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Predictors of RSV LRTI Hospitalization in Infants Born at 33 to 35 Weeks Gestational Age: A Large Multinational Study
Zbyněk Straňák1, Elie Saliba2, Paraskevi Kosma3
1Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Insights
Preterm infants born at 33-35 weeks gestation face significant risk of respiratory syncytial virus (RSV) hospitalization. Key risk factors include family smoking, maternal age, and household factors, aiding in identifying high-risk infants.
Area of Science:
- Pediatrics
- Epidemiology
- Infectious Diseases
Background:
- Preterm infants, particularly those 33-35 weeks gestation, are vulnerable to severe respiratory syncytial virus (RSV) lower respiratory tract infections (LRTI).
- This study addresses the disease burden and identifies risk factors for RSV-associated LRTI hospitalization in this population who did not receive RSV prophylaxis.
Purpose of the Study:
- To evaluate the burden of RSV-associated LRTI hospitalizations in preterm infants (33-35 weeks gestation).
- To identify specific risk factors associated with RSV-related LRTI hospitalization in this vulnerable group.
Main Methods:
- An observational, multi-country epidemiologic study followed preterm infants (≤6 months) during the RSV season (Oct 2013-Apr 2014).
- RSV testing was conducted per local practice, and multivariable logistic regression identified risk factors for LRTI hospitalization.
Main Results:
- The normalized RSV hospitalization rates were 4.1 per 100 infant-years (study period) and 6.1 per 100 infant-years (RSV season).
- Significant risk factors for RSV hospitalization included family smoking, congenital heart disease, younger maternal age, lower maternal education, household children aged 4-5, infant age ≤3 months, and paternal atopy.
Conclusions:
- Confirmed RSV LRTI hospitalization incidence was 4.1-6.1 per 100 infant-years in preterm infants (33-35 weeks gestation) during 2013-2014.
- Identifying combinations of risk factors can accurately predict RSV hospitalization risk, aiding in early intervention for high-risk preterm infants.
Background:
Preterm infants are at high risk of developing respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRTI). This observational epidemiologic study evaluated RSV disease burden and risk factors for RSV-associated LRTI hospitalization in preterm infants 33 weeks+0 days to 35 weeks+6 days gestational age not receiving RSV prophylaxis.
Methods:
Preterm infants ≤6 months of age during RSV season (1 October 2013-30 April 2014) were followed at 72 sites across 23 countries from September 2013-July 2014 (study period). RSV testing was performed according to local clinical practice. Factors related to RSV-associated hospitalization for LRTI were identified using multivariable logistic regression with backward selection.
Results:
Of the 2390 evaluable infants, 204 and 127 were hospitalized for LRTI during the study period and RSV season, respectively. Among these subjects, 64/204 and 46/127, respectively, were hospitalized for confirmed RSV LRTI. Study period and RSV season normalized RSV hospitalization rates (per 100 infant years) were 4.1 and 6.1, respectively. Factors associated with an increased risk of RSV-related LRTI hospitalization in multivariable analyses were smoking of family members (P<0.0001), non-hemodynamically significant congenital heart disease diagnosis (P = 0.0077), maternal age of ≤25 years at delivery (P = 0.0009), low maternal educational level (P = 0.0426), household presence of children aged 4 to 5 years (P = 0.0038), age on 1 October ≤3 months (P = 0.0422), and presence of paternal atopy (P<0.0001).
Conclusions:
During the 2013-2014 RSV season across 23 countries, for preterm infants 33-35 weeks gestation ≤6 months old on 1 October not receiving RSV prophylaxis, confirmed RSV LRTI hospitalization incidence was 4.1 per 100 infant years during the study period and 6.1 per 100 infant years during the RSV season. This study enhances the findings of single-country studies of common risk factors for severe RSV infection in preterm infants and suggests that combinations of 4-6 risk factors may be used to accurately predict risk of RSV hospitalization. These findings may be useful in the identification of infants most at risk of severe RSV infection.
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