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Published on: July 27, 2021
Respiratory Syncytial Virus in Otherwise Healthy Prematurely Born Infants: A Forgotten Majority
1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Insights
Premature infants, especially those younger and born earlier, face higher risks from respiratory syncytial virus (RSV) infections. Targeted RSV prophylaxis is recommended for vulnerable preterm infants to prevent severe illness and long-term respiratory issues.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Infectious Diseases
Background:
- Premature infants (≤35 weeks' gestational age) have increased risks of perinatal complications.
- Respiratory syncytial virus (RSV) lower respiratory tract infections significantly burden hospitalized premature infants.
- RSV infection in infancy can lead to long-term obstructive lung function and potentially chronic obstructive pulmonary disease in adulthood.
Purpose of the Study:
- To evaluate the risks associated with RSV infection in healthy premature infants.
- To determine the optimal strategy for RSV prophylaxis in preterm infants.
- To identify criteria for cost-effective RSV prevention in moderate- to high-risk preterm infants.
Main Methods:
- Analysis of existing data on RSV infection morbidities in premature infants.
- Assessment of short- and long-term respiratory outcomes following RSV infection.
- Evaluation of risk factors including gestational age and chronological age for RSV severity.
Main Results:
- Youngest and lowest gestational age premature infants experience the highest RSV-related morbidities.
- RSV infection exacerbates baseline obstructive lung function in preterm infants.
- Infants <32 weeks' gestational age are identified as warranting RSV prophylaxis.
Conclusions:
- Healthy premature infants <32 weeks' gestational age should receive RSV prophylaxis.
- Moderate- and high-risk preterm infants (32-35 weeks' wGA) require selective, cost-effective prophylaxis targeting.
- Risk scoring tools and country-specific funding thresholds are essential for targeted RSV prophylaxis in preterm infants.
Abstract:
Healthy, premature infants ≤35 weeks' gestational age (wGA) are universally recognized to be at an increased risk of perinatal morbidity and mortality. Serious respiratory syncytial virus (RSV) lower respiratory tract infection imposes an additional burden of illness on these infants following hospitalization. Incurred morbidities relative to term infants include longer lengths of hospital stay, admission to intensive care, and need for oxygen and mechanical ventilation, all of which are associated with increased hospital costs. The highest morbidities are experienced by premature infants who are youngest (<3 months' chronological age) and are of lower gestational age. Short- and long-term follow-up indicates that healthy preterm infants both of lower gestational age and who are late preterm have obstructive lung function at baseline, which is further compromised by RSV-related infection during infancy. There is increasing evidence that childhood exposure to an episode of RSV infection may set the stage for an abnormal respiratory function trajectory, which, in adulthood, leads to chronic obstructive pulmonary disease. Healthy premature infants <32 wGA merit RSV prophylaxis based on existing data, whereas moderate- and high-risk preterm infants 32 to 35 wGA should be selectively and cost-effectively targeted for prophylaxis using validated risk scoring tools and country-specific thresholds for funding.
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