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Pulmonary hypertension during respiratory syncytial virus bronchiolitis: a risk factor for severity of illness
Dai Kimura1, Isabella F McNamara2, Jiajing Wang3
1Division of Critical Care Medicine, Department of Pediatrics,University of Tennessee Health Science Center/Le Bonheur Children's Hospital,Memphis, TN,USA.
Insights
Pulmonary hypertension in infants with respiratory syncytial virus (RSV) bronchiolitis is linked to worse outcomes. Echocardiography can detect this condition, but routine screening is not recommended for all infants with RSV.
Area of Science:
- Pediatrics
- Cardiology
- Infectious Diseases
Background:
- Respiratory syncytial virus (RSV) is a common cause of severe respiratory illness in infants.
- Pulmonary hypertension has been anecdotally linked to increased RSV infection severity.
- This study investigates the association between echocardiography-detected pulmonary hypertension and clinical outcomes in infants with RSV bronchiolitis.
Purpose of the Study:
- To determine the relationship between pulmonary hypertension identified via echocardiography during RSV bronchiolitis and infant clinical outcomes.
- To assess if pulmonary hypertension is a predictor of severe disease in infants hospitalized with RSV bronchiolitis.
Main Methods:
- Retrospective review of 154 infants admitted with RSV bronchiolitis who underwent echocardiography.
- Evaluation of the association between pulmonary hypertension and outcomes like mortality, ICU admission, prolonged ICU stay, intubation, and mechanical ventilation.
- Analysis of risk factors including congenital heart disease, chronic lung disease, prematurity, and Down syndrome.
Main Results:
- Pulmonary hypertension was detected in 18.7% of infants.
- Higher prevalence of pulmonary hypertension was noted in infants with congenital heart disease (33%), chronic lung disease (48%), prematurity (29%), and Down syndrome (40%).
- Pulmonary hypertension correlated with increased morbidity (p < 0.001) and mortality (p = 0.02), and was independently associated with ICU admission (OR=6.4), intubation (OR=4.7), high-frequency oscillatory ventilation (OR=8.4), and prolonged ICU stay (OR=4.9).
Conclusions:
- Echocardiography-detected pulmonary hypertension in infants with RSV infection is associated with higher morbidity and mortality.
- Chronic lung disease is a significant risk factor for developing pulmonary hypertension during RSV bronchiolitis.
- Routine echocardiography is not advised for hemodynamically stable, otherwise healthy infants diagnosed with RSV bronchiolitis.
Background:
Respiratory syncytial virus infection is the most frequent cause of acute lower respiratory tract disease in infants. A few reports have suggested that pulmonary hypertension is associated with increased severity of respiratory syncytial virus infection. We sought to determine the association between the pulmonary hypertension detected by echocardiography during respiratory syncytial virus bronchiolitis and clinical outcomes.
Methods:
We retrospectively reviewed 154 children admitted with respiratory syncytial virus bronchiolitis who had an echocardiography performed during the admission. The association between pulmonary hypertension and clinical outcomes including mortality, intensive care unit (ICU) admission, prolonged ICU stay (>10 days), tracheal intubation, and need of high frequency oscillator ventilation was evaluated.
Results:
Echocardiography detected pulmonary hypertension in 29 patients (18.7%). Pulmonary hypertension was observed more frequently in patients with congenital heart disease (CHD) (n = 11/33, 33%), chronic lung disease of infancy (n = 12/25, 48%), prematurity (<37 weeks gestational age, n = 17/59, 29%), and Down syndrome (n = 4/10, 40%). The presence of pulmonary hypertension was associated with morbidity (p < 0.001) and mortality (p = 0.02). However, in patients without these risk factors (n = 68), pulmonary hypertension was detected in five patients who presented with shock or poor perfusion. Chronic lung disease was associated with pulmonary hypertension (OR = 5.9, 95% CI 2.2-16.3, p = 0.0005). Multivariate logistic analysis demonstrated that pulmonary hypertension is associated with ICU admission (OR = 6.4, 95% CI 2.2-18.8, p = 0.0007), intubation (OR = 4.7, 95% CI 1.8-12.3, p = 0.002), high frequency oscillator ventilation (OR = 8.4, 95% CI 2.95-23.98, p < 0.0001), and prolonged ICU stay (OR = 4.9, 95% CI 2.0-11.7, p = 0.0004).
Conclusions:
Pulmonary hypertension detected by echocardiography during respiratory syncytial virus infection was associated with increased morbidity and mortality. Chronic lung disease was associated with pulmonary hypertension detected during respiratory syncytial virus bronchiolitis. Routine echocardiography is not warranted for previously healthy, haemodynamically stable patients with respiratory syncytial virus bronchiolitis.
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