Respiratory morbidity associated with viral respiratory infections during neonatal stage in premature infants

Abstract

Background and Objective Very low birth weight (VLBW) infants are highly susceptible to viral respiratory infections (VRIs), even during admission to the neonatal intensive care unit (NICU). Although the role of VRI in childhood in the development of recurrent wheezing and long‐term asthma is well known, information on the impact in later morbidity of VRI in the neonatal period is lacking. We aimed to explore the occurrence of recurrent wheezing over the first 2 years of life according to VRI status during NICU admission. Methods During April 2016 and December 2017, infants below 32 weeks of gestation were prospectively studied in VRI surveillance during NICU admission. Families were contacted between September 2018 and May 2019 by a telephone questionnaire. Results A total of 99 patients were enrolled. The mean gestational age and birth weight were 28.8 (1.9) weeks and 1118 (329) g, respectively. During the first 2 years of life, neither episodes of wheezing nor the respiratory impairment‐related hospital admissions differed between positive and negative VRI infants. Episodes of wheezing and respiratory impairment‐related hospital admissions, as well as specific respiratory treatment prescription, were more frequent within the first 2 years in infants who had suffered symptomatic VRI during NICU admission. Conclusion Symptomatic VRI in VLBW infants is associated with long‐term respiratory morbidity. The early surveillance of VRI in the preterm infant during NICU admission is justified for prognostic counseling and closely monitoring after discharge. Routine instruction on asthma‐related risk factors and early prescription of antiasthmatic treatments, when indicated, should be established.

Surveillance of Viral Respiratory Infections in the Neonatal Intensive Care Unit—Evolution in the Last 5 Years

“…Our research suggests that premature infants with symptomatic VRIs during NICU admission have an increased risk of developing recurrent wheezing during the first two years of age. There is an increasing amount evidence to suggest that early life VRIs favour the development of an abnormal respiratory epithelial layer, leading to deviations in T cell maturation along the pro-allergic T2 pathway [ 21 ].…”

In‐hospital respiratory viral infections for patients with established BPD in the SARS‐CoV‐2 era

“…This patient was treated with invasive mechanical ventilation, solumedrol, and hydroxychloroquine in the PICU and discharged home on room air after a 27 day hospital stay. 27 Although the reported incidences of RVIs of any type in the NICU are relatively low, 8,28,29 preterm infants with established BPD are highly susceptible to in-hospital RVIs due to their immature immune system 30 and need for prolonged initial NICU hospitalization. 31 Given the underlying pulmonary insufficiency that characterizes lung function in infants with established BPD, 32,33 exposure to RVIs can cause major short-and long-term respiratory morbidities.…”

“…This is of particular importance for high‐risk preterm infants, given the relatively high occurrence of rhino/enterovirus RVIs in this population, which are associated with increased need for respiratory support, nursing care, and medical resources 3,8,18,19 . A recent report by Sánchez García et al 29 suggested that any symptomatic RVI in the NICU was associated with a significantly increased odds of respiratory morbidity in early childhood. Following discharge from the NICU, multiple studies have identified the increased susceptibility of BPD patients to adverse respiratory outcomes following RVIs in early childhood, particularly with respiratory syncytial virus (RSV) infection 4,34–36 .…”

Filaggrin and cytokines in respiratory samples of preterm infants at risk for respiratory viral infection

“…Various surveillance studies have shown that RVIs, including those caused by respiratory syncytial virus (RSV), human rhinovirus (hRV), adenovirus (hAdV), metapneumovirus (hMPV), bocavirus (hBoV), or human coronavirus (hCoV), are very frequent in Neonatal Intensive Care Units (NICUs) 2-4 . Despite causing subtle or even asymptomatic infections, RVIs may have an important mid and long-term impact on children's health 4,5 .In preterm infants, immune response to RVIs and their pathophysiology are poorly understood 6 . Severe RVIs occurring in infancy have been found to be an independent risk factor for the subsequent development of asthma and recurrent wheezing 7,8 .…”

“…Various surveillance studies have shown that RVIs, including those caused by respiratory syncytial virus (RSV), human rhinovirus (hRV), adenovirus (hAdV), metapneumovirus (hMPV), bocavirus (hBoV), or human coronavirus (hCoV), are very frequent in Neonatal Intensive Care Units (NICUs) 2-4 . Despite causing subtle or even asymptomatic infections, RVIs may have an important mid and long-term impact on children's health 4,5 .…”