Abstract
Objective: To define the impact of associated abnormalities on the efficacy of the novel subtropical guidelines for palivizumab prophylaxis on respiratory syncytial virus (RSV)-related hospitalizations in patients with hemodynamically significant congenital heart disease (hsCHD).Method: This prospective study enrolled every patient seen at a tertiary care center for hsCHD, who was born between 2014 and 2018 and received at least 1 dose of palivizumab, according to the subtropical guidelines. The patients were followed until the age of 2 years.Results: A total of 772 patients (49% male) were enrolled. Cyanotic CHD was seen in 46% of patients, of whom 23% had associated abnormalities. Lung/airway abnormalities (14%) were the most common followed by the genetic syndromes associated with CHD (7.3%). Among the 772 patients, RSV-related hospitalizations occurred in 3.2 and 2.2% children aged ≤ 12 and 13–24 months, respectively. Most of the RSV infections occurred in patients no longer satisfying the criteria for palivizumab prophylaxis. The patients with associated abnormalities but not the type of CHD, patient age, and patient sex were risk factors for RSV-related hospitalizations. The rates of RSV-related hospitalizations, admission to the intensive care unit, and endotracheal intubation were higher for patients with associated anomalies than for other patients before 24 months of age (10.2 vs. 4.0%, 67 vs. 33%, and 39 vs. 4.2%, p = 0.004, 0.06, 0.013, respectively).Conclusion: Children with abnormalities, especially genetic syndromes and lung/airway problems associated with CHD, are at high risk for RSV-related hospitalization. Our current subtropical guidelines for palivizumab prophylaxis in patients with hsCHD, should be revised to include the results of this study.
Highlights
Respiratory syncytial virus (RSV) is the most common cause of admission for lower respiratory tract infections in children aged younger than 2 years [1, 2]
All patients with cyanotic congenital heart disease (CHD) and hemodynamically significant acyanotic CHD aged younger than 1 year should receive monthly palivizumab prophylaxis for a maximum of 6 doses after the diagnosis of CHD if they fulfilled the criteria of hemodynamically significant CHD (hsCHD)
We reported the following findings: [1] most of the RSV infections occurring in patients with CHD who were treated based on the subtropical guidelines for palivizumab prophylaxis could be accounted for by the fact that the infected children no longer satisfied the criteria of the protocol for palivizumab prophylaxis, and not because of the ineffectiveness of palivizumab; [2] CHD patients with associated anomalies, especially those with genetic syndromes or lung/airway abnormalities, had increased risk for RSVrelated hospitalizations, compared with patients without associated anomalies
Summary
Respiratory syncytial virus (RSV) is the most common cause of admission for lower respiratory tract infections in children aged younger than 2 years [1, 2]. We found that that those with cyanotic CHD had higher RSV-related hospitalization rates and more severe disease than those with acyanotic CHD [11]. All patients with cyanotic CHD and hemodynamically significant (hs) acyanotic CHD aged younger than 1 year should receive monthly palivizumab prophylaxis for a maximum of 6 doses after the diagnosis of CHD if they fulfilled the criteria of hsCHD. The efficacy of this subtropical prophylaxis protocol has been validated by a multicenter study of patients living in a subtropical region [12]
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