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Preterm twins and triplets. A high-risk group for severe respiratory syncytial virus infection
E A Simoes1, S J King, M V Lehr
1Department of Pediatrics, University of Colorado School of Medicine, Denver.
Insights
Multiple birth and crowded homes increase the risk of severe respiratory syncytial virus illness in preterm infants with bronchopulmonary dysplasia. These infants require targeted interventions for prevention and treatment.
Area of Science:
- Pediatrics
- Neonatology
- Infectious Diseases
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in preterm infants.
- Preterm infants with BPD are susceptible to respiratory infections.
- Respiratory syncytial virus (RSV) is a major cause of respiratory illness in infants.
Purpose of the Study:
- To evaluate the impact of multiple births and crowded living conditions on RSV illness severity in preterm infants with BPD.
- To identify risk factors associated with severe RSV outcomes in this population.
Main Methods:
- Retrospective case-control chart review of a prospective longitudinal study.
- Involved preterm infants with BPD from a Neonatal High-Risk Follow-Up Clinic and tertiary care hospitals.
- Matched multiple-birth infants (twins, triplets) with singleton infants based on birth date and gestational age.
Main Results:
- Multiple-birth infants had a significantly higher risk of RSV illness (53% vs. 24%) and pneumonia (24% vs. 6%) compared to singletons.
- Hospitalization rates were also higher for multiple-birth infants (32% vs. 18%).
- Additional risk factors for pneumonia included gestational age < 30 weeks and crowded homes.
Conclusions:
- Preterm infants born as multiples with BPD face an elevated risk of pneumonia.
- Gestational age < 30 weeks and crowded homes are significant risk factors for pneumonia in these infants.
- Targeted prophylactic and therapeutic interventions for RSV are recommended for high-risk infants.
Objective:
To assess the impact of multiple births and crowded homes on the severity of respiratory syncytial virus illness in preterm infants with bronchopulmonary dysplasia.
Research Design:
Retrospective case-control chart review from a prospective longitudinal respiratory illness study.
Setting:
Neonatal High-Risk Follow-Up Clinic (outpatient setting) and tertiary care hospitals (inpatient setting).
Participants:
Fourteen sets of twins and two sets of triplets followed up between 1983 and 1989 and matched with 34 singleton infants for date of birth (within 3 months) and gestational age (within 1 month).
Measurements/Main Results:
The risk of developing respiratory syncytial virus illness was significantly higher in multiple-birth infants than in singletons (53% vs 24%; P = .01). Multiple-birth infants were also at greater risk for developing pneumonia (24% vs 6%; P = .05) and requiring hospitalization (32% vs 18%; P = .05) than were singletons. Additional risk factors for developing pneumonia and bronchiolitis were examined in all 68 children. Multiple birth (P = .05), gestational age of less than 30 weeks (P = .02), and crowded homes (defined as more than one person living in 19 m2 of living space [P = .002] or more than one child living in 22 m2 of living space [P = .004]) were additional risk factors for developing pneumonia.
Conclusion:
Multiple-birth preterm infants are at a higher risk of developing pneumonia than are singletons. Additional risk factors for developing pneumonia in preterm infants with bronchopulmonary dysplasia include gestational age of less than 30 weeks and crowded homes. At-risk infants with any of these risk factors should be targeted for prophylactic and therapeutic interventions against respiratory syncytial virus.