High risk of nosocomial-acquired RSV infection in children with congenital heart disease

Abstract

To the Editor: Children with congenital heart disease (CHD) are at increased risk for severe respiratory syncytial virus (RSV) lower respiratory tract infections (LRTIs).1.Altman C.A. Englund J.A. Demmler G. Drescher K.L. Alexander M.A. Watrin C. et al.Respiratory syncytial virus in patients with congenital heart disease: a contemporary look at epidemiology and success of preoperative screening.Pediatr Cardiol. 2000; 21: 433-438Crossref PubMed Scopus (77) Google Scholar Among CHD infants hospitalized for RSV disease, approximately one-third will require treatment in the intensive care unit, and eventually 2% to 3.5% will die,2.Prais D. Schonfeld T. Amir J. Israeli Respiratory Syncytial Virus Monitoring Group Admission to the intensive care unit for respiratory syncytial virus bronchiolitis: a national survey before palivizumab use.Pediatrics. 2003; 112: 548-552Crossref PubMed Scopus (53) Google Scholar whereas nosocomial RSV infection in CHD infants has an adverse impact on surgery for their CHD.3.Khongphatthanayothin A. Wong P.C. Samara Y. Newth C.J. Wells W.J. Starnes V.A. et al.Impact of respiratory syncytial virus infection on surgery for congenital heart disease: postoperative course and outcome.Crit Care Med. 1999; 27: 1974-1981Crossref PubMed Scopus (87) Google Scholar Recently, Feltes and co-workers demonstrated that palivizumab prophylaxis reduces hospitalization due to RSV in young children with hemodynamically significant CHD.4.Feltes T.F. Cabalka A.K. Meissner H.C. Piazza F.M. Carlin D.A. Top Jr., F.H. for the Cardiac Synagis Study Group et al.Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease.J Pediatr. 2003; 143: 532-540Abstract Full Text Full Text PDF PubMed Scopus (579) Google Scholar On the basis of these observations, we assessed the prevalence and severity of RSV infections both in CHD infants hospitalized for LRTI and in infants who develop RSV-induced LRTI during hospitalization. We used data from a national study (RADAR) aimed to evaluate a cohort of children younger than 2 years, hospitalized for LRTI, or who developed RSV-induced LRTI during hospitalization in 32 Italian pediatric tertiary care centers over the epidemic period between November 1999 to April 2000.5.Lanari M. Giovannini M. Giuffre L. Marini A. Rondini G. Rossi G.A. Merolla R. Zuccotti G.V. Salvioli G.P. Investigators R.A.DA.R. Study Group Prevalence of respiratory syncytial virus infection in Italian infants hospitalized for acute lower respiratory tract infections, and association between respiratory syncytial virus infection risk factors and disease severity.Pediatr Pulmonol. 2002; 33: 458-465Crossref PubMed Scopus (117) Google Scholar Of the 1214 infants evaluated, 42 (3.5%) had a nonsurgically corrected CHD (NSCHD+). Rates of prematurely born (≤35 weeks) and low-birth-weight (<2500 g) infants were significantly higher in NSCHD+ infants (15.4% and 29.3%, respectively) than in infants without CHD (CHD−) (8.2% and 13.4%, respectively) (P < .01). None of the NSCHD+ infants had chronic lung disease. Performing RSV antigen detection on nasopharyngeal specimen by an enzyme immunoassay (Abbott Testpack RSV), we found positive results in 35.7% of NSCHD+ and in 40.8% of CHD− infants. The proportion of infants who had a nosocomially-acquired RSV infection was higher in NSCHD+ than in CHD− infants (9.8% vs 2.9%; P < .05), indicating a greater chance of developing RSV infection after hospitalization in the former group (OR, 3.6; [95% CI, 1.03-11.3]; P < .05). As expected, LRTI was associated with significantly more severe respiratory impairment in NSCHD+ than in CHD− infants, both evaluating the days of hospitalization (9.2 ± 8.0 days vs 6.1 ± 3.9 days; P < .01) and the days of oxygen therapy (2.2 ± 3.3 days vs 1.0 ± 2.0 days; P < .05). These data confirm the high risk of nosocomially-acquired RSV infection in CHD+ infants and support the need for RSV prophylaxis in CHD+ patients even during hospitalization. ReplyThe Journal of PediatricsVol. 145Issue 1PreviewTo the Editor: Full-Text PDF