Impact of respiratory syncytial virus infection on surgery for congenital heart disease: Postoperative course and outcome

Khongphatthanayothin, Apichai; Wong, Pierre C.; Samara, Yousef; Newth, Christopher J L; Wells, Winfield J.; Starnes, Vaughn A.; Chang, Anthony

doi:10.1097/00003246-199909000-00042

Cited by 94 publications

(59 citation statements)

References 12 publications

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“…A IRA das vias aéreas inferiores tem sido associada a níveis significativos de morbimortalidade em crianças com DCC e comprometimento hemodinâmico [5][6][7]18 . A infecção pelo VSR parece ser significativamente mais grave se esse vírus comparada a infecções por outros vírus respiratórios 8,9,[19][20][21][22] .…”

Section: Discussionunclassified

“…Vários relatos indicam aumento na susceptibilidade à IRA em crianças com DCC, principalmente naquelas com comprometimento hemodinâmico significativo, com uma maior taxa de internação em unidades de terapia intensiva e maior risco de mortalidade do que a população pediátrica em geral. Entre os agentes etiológicos da IRA nesse grupo, o VSR causa maior morbidade do que outros vírus respiratórios [7][8][9] .…”

Section: Introductionunclassified

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Hospitalization due to respiratory syncytial virus infection in patients under 2 years of age with hemodynamically significant congenital heart disease

Andres¹,

Bauer²,

Rodríguez³

et al. 2012

J Pediatr (Rio J)

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Objective: To describe hospitalization rates, burden of disease, and associated risk factors of acute respiratory infections (ARI), particularly those caused by respiratory syncytial virus (RSV) and non-RSV-ARI, in a cohort of patients under 2 years of age with congenital heart disease (CHD). Methods:A prospective, observational cohort study was conducted with CHD patients discharged from the neonatal unit and followed up at a referral center. Demographic variables, type of CHD, and medical needs were recorded. Study primary outcome was hospitalization for ARI (overall, due to RSV, and due to other causes). Secondary outcome was burden of disease in hospitalized patients. Incidence rates of hospitalization were calculated for overall ARI and RSV-ARI. Incidence densities were additionally calculated. Results:Seventy-one patients with birth weight 3,043±720 g (mean ± SD) were included; 74% required surgery and 8.4% died of CHD during the study. Overall, 22/71 patients were hospitalized due to ARI (31%; 95%CI 20-43), 15 of them RSV-associated (21%; 95% CI 12-32), and there were 1.35 episodes of hospitalization for ARI/1,000 days of follow-up (0.92 episodes of hospitalization for RSV-ARI/1,000 days). Forty per cent of patients with ARI due to RSV needed admission to pediatric ICU and 30% required mechanical ventilation vs. none in non-RSV-ARI. Conclusions:In the studied population, ARI hospitalization was common, and RSV was its most frequent cause. Disease burden associated with RSV-ARI was considerable, although no patient died from ARI. Except younger age, no other biological or social risk factors were found associated with RSV-ARI hospitalization. J Pediatr (Rio J). 2012;88(3):246-52:Respiratory syncytial virus, respiratory tract infections, heart disease, infants. ResumoObjetivo: Descrever taxas de hospitalização, carga de doença e fatores de risco associados a infecções agudas respiratórias (IRAs), especialmente aquelas causadas pelo vírus sincicial respiratório (VSR) e as causadas por outros vírus, em uma coorte de pacientes menores de 2 anos com doença cardíaca congênita (DCC).Métodos: Um estudo de coorte observacional e prospectivo foi realizado com pacientes com DCC que receberam alta da unidade neonatal e foram acompanhados em um centro de referência. Foram registradas variáveis demográficas, tipo de DCC e necessidades médicas. O desfecho primário foi a internação por IRA (em valores totais e referentes apenas à infecção pelo VSR e por outras causas), e o secundário a carga da doença em pacientes hospitalizados. As taxas de internação foram calculadas considerando os valores totais de IRA e também os referentes apenas à IRA pelo VSR. Também foi calculada a densidade de incidência. Resultados:Foram incluídos 71 pacientes com peso de nascimento de 3.043±720 g (média ± DP); 74% necessitaram de cirurgia e 8,4% faleceram em decorrência da DCC. No total, 22/71 pacientes foram hospitalizados por IRA (31%; IC95% 20-43), 15 deles pelo VSR (21%; IC95% 12-32), e ocorreram 1,35 episódios de internação por IR...

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Section: Discussionunclassified

Section: Introductionunclassified

Hospitalization due to respiratory syncytial virus infection in patients under 2 years of age with hemodynamically significant congenital heart disease

Andres¹,

Bauer²,

Rodríguez³

et al. 2012

J Pediatr (Rio J)

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“…R espiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection in early childhood and leads to hospitalization in up to 2% of Canadian children younger than two years of age each winter (1). Children with hemodynamically significant cardiac disease may develop respiratory or cardiac failure during RSV infection, and have prolonged hospital stay, need intensive care and have higher mortality rates than healthy infants (2); they may also have worse postoperative clinical outcomes after corrective cardiac surgery (3,4). Seasonal prophylaxis with a humanized mouse monoclonal anti-RSV antibody (palivizumab, Abbott Laboratories, Canada) (5), reduces RSV-related hospitalization rates in children with hemodynamically significant heart disease, and Canadian authorities recommended in 2003 that eligible children be considered for passive immunization during the winter (6,7).…”

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confidence: 99%

Optimizing the delivery and use of a new monoclonal antibody in children with congenital heart disease: A successful provincial respiratory syncytial virus prophylaxis program

Warren

Langley

Thomas³

et al. 2007

Canadian Journal of Cardiology

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A Warren, JM Langley, W Thomas, J Scott. Optimizing the delivery and use of a new monoclonal antibody in children with congenital heart disease: A successful provincial respiratory syncytial virus prophylaxis program. Can J Cardiol 2007;23(6):463-466.OBJECTIVES: To describe a program for passive immunization against respiratory syncytial virus infection in infants with hemodynamically significant congenital heart disease (CHD) in accordance with the Canadian Paediatric Society recommendations. METHODS: A provincial coordinating committee composed of specialists in pediatrics, cardiology, infectious diseases, neonatology and public health collaborated to develop and implement a program to identify children with hemodynamically significant heart disease and offer respiratory syncytial virus prophylaxis. Database records for all children younger than two years of age who were seen by the provincial pediatric cardiology referral service were reviewed. Children with hemodynamically significant heart disease, as determined by a clinical assessment and echocardiography, were considered to be eligible for monthly palivizumab prophylaxis for five winter months. All physicians in the province were notified that approval of the provincial cardiology service was required for prophylaxis to be administered. Immunization rates were compared with projected rates based on the expected population-based immunization rates in infants with CHD in other provinces. RESULTS: 401 children with any cardiac diagnoses were identified, representing 545 potential patient-seasons of prophylaxis over two years in a birth cohort of 20,173 and 19,227 children, in each respective season (13.8 patient-seasons per 1000 births). Of these, 21 children were eligible for palivizumab prophylaxis according to the Canadian Paediatric Society criteria. All eligible children were immunized, and no ineligible children received the immunization. A review of palivizumab use in other provinces revealed highly variable rates of prophylaxis. CONCLUSIONS: The use of palivizumab for children with CHD can be optimized through a provincial model, in which children requiring prophylaxis are prospectively identified and reviewed by pediatric cardiologists -and to whom evidence-based guidelines developed by a multidisciplinary team -are applied. Such a model ensures that all patients requiring prophylaxis receive the appropriate immunization and avoids the immunization of low-risk children with CHD, in whom the benefits of palivizumab have not been proven.Key Words: Congenital heart disease; Palivizumab; Respiratory syncytial virus L'optimisation de la délivrance et de l'utilisation d'un nouvel anticorps monoclonal chez des enfants atteints d'une cardiopathie congénitale : Un programme provincial efficace de prophylaxie contre le virus respiratoire syncytial OBJECTIFS : Décrire un programme d'immunisation passive contre l'infection par le virus respiratoire syncytial chez des nourrissons atteints d'une cardiopathie congénitale importante sur le plan hémodynamique, con...

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“…This seems to be particularly important in the case of complex procedures, such as open heart surgery and major airway reconstruction. [3][4][5] The exact period that surgery must be postponed must take into account the nature and urgency of the surgery, any other comorbidities and the presence of any ongoing symptoms or abnormal physical signs.…”

mentioning

confidence: 99%

“…The surgical infant facing major cardiac or airway reconstructive surgery may be screened for RSV and surgery postponed in the face of a positive test. [3][4][5] There is no benefit, however, in conducting routine RSV testing for less complex surgery in asymptomatic patients. 17 High risk infants may be protected during the RSV season with palivizumab, a form of passive immunoprophylaxis.…”

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confidence: 99%

Repair of incarcerated inguinal hernia in an infant with acute viral bronchiolitis

Cox

2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To describe the anesthetic concerns and management options in an infant with acute viral bronchiolitis who required emergency surgery.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 12-week-old infant presented to the emergency department with an incarcerated right inguinal hernia. The history was complicated by concurrent acute bronchiolitis. As the hernia was irreducible, emergency surgery was required. General endotracheal anesthesia, following a rapid sequence induction, was supplemented with a caudal epidural block. Inhaled salbutamol and suctioning for thick tracheal secretions were required and were found to be clinically useful. The baby made a good postoperative recovery.C Co on nc cl lu us si io on ns s: : A variety of techniques may be used to anesthetize the infant with concurrent acute bronchiolitis. In this case a good outcome was achieved with combined general and regional anesthesia, together with the use of inhaled salbutamol. CUTE viral bronchiolitis is a common respiratory infection in infants. The causal agent is nearly always the respiratory syncytial virus (RSV). It is estimated that approximately 1% of infants with RSV infection will require hospitalization and that these account for more than 125,000 admissions per annum in the United States. 1 The clinical features of RSV bronchiolitis are those of an acute viral illness, characterized by wheezing and respiratory distress. The recovery period may be quite prolonged and residual airway reactivity may persist for months or even years after an infection. 2 In infants in the acute phase of RSV bronchiolitis who require elective surgery, the operation is generally postponed until the infection has resolved. The exact period required before anesthesia can be undertaken is unclear and will depend on many factors, including the urgency of the surgery. Occasionally an infant with active bronchiolitis will present for emergency surgery and some form of anesthesia will be required. ObjectifA case is presented of a 12-week-old baby with moderately severe bronchiolitis, who presented with an incarcerated inguinal hernia. Options for anesthesia are presented and the topic of RSV infection and anesthesia is discussed.C Ca as se e r re ep po or rt t The infant was a 5.1-kg male, born at 37 weeks postconceptual age. There were no neonatal concerns and he was quite well until the age of 12 weeks. At this time, five days prior to admission, he developed a fever, runny nose and congested cough. He was medicated with acetaminophen at home. On the day of presentation the

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Impact of respiratory syncytial virus infection on surgery for congenital heart disease: Postoperative course and outcome

Cited by 94 publications

References 12 publications

Hospitalization due to respiratory syncytial virus infection in patients under 2 years of age with hemodynamically significant congenital heart disease

Hospitalization due to respiratory syncytial virus infection in patients under 2 years of age with hemodynamically significant congenital heart disease

Optimizing the delivery and use of a new monoclonal antibody in children with congenital heart disease: A successful provincial respiratory syncytial virus prophylaxis program

Repair of incarcerated inguinal hernia in an infant with acute viral bronchiolitis

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