Abstract
Children with hemodynamically significant congenital heart disease (CHD) are at elevated risk of morbidity and mortality due to respiratory syncytial virus (RSV) disease compared to their healthy peers. Previous studies have demonstrated lower RSV hospitalization risk among all children with CHD at 12–23 months of age versus 0–11 months of age. However, RSV hospitalization risk at 12–23 months of age by specific CHD diagnosis has not been characterized. Both case-control and cohort studies were conducted using data from the US National Inpatient Sample from 1997 to 2013 to characterize relative risk of RSV hospitalization among children 12–23 months of age with CHD. Related CHD diagnoses were combined for analysis. Hospitalizations for RSV and unspecified bronchiolitis were described by length of stay, mechanical ventilation use, mortality, and total charges. Over the 17-year period, 1,168,886 live birth hospitalizations with CHD were identified. Multiple specific CHD conditions had an elevated odds ratio or relative risk of RSV hospitalization. Mean total RSV hospitalization charges were significantly higher among children with CHD relative to those without CHD ($19,650 vs $7,939 in 2015 dollars) for this period. Compared to children without CHD, children with Ebstein’s anomaly, transposition of the great arteries, aortic stenosis, heterotaxia, and aortic arch anomalies had 367-, 344-, 203-, 117- and 47-fold increased risk of inpatient RSV mortality, respectively. Unspecified bronchiolitis hospitalization odds and relative risk across CHD diagnoses were similar to those observed with RSV hospitalization; however, unspecified bronchiolitis hospitalizations were associated with shorter mean days of stay and less frequently associated with mechanical ventilation or mortality. Among children with more severe CHD diagnoses, RSV disease remains an important health risk through the second year of life. These data can help inform decisions regarding interventions to protect children with CHD from severe RSV disease during their second year of life.
Highlights
Respiratory syncytial virus (RSV) is a common pediatric respiratory infection, with most children affected by 2 years of age [1]
Despite the previous observation that overall RSV hospitalization rates among children with congenital heart disease (CHD) are lower at 12–23 months of age relative to children with CHD at 0–11 months of age [6], the present study demonstrates that compared to children without CHD, multiple specific CHD diagnoses are associated with substantial risks of mechanical ventilation and inpatient mortality as well as an increased risk of RSV hospitalization at 12–23 months of age with increased mean lengths of stay and total charges during RSV hospitalization
The results from the present study provide clear evidence that for children with these high-risk types of CHD, RSV lower respiratory tract illness continues to be an important risk to their health through the second year of life
Summary
Respiratory syncytial virus (RSV) is a common pediatric respiratory infection, with most children affected by 2 years of age [1]. Morbidity and mortality associated with RSV are increased among certain populations, including children with hemodynamically significant congenital heart disease [4,5,6]. Children with hemodynamically significant CHD can experience a more complicated clinical course, with a high proportion requiring intensive care unit admission, assisted ventilation, longer duration of oxygen supplementation, and prolonged duration of hospital stay [7,8,9,10]. Congenital heart disease (CHD) has been associated with a 3.7-fold increased risk of death among infants hospitalized for RSV [11]. Immunoprophylaxis with palivizumab has demonstrated reduced RSV-related hospitalization in high-risk groups, including preterm infants 35 weeks’ gestational age and children
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