Hospitalized Children With Respiratory Syncytial Virus Infection and Neuromuscular Impairment Face an Increased Risk of a Complicated Course

Wilkesmann, Anja; Ammann, Roland A.; Schildgen, Oliver; Eis-Hübinger, AM; Müller, Andreas; Seidenberg, J.; Stéphan,; Rieger, Christian; Herting, Egbert; Wygold, T.; Hornschuh, F; Groothuis,; Simon, Arne

doi:10.1097/inf.0b013e31805d01e3

Cited by 119 publications

(84 citation statements)

References 26 publications

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“…Table I gives details of the medical history and the clinical situation of the patients at the time of diagnosis in the group ventilated mechanically (Table I). According to the categories of the DSM RSV Paed study [Simon Wilkesmann et al, 2007], the following age distribution was found: newborns (4 weeks), n ¼ 1 (5%); 5 weeks to 5 months, n ¼ 10 (50%); 6-12 months, n ¼ 7 (35%); 13-24 months, n ¼ 1 (5%); and >24 months n ¼ 1 (5%). Forty percent (n ¼ 8) of all RSV infections in the group ventilated mechanically were acquired nosocomially.…”

Section: Resultsmentioning

confidence: 99%

“…This may increase the risk of gastroesophageal reflux and recurrent aspiration. -Other preexisting comorbidities, as congenital heart disease [Feltes et al, 2003;Thorburn et al, 2004] or severe neuromuscular impairment [Panitch, 2004;Wilkesmann et al, 2007] contribute to an adverse outcome of infection.…”

Section: Discussionmentioning

confidence: 99%

“…Positive RSV results by antigen detection, cell culture methods, and/or PCR were reported within a few hours to the attending physicians [for details of virological methods see Wilkesmann et al 2007]. The prospective surveillance period covered 6 months of each year (November 1 -April 30).…”

Section: Methodsmentioning

confidence: 99%

“…The primary purpose of the surveillance was to facilitate the collection and analysis of detailed information on the population of hospitalized children with RSV infection in Germany. The additional risk factors, neuromuscular impairment [Wilkesmann et al, 2007], and nosocomial RSV infection [Simon et al, 2007a] have been reported in detail in separate publications and a subgroup analysis for premature infants has also been published [Simon et al, 2007b].…”

Section: Introductionmentioning

confidence: 99%

“…About 1-2% of all RSV infected children require hospital care. The RSV related hospitalization rate and the risk of severe complications are increased in prematurely born infants with chronic lung disease [Meissner, 2003] and in children with hemodynamically relevant congenital heart disease [Buckingham et al, 2001;Feltes et al, 2003], as well as with other forms of chronic lung disease or severe neuromuscular impairment [Panitch, 2004;Wilkesmann et al, 2007]. Specific therapeutic agents with proven efficacy against RSV are still not available [Black, 2003;Fitzgerald and Kilham, 2004].…”

Section: Introductionmentioning

confidence: 99%

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Respiratory syncytial virus infection in children admitted to hospital but ventilated mechanically for other reasons

Renesse

Schildgen

Klinkenberg

et al. 2008

Journal of Medical Virology

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One thousand five hundred sixty-eight RSV infections were documented prospectively in 1,541 pediatric patients. Of these, 20 (1.3%) had acquired the RSV infection while treated by mechanical ventilation for reasons other than the actual RSV infection (group ventilated mechanically). The clinical characteristics of children who were infected with respiratory syncytial virus (RSV) infection while ventilated mechanically for other reasons are described and compared with a matched control group. Sixty percent of the group ventilated mechanically had at least one additional risk factor for a severe course of infection (prematurity 50%, chronic lung disease 20%, congenital heart disease 35%, immunodeficiency 20%). The median age at diagnosis in the group ventilated mechanically was 4.2 months. The matched pairs analysis (group ventilated mechanically vs. control group) revealed a higher proportion of patients with hypoxemia and apnoea in the group ventilated mechanically; more patients in the control group showed symptoms of airway obstruction (wheezing). At least one chest radiography was performed in 95% of the patients (n ¼ 19) in the group ventilated mechanically versus 45% (n ¼ 9) in the control group (P ¼ 0.001). The frequency of pneumonia was 40% in the group ventilated mechanically and 20% in the control group. Despite existing consensus recommendations, only two patients (10%) of the group ventilated mechanically had received palivizumab previously. Significantly more patients in the group ventilated mechanically received antibiotic treatment (85% vs. 45%, P ¼ 0.008), and attributable mortality was higher in the group ventilated mechanically (15% [n ¼ 3] vs. 0% in the control group, P ¼ 0.231). Children treated by long term mechanical ventilation may acquire RSV infection by transmission by droplets or caregivers and face an increased risk of a severe course of RSV infection. The low rate of immunoprophylaxis in this particular risk group should be improved.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Respiratory syncytial virus infection in children admitted to hospital but ventilated mechanically for other reasons

Renesse

Schildgen

Klinkenberg

et al. 2008

Journal of Medical Virology

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Factors predicting prolonged hospital stay for infants with bronchiolitis

Weisgerber

Lye

et al. 2011

Journal of Hospital Medicine

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BACKGROUND: Prior prediction models for length of stay (LOS) in bronchiolitis have focused more on birth‐ and disease‐related risk factors than on early hospital course factors, particularly common clinical markers including respiratory status and caloric intake. OBJECTIVES: 1) Study the associations of various clinical markers and LOS; and 2) develop a LOS prediction model. DESIGN: Retrospective cohort study. SETTING: Children's Hospital of Wisconsin. PATIENTS: Inclusion criteria were: age <365 days old; admission between November 1, 2004 and April 15, 2005; final diagnosis of bronchiolitis; placement on the bronchiolitis treatment protocol; and lack of concurrent condition impacting LOS. RESULTS: During the study period, 272/347 infants admitted with bronchiolitis met inclusion criteria. On hospital day 2, infants in the prolonged LOS group (≥108 hours) had a significantly greater number of hours on supplemental oxygen, maximum supplemental oxygen use, minimum supplemental oxygen use, maximum respiratory rate, mean respiratory score, and number of times suctioned. They had significantly lower minimum oxygen saturation and caloric intake. Recursive partitioning demonstrated five variables (hours of supplemental oxygen, maximum respiratory rate, minimum supplemental oxygen use, gestation, and caloric intake) to predict short or prolonged LOS with an area under the receiver‐operator characteristic curve of 0.89/0.72 in the learning/test trees; sensitivity, 0.85; and specificity, 0.82. CONCLUSIONS: There are important differences between infants with bronchiolitis having short and prolonged hospital stays, including several clinical markers identifiable on hospital day 2. This model may be a useful prediction tool for targeting early interventions for high‐risk infants. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine

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Use of palivizumab in infants and young children with severe respiratory disease: A delphi study

et al. 2013

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A set of indication for off-label uses of palivizumab in pediatric pulmonology was developed in accordance with the degree of professional consensus on which they were based. The applicability of the present results to clinical practice should be evaluated individually and reviewed periodically in the light of new emerging evidence. Further studies are needed to add evidence to the most frequent and clinically oriented scenarios that have shown higher levels of uncertainty.

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Hospitalized Children With Respiratory Syncytial Virus Infection and Neuromuscular Impairment Face an Increased Risk of a Complicated Course

Abstract: This is the first prospective multicenter study confirming the hypothesis that children with clinically relevant NMI face an increased risk for severe RSV-disease. It seems reasonable to include NMI as a cofactor into the decision algorithm of passive immunization.

Cited by 119 publications

References 26 publications

Respiratory syncytial virus infection in children admitted to hospital but ventilated mechanically for other reasons

Respiratory syncytial virus infection in children admitted to hospital but ventilated mechanically for other reasons

Factors predicting prolonged hospital stay for infants with bronchiolitis

Use of palivizumab in infants and young children with severe respiratory disease: A delphi study

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