Predictors of RSV LRTI Hospitalization in Infants Born at 33 to 35 Weeks Gestational Age: A Large Multinational Study (PONI).

Zbyněk Straňák,Gerard Notario,Fiona J Campbell,Teresa Farstad,Stefanie Kalus,Khalid Yunis,Paraskevi Kosma,Klara Posfay-Barbe,Kristina Unnebrink,Jean Van Wyk,Colleen Wegzyn,Elie Saliba,Raymond J Pickles

doi:10.1371/journal.pone.0157446

Abstract

BackgroundPreterm infants are at high risk of developing respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRTI). This observational epidemiologic study evaluated RSV disease burden and risk factors for RSV-associated LRTI hospitalization in preterm infants 33 weeks+0 days to 35 weeks+6 days gestational age not receiving RSV prophylaxis.MethodsPreterm infants ≤6 months of age during RSV season (1 October 2013–30 April 2014) were followed at 72 sites across 23 countries from September 2013–July 2014 (study period). RSV testing was performed according to local clinical practice. Factors related to RSV-associated hospitalization for LRTI were identified using multivariable logistic regression with backward selection.ResultsOf the 2390 evaluable infants, 204 and 127 were hospitalized for LRTI during the study period and RSV season, respectively. Among these subjects, 64/204 and 46/127, respectively, were hospitalized for confirmed RSV LRTI. Study period and RSV season normalized RSV hospitalization rates (per 100 infant years) were 4.1 and 6.1, respectively. Factors associated with an increased risk of RSV-related LRTI hospitalization in multivariable analyses were smoking of family members (P<0.0001), non-hemodynamically significant congenital heart disease diagnosis (P = 0.0077), maternal age of ≤25 years at delivery (P = 0.0009), low maternal educational level (P = 0.0426), household presence of children aged 4 to 5 years (P = 0.0038), age on 1 October ≤3 months (P = 0.0422), and presence of paternal atopy (P<0.0001).ConclusionsDuring the 2013–2014 RSV season across 23 countries, for preterm infants 33–35 weeks gestation ≤6 months old on 1 October not receiving RSV prophylaxis, confirmed RSV LRTI hospitalization incidence was 4.1 per 100 infant years during the study period and 6.1 per 100 infant years during the RSV season. This study enhances the findings of single-country studies of common risk factors for severe RSV infection in preterm infants and suggests that combinations of 4–6 risk factors may be used to accurately predict risk of RSV hospitalization. These findings may be useful in the identification of infants most at risk of severe RSV infection.

Highlights

By the age of 2, most children will experience a respiratory syncytial virus (RSV) infection [1]
Factors associated with an increased risk of RSV-related lower respiratory tract infection (LRTI) hospitalization in multivariable
This study enhances the findings of single-country studies of common risk factors for severe RSV infection in preterm infants and suggests that combinations of 4–6 risk factors may be used to accurately predict risk of RSV hospitalization

Summary

Introduction

By the age of 2, most children will experience a respiratory syncytial virus (RSV) infection [1]. Preterm infants (defined as any infant born before the end of the 37th week of gestation [2,3]) are more prone to severe LRTI due to RSV disease, irrespective of the degree of prematurity [4,5] These infants experience a more complicated clinical course compared with term infants, as demonstrated by increased length of hospital stay and a greater use of supplemental oxygen and respiratory support, and an increased risk for mortality [6,7,8]. Preterm infants are at high risk of developing respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRTI) This observational epidemiologic study evaluated RSV disease burden and risk factors for RSV-associated LRTI hospitalization in preterm infants 33 weeks+0 days to 35 weeks+6 days gestational age not receiving RSV prophylaxis

Results

Discussion

Conclusion