccm.201708-1605le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chabra S. Completed Weeks of Gestation and Risk of Respiratory Syncytial Virus in Late Preterm Infants. Pediatr Infect Dis J 2017; 36:1227. [PMID: 28333711 DOI: 10.1097/inf.0000000000001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Shilpi Chabra
- Department of Pediatrics, Division of Neonatology, University of Washington, Seattle, Washington
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Re: "Completed Weeks of Gestation and Risk of Respiratory Syncytial Virus in Late Preterm Infants". Pediatr Infect Dis J 2017; 36:1227-1228. [PMID: 28198790 DOI: 10.1097/inf.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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Figueras-Aloy J, Manzoni P, Paes B, Simões EAF, Bont L, Checchia PA, Fauroux B, Carbonell-Estrany X. Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Preterm Infants Without Chronic Lung Disease or Congenital Heart Disease. Infect Dis Ther 2016; 5:417-452. [PMID: 27628014 PMCID: PMC5125133 DOI: 10.1007/s40121-016-0130-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The REGAL (RSV Evidence-a Geographical Archive of the Literature) series provide a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This second publication covers the risk and burden of RSV infection in preterm infants born at <37 weeks' gestational age (wGA) without chronic lung disease or congenital heart disease. METHODS A systematic review was undertaken for articles published between January 1, 1995 and December 31, 2015. Studies reporting data for hospital visits/admissions for RSV infection among preterm infants as well as studies reporting RSV-associated morbidity, mortality, and risk factors were included. Study quality and strength of evidence (SOE) were graded using recognized criteria. RESULTS 2469 studies were identified of which 85 were included. Preterm infants, particularly those born at lower wGA, tended to have higher RSV hospitalization (RSVH) rates compared with otherwise healthy term infants (high SOE). RSVH rates ranged from ~5 per 1000 children to >100 per 1000 children with the highest rates shown in the lowest gestational age infants (high SOE). Independent risk factors associated with RSVH include: proximity of birth to the RSV season, living with school-age siblings, smoking of mother during pregnancy or infant exposure to environmental smoking, reduced breast feeding, male sex, and familial atopy (asthma) (high SOE). Predictive models can identify 32/33-35 wGA infants at risk of RSVH (high SOE). CONCLUSION RSV infection remains a major burden on Western healthcare systems and is associated with significant morbidity. Further studies focusing on the prevalence and burden of RSV in different gestational age cohorts, the changing risk of RSVH during the first year of life, and on RSV-related mortality in preterm infants are needed to determine the true burden of disease. FUNDING AbbVie.
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Affiliation(s)
- Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | | | - Bosco Paes
- Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | - Eric A F Simões
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital Houston, Texas, USA
| | - Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
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Korsten K, Blanken MO, Nibbelke EE, Moons KGM, Bont L. Prediction model of RSV-hospitalization in late preterm infants: An update and validation study. Early Hum Dev 2016; 95:35-40. [PMID: 26930376 DOI: 10.1016/j.earlhumdev.2016.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND New vaccines and RSV therapeutics have been developed in the past decade. With approval of these new pharmaceuticals on the horizon, new challenges lie ahead in selecting the appropriate target population. We aimed to improve a previously published prediction model for prediction of RSV-hospitalization within the first year of life. METHODS Two consecutive prospective multicenter birth cohort studies were performed from June 2008 until February 2015. The first cohort (RISK-I, n=2524, 2008-2011) was used to update the existing model. The updated model was subsequently validated in the RISK-II cohort (n=1564, 2011-2015). We used the TRIPOD criteria for transparent reporting. RESULTS 181 infants (n=127 in RISK-I, n=54 in RISK-II) were hospitalized for RSV within their first year of life. The updated model included the following predictors; day care attendance and/or siblings (OR: 5.3; 95% CI 2.8-10.1), birth between Aug. 14th and Dec. 1st (OR: 2.4; 1.8-3.2), neonatal respiratory support (OR 2.2; 1.6-3.0), breastfeeding ≤4 months (OR 1.6; 1.2-2.2) and maternal atopic constitution (OR 1.5; 1.1-2.1). The updated models' discrimination was superior to the original model in the RISK-II cohort (AUROC 0.72 95% CI 0.65-0.78 versus AUROC 0.66, 95% CI 0.60-0.73, respectively). The updated model was translated into a simple nomogram to be able to distinguish infants with high versus low risk of RSV-hospitalization. CONCLUSION We developed and validated a clinical prediction model to be able to predict RSV-hospitalization in preterm infants born within 32-35 weeks gestational age. A simple nomogram was developed to target RSV therapeutics to those children who will benefit the most.
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Affiliation(s)
- Koos Korsten
- Division of Paediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten O Blanken
- Division of Paediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth E Nibbelke
- Division of Paediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Louis Bont
- Division of Paediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.
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