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Phenotypical characterization of human rhinovirus infections in severely premature children
Geovanny F Perez1, Bassem Kurdi2, Rosemary Megalaa3
1Division of Pulmonary and Sleep Medicine, Children's National Medical Center, Washington, DC, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Department of Integrative Systems Biology and Center for Genetic Medicine Research, George Washington University, Washington, DC, USA; Center for Genetic Research Medicine, Children's National Medical Center, Washington, DC, USA.
Insights
Human Rhinovirus (HRV) infections cause more respiratory distress in severely premature children, indicating enhanced airway reactivity. This susceptibility is linked to lower airway obstruction, not hypoxemia or tachypnea.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Human Rhinovirus (HRV) is a common cause of respiratory infections in premature infants.
- Susceptibility in premature children may stem from reduced pulmonary reserve or increased lower airway reactivity.
Purpose of the Study:
- To analyze the clinical presentation of HRV infections in full-term versus premature children.
- To differentiate the mechanisms of respiratory distress in premature infants with HRV.
Main Methods:
- Retrospective analysis of PCR-confirmed HRV infections in children aged ≤3 years.
- Utilized standardized respiratory distress scores for lower airway obstruction and pulmonary reserve markers.
- Extracted data from electronic medical records.
Main Results:
- Severely premature children ( <32 weeks gestation) had higher respiratory distress scores with HRV infection.
- HRV-infected severely premature children showed increased lower airway obstruction compared to preterm and full-term.
- Tachypnea and hypoxemia were not more frequent in severely premature infants during HRV infection.
Conclusions:
- HRV infections in severely premature children are associated with lower airway obstruction, suggesting enhanced airway reactivity.
- Airway hyper-reactivity appears to be the mechanism behind increased HRV susceptibility in this population.
- Further longitudinal studies are needed to explore the reasons for and long-term effects of airway hyper-reactivity to HRV in premature infants.
Background:
Human Rhinovirus (HRV) has been identified as the most common cause of acute respiratory infections and hospitalizations in premature children. It is unclear if premature children are more susceptible to HRV due to their decreased pulmonary reserve or because they have enhanced lower airway reactivity to HRV.
Methods:
We conducted a retrospective analysis of the clinical respiratory presentation of all PCR-confirmed HRV infections in full-term and premature children aged ≤3 years in our institution. Standardized respiratory distress scores were developed to examine lower airway obstruction (i.e., wheezing, hyperinflation, and sub-costal retractions) along with markers of decreased pulmonary reserve (hypoxemia and tachypnea) in young children with HRV infections. Demographic and clinical variables were obtained from reviewing electronic medical records (EMR).
Results:
This study included a total of 205 children; 71% of these children were born full-term (>37 weeks gestation), 10% preterm (32-37 weeks) and 19% severely premature (<32 weeks). Our results demonstrated that: 1) HRV infections in the first 3 years of life were associated with higher overall respiratory distress scores in severely premature children relative to children born preterm or full-term; 2) HRV-infected severely premature children ≤3 years old were more likely to have lower airway obstruction than HRV-infected children born preterm or full-term; and 3) other clinical signs of respiratory distress such as tachypnea and hypoxemia were not more common in severely premature than in preterm and full-term children during an HRV infection.
Conclusions:
Our results indicate that HRV infections in severely premature children are associated with lower airway obstruction rather than hypoxemia or tachypnea. The latter suggests that enhanced airway reactivity is the underlying mechanism for the increased susceptibility to HRV in severely premature children. Longitudinal studies are needed to understand why premature babies develop airway hyper-reactivity to HRV and the long-term effects of early HRV infection in this population.