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Respiratory syncytial virus infection in children with bronchopulmonary dysplasia
J R Groothuis1, K M Gutierrez, B A Lauer
1Department of Pediatrics, University of Colorado School of Medicine, Denver 80262.
Insights
Children with bronchopulmonary dysplasia (BPD) face a high risk of severe respiratory syncytial virus (RSV) illness, often requiring hospitalization and intensive care. Factors like passive smoking and larger household size increase RSV risk in these vulnerable children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pulmonology
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in infants.
- The impact of respiratory syncytial virus (RSV) on children with BPD is not well understood.
Purpose of the Study:
- To investigate the natural history and risk factors of RSV infection in young children with BPD.
- To identify clinical characteristics associated with severe RSV illness in this population.
Main Methods:
- Prospective study of 30 children (<2 years) with BPD on home oxygen.
- Weekly telephone surveillance for respiratory symptoms.
- Clinical examination, oximetry, and laboratory testing (virus culture, antigen tests) for symptomatic children.
Main Results:
- 59% (16/27) of symptomatic children developed RSV infection.
- Passive smoking and larger household size (≥4 members) were significant risk factors for symptomatic RSV.
- 69% (11/16) of RSV-infected children required hospitalization, with 9/11 having recent or ongoing oxygen needs.
- Hospitalizations were prolonged, with ICU admissions, ribavirin treatment, and mechanical ventilation in some cases.
Conclusions:
- Children with BPD are at high risk for severe RSV illness.
- Ongoing or recent oxygen requirement is a strong predictor of hospitalization.
- Environmental factors like passive smoking and household size contribute to RSV risk.
Abstract:
Little is known about the risk of severe illness from respiratory syncytial virus infection in children with bronchopulmonary dysplasia. A prospective study was done of the natural history of respiratory syncytial virus infection in 30 children less than 2 years of age with bronchopulmonary dysplasia who were in a home oxygen program. Surveillance to identify children with acute respiratory symptoms was done by weekly telephone interview. Symptomatic children were examined, oxygen saturation was determined by oximetry, and nasopharyngeal lavage fluid was collected for virus cultures and rapid respiratory syncytial virus antigen tests. During the 4-month study period (December to April), 27 children had one or more acute respiratory illnesses, and respiratory syncytial virus developed in 16/27 (59%). Passive smoking and greater than or equal to four members in the home increased the risk of symptomatic respiratory syncytial virus (P less than .01 and P less than .03, respectively). Of 16 children, 11 (69%) required hospitalization. Of the 11 hospitalized children with respiratory syncytial virus, nine were either still receiving oxygen at home or required oxygen therapy within the previous 3 months v none of five nonhospitalized children (P less than .005). Five of the hospitalized children were greater than 12 months of age and five had respiratory syncytial virus infection previously that had been confirmed by culture results. Hospitalizations were prolonged and complicated. Seven of 11 children were hospitalized for greater than 1 week; four were admitted to the intensive care unit; four were treated with ribavirin aerosol, and two needed mechanical ventilation. There were no deaths.(ABSTRACT TRUNCATED AT 250 WORDS)