Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-28T00:55:59.808Z Has data issue: false hasContentIssue false
  • English
  • Français

Respiratory syncytial virus prophylaxis in children with cardiac disease: a retrospective single-centre study

Published online by Cambridge University Press:  29 April 2013

Michelle Butt ,
Amanda Symington ,
Marianne Janes ,
Susan Steele ,
LouAnn Elliott ,
Catherine Chant-Gambacort ,
Tapas Mondal  and
Bosco Paes
Michelle Butt
Affiliation:
School of Nursing, McMaster University, Hamilton, Ontario, Canada
Amanda Symington
Affiliation:
Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada
Marianne Janes
Affiliation:
Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada
Susan Steele
Affiliation:
Department of Pediatrics (Neonatology and Cardiac Divisions), McMaster University, Hamilton, Ontario, Canada
LouAnn Elliott
Affiliation:
Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada
Catherine Chant-Gambacort
Affiliation:
Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada
Tapas Mondal
Affiliation:
Department of Pediatrics (Neonatology and Cardiac Divisions), McMaster University, Hamilton, Ontario, Canada
Bosco Paes*
Affiliation:
Department of Pediatrics (Neonatology and Cardiac Divisions), McMaster University, Hamilton, Ontario, Canada
*
Correspondence to: Dr B. Paes, MBBS, FRCPC, Department of Pediatrics (Room HSC-3A), McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Tel: (905) 521-2100×73672; Fax: (905) 521-5007; E-mail: paes@mcmaster.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To examine the characteristics of congenital heart disease patients hospitalised with respiratory syncytial virus infection after prophylaxis and determine the associated comorbidities and the incidence of breakthrough respiratory syncytial virus infections.

Study design

This is a retrospective, single-centre study that was conducted over a period of 7 years. Respiratory syncytial virus infection was identified by classification codes and confirmed by virological tests. Data on baseline demographics, cardiac anomalies, other underlying disease, criteria for hospitalisation, type of respiratory illness and management, complications, and palivizumab prophylaxis were analysed by standard descriptive methods and comparative statistics.

Results

A total of 30 patients were enrolled. The majority were ≤2 years (n = 24). The mean admission age was 15.1 months (standard deviation = 18.3). In all, 90% were acyanotic, 40% had haemodynamically significant disease, and 60% had ≥1 underlying medical illness. Patients were admitted with: respiratory distress (86.7%), hypoxaemia (66.7%), fever (60%), inability to maintain oral intake (36.7%), and apnoea (16.7%). More than 50% required mechanical ventilation and intensive care with a median stay of 11 days (range: 1–43); the length of hospital stay for all children was 10 days (range: 1–65). Complications included: concurrent bacterial sepsis (20%), electrolyte abnormalities (16.7%), and worsening pulmonary hypertension (13.3%). Of 10 infants ≤2 years with haemodynamically significant heart disease, four had received prophylaxis. There was one death, which was attributed to respiratory syncytial virus infection.

Conclusions

Overall, 185 infants ≤2 years with haemodynamically significant cardiac disease received prophylaxis. In all, six qualifying infants missed immunisation and were hospitalised. Breakthrough respiratory syncytial virus infections occurred in 2.2%, demonstrating good efficacy of palivizumab in this population compared with the original, multi-centre, randomised trial.

Keywords

Respiratory syncytial virusinfectionhaemodynamically significant cardiac diseasepalivizumab
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 2 , April 2014 , pp. 337 - 343
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hall, CB, Weinberg, GA, Iwane, MK, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med 2009; 360: 588–598.CrossRefGoogle ScholarPubMed
2. Schanzer, DL, Langley, JM, Tam, TWS. Hospitalization attributable to influenza and other viral respiratory illnesses in Canadian children. Pediatr Infect Dis J 2006; 25: 795–800.CrossRefGoogle ScholarPubMed
3. Iwane, MK, Edwards, KM, Szilagyi, PG, et al. New Vaccine Surveillance Network. Population-based surveillance for hospitalizations associated with respiratory syncytial virus, influenza virus, and parainfluenza viruses among young children. Pediatrics 2004; 113: 1758–1764.CrossRefGoogle Scholar
4. Nair, H, Nokes, DJ, Gessner, BD, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 2010; 375: 1545–1555.CrossRefGoogle ScholarPubMed
5. Welliver, RC. Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection. J Pediatr 2003; 143: S112–S117.CrossRefGoogle ScholarPubMed
6. Cabalka, AK. Physiologic risk factors for respiratory viral infections and immunoprophylaxis for respiratory syncytial virus in young children with congenital heart disease. Ped Infect Dis J 2004; 23: S41–S45.CrossRefGoogle ScholarPubMed
7. Chang, R-KR, Chen, AY. Impact of Palivizumab on RSV hospitalizations for children with hemodynamically significant congenital heart disease. Pediatr Cardiol 2010; 31: 90–95.CrossRefGoogle ScholarPubMed
8. Kristensen, K, Hjuler, T, Ravn, H, Simoes, EAF, Stensballe, LG. Chronic diseases, chromosomal abnormalities, and congenital malformations as risk factors for respiratory syncytial virus hospitalization: A population-based cohort study. Clin Infect Dis 2012; 54: 810–817.CrossRefGoogle ScholarPubMed
9. Meberg, A, Bruu, AL. Respiratory syncytial virus infections in congenital heart defects-hospitalizations and costs. Acta Paediatr 2006; 95: 404–406.CrossRefGoogle ScholarPubMed
10. Thorburn, K. Pre-existing disease is associated with a significantly higher risk of death in severe respiratory syncytial virus infection. Arch Dis Child 2009; 94: 99–103.CrossRefGoogle ScholarPubMed
11. Navas, L, Wang, E, de Carvalho, V, Robinson, J. Improved outcome of respiratory syncytial virus infection in a high-risk hospitalized population of Canadian children. J Pediatr 1992; 121: 348–354.CrossRefGoogle Scholar
12. MacDonald, NE, Hall, CB, Suffin, SC, Alexson, C, Harris, PJ, Manning, JA. Respiratory syncytial viral infection in infants with congenital heart disease. N Engl J Med 1982; 307: 397–400.CrossRefGoogle ScholarPubMed
13. Medrano, C, Garcia-Guereta, L, Grueso, J, et al. The CIVIC Study Group from the Spanish Society of Pediatric Cardiology and Congenital Heart Disease. Respiratory infection in congenital cardiac disease. Hospitalizations in young children in Spain during 2004 and 2005: the CIVIC Epidemiologic Study. Cardiol Young 2007; 17: 360–371.CrossRefGoogle Scholar
14. Feltes, TF, Cabalka, AK, Meissner, HC, et al. Cardiac Synagis Group. Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr 2003; 143: 532–540.CrossRefGoogle ScholarPubMed
15. Committee on Infectious Diseases. From the American Academy of Pediatrics: Policy statements – modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. Pediatrics 2009; 124: 1694–1701.CrossRefGoogle Scholar
16. Langley, JM. Canadian Pediatric Society, Infectious Diseases and Immunization Committee. Use of palivizumab in children with congenital heart disease. Paediatr Child Health 2003; 8: 631–633.Google Scholar
17. Figueras Aloy, J, Quero, J, Doménech, E, et al. Comité de Estándares de la Sociedad Española de Neonatología [Recommendations for the prevention of respiratory syncytial virus infection]. An Pediatr (Barc) 2005; 63: 357–362.CrossRefGoogle Scholar
18. Rondini, G, Macagno, F, Barberi, I. Raccomandazioni della Societa Italiana di Neonatologia per la prevenzione delle malattie da virus respiratorio sinciziale (VRS). Acta Neonatal 2004; 1: 1–11.Google Scholar
19. Nakazawa, M, Saji, T, Ichida, F, Oyama, K, Harada, K, Kususda, S. Guidelines for the use of palivizumab in infants and young children with congenital heart disease. Pediatr Int 2006; 48: 190–193.CrossRefGoogle Scholar
20. Chantepie, A. bureau de la Filiale de Cardiologie Pédiatrique de la Société Française de Cardiologie [Use of palivizumab for the prevention of respiratory syncytial virus infections in children with congenital heart disease. Recommendations from the French Paediatric Cardiac Society]. Arch Pediatr 2004; 11: 1402–1405.CrossRefGoogle Scholar
21. Tulloh, RM, Feltes, TF. The European Forum for Clinical Management: prophylaxis against the respiratory syncytial virus in infants and young children with congenital cardiac disease. Cardiol Young 2005; 15: 274–278.CrossRefGoogle ScholarPubMed
22. Butt, ML, Symington, A, Janes, M, Elliott, L, Steele, S, Paes, BA. The impact of prophylaxis on paediatric intensive care unit admissions for respiratory syncytial virus infection: a retrospective, single-centre study. Eur J Pediatr 2011; 170: 907–913.CrossRefGoogle ScholarPubMed
23. Feltes, TF, Sondheimer, HM, Tulloh, RM, et al. Motavizumab Cardiac Study Group. A randomized controlled trial of motavizumab versus palivizumab for the prophylaxis of serious respiratory syncytial virus disease in children with hemodynamically significant congenital heart disease. Pediatr Res 2011; 70: 186–191.CrossRefGoogle ScholarPubMed
24. Medrano López, C, García-Guereta, L; CIVIC Study Group. Community-acquired respiratory infections in young children with congenital heart diseases in the palivizumab era: the Spanish 4-season civic epidemiologic study. Pediatr Infect Dis J 2010; 29: 1077–1082.CrossRefGoogle ScholarPubMed
25. Alexander, PM, Eastaugh, L, Royle, J, Daley, AJ, Shekerdemian, LS, Penny, DJ. Respiratory syncytial virus immunoprophylaxis in high-risk infants with heart disease. J Paediatr Child Health 2012; 48: 395–401.CrossRefGoogle ScholarPubMed
26. Cohen, SA, Zanni, R, Cohen, A, et al; Palivizumab Outcomes Registry Group. Palivizumab use in subjects with congenital heart disease results from the 2000–2004 Palivizumab Outcomes Registry. Pediatr Cardiol 2008; 29: 382–387.CrossRefGoogle ScholarPubMed
27. Mitchell, I, Paes, BA, Li, A, Lanctot, K. and the CARESS investigators. CARESS: The Canadian registry of palivizumab. Pediatr Infect Dis J 2011; 30: 651–655.CrossRefGoogle ScholarPubMed
28. Khongphatthanayothin, A, Wong, PC, Samara, Y, et al. Impact of respiratory syncytial virus infection on surgery for congenital heart disease: postoperative course and outcome. Crit Care Med 1999; 27: 1974–1981.CrossRefGoogle ScholarPubMed
29. Welliver, RC, Checchia, PA, Bauman, JH, Fernandes, AW, Mahadevia, PJ, Hall, CB. Fatality rates in published reports of RSV hospitalizations among high-risk and otherwise healthy children. Curr Med Res Opin 2010; 26: 2175–2181.CrossRefGoogle ScholarPubMed
30. Hussman, JM, Lanctot, KL, Paes, B. The cost effectiveness of palivizumab in congenital heart disease: a review of the current evidence. J Med Econ 2013; 16: 115–124.CrossRefGoogle ScholarPubMed
31. American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics 2006; 118: 1774–1793.CrossRefGoogle Scholar
32. Duttweiler, L, Nadal, D, Frey, B. Pulmonary and systemic bacterial co-infections in severe bronchiolitis. Arch Dis Child 2004; 89: 1155–1157.CrossRefGoogle Scholar
33. Kneyber, MCJ, Blusse van Oud-Albas, H, van Vliet, M, Uiterwaal, CSPM, Kimpen, JLL, van Vught, AJ. Concurrent bacterial infection and prolonged mechanical ventilation in infants with respiratory syncytial virus lower respiratory tract infection. Intensive Care Med 2005; 31: 680–685.CrossRefGoogle Scholar
34. Randolph, AG, Reder, L, Englund, JA. Risk of bacterial infection in previously healthy respiratory syncytial virus-infected young children admitted to the intensive care unit. Pediatr Infect Dis J 2004; 23: 990–994.CrossRefGoogle ScholarPubMed
35. Thorburn, K, Harigopal, S, Reddy, V, Taylor, N, van Saene, HK. High incidence of pulmonary bacterial co-infection in children ventilated for severe respiratory syncytial virus (RSV) bronchiolitis. Thorax 2006; 61: 611–615.CrossRefGoogle ScholarPubMed
36. Ralston, S, Hill, V, Waters, A. Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review. Arch Pediatr Adolesc Med 2011; 65: 951–956.CrossRefGoogle Scholar
37. Krief, WI, Levine, DA, Platt, SL, et al. Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Influenza virus infection and the risk of serious bacterial infections in young febrile infants. Pediatrics 2009; 124: 30–39.CrossRefGoogle Scholar
38. Paes, B, Mitchell, I, Li, A, Lanctot, K. and the CARESS investigators. A comparative study of respiratory syncytial virus (RSV) prophylaxis in premature infants within the Canadian Registry of Palivizumab (CARESS). Eur J Clin Microbiol Infect Dis 2012; 31: 2703–2711.CrossRefGoogle ScholarPubMed
39. Paes, B, Mitchell, I, Li, A, Lanctôt, KL. Respiratory hospitalizations and respiratory syncytial virus prophylaxis in special populations. Eur J Pediatr 2012; 171: 833–841.CrossRefGoogle ScholarPubMed