Predictors and incidence of hospitalization due to respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRTI) in non-prophylaxed moderate-to-late preterm infants in Bosnia and Herzegovina.

Hajrija Maksić,Veroslava Milošević,Notario Gerard,Almir Zlatanović,Fahrija Skokić,Suada Heljić,Darinka Šumanović-Glamuzina

doi:10.17305/bjbms.2018.2318

Abstract

Prematurity is a risk factor for respiratory syncytial virus (RSV)-associated lower respiratory tract infections (LRTIs), due to immature humoral and cell-mediated immune system in preterm newborns, as well as their incomplete lung development. Palivizumab, a humanized monoclonal antibody against the F glycoprotein of RSV, is licensed for the prevention of severe RSV LRTI in children at high risk for the disease. This study is a part of a larger observational, retrospective-prospective epidemiological study (PONI) conducted at 72 sites across 23 countries in the northern temperate zone. The aim of our non-interventional study was to identify common predictors and factors associated with RSV LRTI hospitalization in non-prophylaxed, moderate-to-late preterm infants, born between 33 weeks and 0 days and 35 weeks and 6 days of gestation, and less than 6 months prior to or during the RSV season in Bosnia and Herzegovina (B&H). A total of 160 moderate-to-late preterm infants were included from four sites in B&H (Sarajevo, Tuzla, Mostar, and Banja Luka). We identified several significant intrinsic and extrinsic factors to be associated with the risk of RSV LRTI hospitalization in the preterm infants, including: comorbidities after birth, shorter hospital stay, admission to NICU/PICU while in the maternity ward, household smoking, low maternal age, breast feeding, number of family members, and history of family/paternal atopy. Overall, our results indicated that the risk of RSV LRTI in preterm newborns can be associated with different environmental and social/cultural factors, and further research is needed to comprehensively evaluate these associations.

Highlights

Respiratory syncytial virus (RSV) is a single-stranded, negative-sense RNA virus belonging to the genus Pneumovirus of Paramyxoviridae family
The published data for Bosnia and Herzegovina (B&H) showed that palivizumab provides significant protection from lower respiratory tract infections (LRTIs), and LRTI RSV hospitalization rate of 1.2% was reported for six RSV seasons, in a population in which palivizumab was used according to the updated guidelines [41,42]
We showed that low maternal age is associated with a higher risk of RSV LRTI hospitalization, which is in agreement with the results of PONI [20] and the study of Gavin et al [18], and may be explained by the inexperience of younger mothers

Summary

Introduction

Respiratory syncytial virus (RSV) is a single-stranded, negative-sense RNA virus belonging to the genus Pneumovirus of Paramyxoviridae family. RSV is highly contagious and it can cause acute respiratory tract illness in groups of all ages. In 2005, it was estimated that among children under 5 years of Submitted: 10 October 2017/Accepted: 02 January 2018 age at least 33.8 million cases of acute lower respiratory infection (ALRI) associated with RSV occurred worldwide, and approximately 3.4 million children required hospitalization due to severe RSV-associated ALRI. An estimated case fatality ratio (CFR) in children younger than 5 years in developing countries was 2.1% [1]. In studies of hospitalized children, RSV infection has been associated with up to 74% of bronchiolitis cases and up to 54% of pneumonia cases [3]

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Conclusion