Lung function prior to viral lower respiratory tract infections in prematurely born infants

Drysdale, Simon B.; Wilson, Theresa; Alcazar-Paris, Mireia; Broughton, Simon; Zuckerman, Mark; Smith, M. A.; Rafferty, Gerrard F.; Johnston, Sebastian L.; Greenough, Anne

doi:10.1136/thx.2010.148023

Cited by 62 publications

(53 citation statements)

References 19 publications

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“…Two studies assessed the role of neonatal lung function in RSV bronchiolitis in prematurely born infants [4,10]. DRYSDALE et al [10] prospectively studied 159 premature born infants that were sampled at each episode of wheeze, cough or shortness of breath. They found impaired neonatal lung function in patients that were hospitalised for a viral lower respiratory tract illness, including RSV, compared with nonhospitalised patients.…”

Section: Discussionmentioning

confidence: 99%

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Decreased lung function precedes severe respiratory syncytial virus infection and post-respiratory syncytial virus wheeze in term infants

et al. 2014

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It is unknown why respiratory syncytial virus (RSV) causes mild disease in some children and severe disease, requiring hospitalisation, in others. We aimed to assess whether diminished premorbid lung function in healthy term infants predisposes to hospitalisation during RSV bronchiolitis, and to post-RSV wheeze.In a prospective birth cohort study of unselected term healthy children, neonatal lung function was measured before the age of 2 months (n52133). From birth through the first year of life, respiratory symptoms were recorded in a diary, and general practitioner consultations and hospitalisations were documented. In a subgroup (n5417) repeated nose and throat swabs were collected for PCR to detect RSV infections.Median neonatal respiratory system compliance (Crs) was significantly lower (41.2 versus 47.4 mL?kPa -1 , p50.03) and resistance (Rrs) was higher (8.2 versus 6.3 kPa?s?L -1 , p50.10) in hospitalised RSV patients (n518) compared with nonhospitalised RSV-positive infants (n584). Every 10 mL?kPa -1 increase in Crs was associated with 55% less post-RSV wheeze (OR 0.56, 95% CI 0.35-0.90), and each kPa?s?L -1 increase in Rrs was associated with 42% more post-RSV wheeze, which was only marginally explained by pre-RSV wheeze or severity of the RSV disease.This unselected birth cohort study shows for the first time that decreased lung function at birth predisposes to severe RSV disease, and to post-RSV wheeze. @ERSpublications Impaired neonatal lung function precedes a severe course of RSV infection in unselected children

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Section: Discussionmentioning

confidence: 99%

“…Based on this finding, they hypothesised that RSV lower respiratory tract illnesses might be associated with pre-existing lower lung function [9]. The latter association has been found in prematurely born infants [10] and in a high risk population [11]; however, these associations have never been studied in term infants.…”

Section: Introductionmentioning

confidence: 96%

Decreased lung function precedes severe respiratory syncytial virus infection and post-respiratory syncytial virus wheeze in term infants

et al. 2014

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“…Previous genetic studies have demonstrated a significant association between the inherited polymorphisms in several immunological and surfactant protein genes and the incidence of severe viral infection and level of infection-related morbidity among preterm infants [50,51]. Also, pre-existing impairments in lung function have also been attributed to increased susceptibility to severe viral infection and infection-related morbidity among preterm infants, particularly during early life [52–54]. …”

Section: Viral Infection Requiring Readmission In Early Lifementioning

confidence: 99%

The impact of respiratory viruses on lung health after preterm birth

Townsi

Laing

Hall

et al. 2018

European Clinical Respiratory Journal

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Children born preterm, less than 37 weeks’ gestation, are at increased risk of viral respiratory infections and associated complications both during their initial birth hospitalisation and in their first years following discharge. This increased burden of viral respiratory infections is likely to have long term implications for lung health and function in individuals born preterm, particularly those with bronchopulmonary dysplasia. Several hypotheses have been put forward to explain the association between early life viral respiratory infection and development of suboptimal lung health and function later in life following preterm birth. Although preterm infants with diminished lung function, particularly small airways, might be particularly susceptible to asthma and wheezing disorders following viral infection, there is evidence that respiratory viruses can activate number of inflammatory and airway re-modelling pathways. Therefore, the aim of this review is to highlight the perinatal and early life risk factors that may contribute to increased susceptibility to viral respiratory infections among preterm infants during early life and to understand how respiratory viral infection may influence the development of abnormal lung health and function later in life.

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“…9 Furthermore, diminished lung function in premature infants has been associated with increased likelihood of severe illness. 10 Despite the known increase in hospitalization rates for premature infants with bronchiolitis, little is understood about how or whether their management should differ from that of nonpremature infants. Understanding management differences in premature infants with bronchiolitis is critical because of increasing rates of prematurity.…”

Section: The Clinical Management Of Preterm Infants With Bronchiolitismentioning

confidence: 99%

The Clinical Management of Preterm Infants With Bronchiolitis

Alverson

McCulloh

Dawson-Hahn

et al. 2013

Hospital Pediatrics

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OBJECTIVES:The goal of this study was to determine physician management choices for hospitalized premature infants with bronchiolitis compared with term infants and to evaluate predictors of steroid use in premature infants. METHODS:A chart review was conducted of premature and nonpremature infants admitted to 2 children's hospitals with bronchiolitis. Reviewers selected charts based on International Classifi cation of Diseases, Ninth Revision diagnosis codes and collected demographic and historical information, as well as evaluation, treatment, treatment effectiveness, length of stay, hospital readmission rates, and adverse outcomes. Reviewers compared documented rates of utilization and effectiveness of inhaled racemic epinephrine and albuterol between patients with and without a history of prematurity. Patients with a history of prematurity underwent subgroup analysis of factors relating to steroid use. RESULTS:A total of 1223 patients met the study criteria for inclusion. Premature infants represented 19% of all children hospitalized with bronchiolitis. These infants had a longer length of stay (3.8 vs 2.6 days; P < .001) and a more severe hospital course. Rates of inhaled therapy and steroid utilization did not differ between premature and term infants. There was no difference in rates of documented positive response to albuterol, but premature infants were more likely to have a positive response to epinephrine. Steroid use in premature infants was associated with older age, history of wheeze, and albuterol use; documentation of albuterol effi cacy did not correlate with steroid use, however. CONCLUSIONS:Management decisions among term and premature infants with bronchiolitis were similar. Premature infants who received albuterol were more likely to receive steroids; however, the decision regarding steroid use was not associated with documentation of effi cacy of albuterol. The Clinical Management of Preterm Infants With BronchiolitisBronchiolitis is a leading cause of hospitalization of infants, resulting in more than $500 million in health care expenditures annually in the United States.1 It has been estimated that >20% of infants aged <1 year will have bronchiolitis-associated wheezing.2 In the United States, >12% of infants are born before 37 weeks' gestational age, and this rate is higher now than at any known historical level.3 Prematurity and chronic lung disease of prematurity are known risk factors for hospitalization in bronchiolitis, and chronic lung disease is disproportionately present among infants hospitalized with bronchiolitis. 4 Up to 14% of all premature infants will be hospitalized with bronchiolitis early in life, and they will typically have a more severe course and a longer length of stay (LOS) than full term infants.5-7 More than one-half of premature infants <29 weeks' gestational age may be admitted by guest on May 11, 2018 http://hosppeds.aappublications.org/ Downloaded from

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Lung function prior to viral lower respiratory tract infections in prematurely born infants

Cited by 62 publications

References 19 publications

Decreased lung function precedes severe respiratory syncytial virus infection and post-respiratory syncytial virus wheeze in term infants

Decreased lung function precedes severe respiratory syncytial virus infection and post-respiratory syncytial virus wheeze in term infants

The impact of respiratory viruses on lung health after preterm birth

The Clinical Management of Preterm Infants With Bronchiolitis

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