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RSV prophylaxis guideline changes and outcomes in children with congenital heart disease
Adam S Walpert1, Ian D Thomas2, Merlin C Lowe1
1Division of Pediatric Hospital Medicine and Outreach, Department of Pediatrics, Banner Diamond Children's Medical Center, University of Arizona, Tucson, Arizona, USA.
Insights
New guidelines restricting respiratory syncytial virus prophylaxis to infants under 12 months with congenital heart disease did not alter inpatient outcomes or costs for older children. This supports current recommendations for targeted prophylaxis in high-risk infants.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Health Services Research
Background:
- Respiratory syncytial virus (RSV) infection poses significant risks to infants with congenital heart disease (CHD).
- Management guidelines for RSV prophylaxis in this population have evolved, impacting eligibility criteria.
Purpose of the Study:
- To compare inpatient outcomes and costs for children with RSV and CHD before and after updated RSV prophylaxis guidelines.
- To evaluate the impact of restricted palivizumab prophylaxis on clinical outcomes and healthcare expenditures.
Main Methods:
- Retrospective analysis of a national administrative discharge database (Vizient) from October 2012 to April 2016.
- Inclusion criteria: patients <24 months with CHD and RSV infection diagnosis.
- Outcome measures: length of stay, ICU admission, mortality, and direct costs.
Main Results:
- No significant changes observed in length of stay, ICU admission rates, in-hospital mortality, or direct costs for children aged 13-24 months with CHD after guideline changes.
- No in-hospital deaths were recorded in the 13-24 month age group across both study periods.
Conclusions:
- The updated guidelines restricting RSV prophylaxis to infants ≤12 months with CHD are supported by these findings.
- The current prophylaxis strategy appears effective in managing RSV-related hospitalizations in this vulnerable pediatric population.
Objective:
The aim of this study was to compare inpatient outcomes and costs for children with respiratory syncytial virus and congenital heart disease before and after the change in management guidelines for respiratory syncytial virus prophylaxis.
Design:
Hospital discharge data from the Vizient (formerly University HealthSystem Consortium) were queried from October 2012 to June 2014 (Era 1) and July 2014 to April 2016 (Era 2) for patients aged <24 months with an any International Classification of Disease (ICD)-9 or ICD-10 code for congenital heart disease (745-747.49, Q20.0-Q26.4) and a primary or secondary admitting diagnosis of respiratory syncytial virus infection (079.6, J20.5), acute bronchiolitis due to respiratory syncytial virus (466.11, J21.0) or respiratory syncytial virus pneumonia (480.1, J12.1).
Setting:
This study is a review of a national administrative discharge database.
Patients:
Respiratory syncytial virus admissions were identified in 1269 patients aged <24 months with congenital heart disease, with 644 patients in Era 1 and 625 in Era 2. Patients 0-12 months old represented 83% of admissions.
Interventions:
Prior to 2014, children aged 0-24 months with congenital heart disease were eligible to receive respiratory syncytial virus prophylaxis. Updated guidelines, published in 2014, restricted the recommendation to administer palivizumab respiratory syncytial virus prophylaxis to children with congenital heart disease only if they are ≤12 months old.
Outcome Measures:
The outcome measures are hospital length of stay, ICU admission rate, mortality, and direct costs.
Results:
There was no change in length of stay, ICU admission rate, in-hospital mortality, or direct costs for children 13-24 months old with congenital heart disease after the change in guidelines. There were no deaths in 13-24 month olds, regardless of era.
Conclusions:
Our findings provide additional support for the new guideline recommendations to provide respiratory syncytial virus prophylaxis only for children ≤12 months old with congenital heart disease.
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