RSV infection – Risk factors, complications and treatment in two Portuguese hospitals

Abstract

Abstract. The aim of this study was to characterize the infection by respiratory syncytial virus (RSV), identify risk factors, complications and compare treatment strategies in children admitted to two Portuguese hospitals. It was a retrospective study performed between January 2005 and December 2006. Demographic and socioeconomic data, risk factors, treatment, complications and medical follow-up were analyzed. A total of 328 children were studied (135 from Hospital Dona Estefânia and 193 from Hospital Fernando Fonseca), about half (52.7%) being male, with a mean age of 5 months. 41% of the patients were from a poor socioeconomic context, 55.8% had older siblings, 32.2% had smoking parents and 11.3% had reactive airway disease. Complications occurred in 76.1% of the patients, namely, hypoxemia (63.5%), secondary bacterial infection (26.5%), atelectasis (11.5%), respiratory failure (10%) and apnea (2.4%). Most of the patients (92.3%) were treated with bronchodilators, 69% had oxygen supplementation, 45% were on antibiotics and 31% were treated with systemic corticosteroids. Ten percent needed mechanical ventilation. Twenty-seven (8.2%) children developed reactive airway disease. Having older siblings (63.1% vs. 49.3% P = 0.05) and being newborn (32.7% vs. 16.5% P = 0.006) resulted as risk factors for complications, while the risk factors identified for bacterial infection were having older siblings (71.4% vs. 55.7%; P = 0.013) and being from a poor socioeconomic context (64.7% vs. 47.6%; P = 0.017). The treatment strategies differed in the two hospitals (Hospital Fernando Fonseca vs. Hospital Dona Estefânia) regarding the use of systemic corticosteroids (1.6% vs. 73.3%, P = 0.000) and antibiotics (39.4% vs. 52.6%; P = 0.011). RSV infections can result in serious complications. According to the current knowledge, most of the therapeutic measures carried out in this study were probably unnecessary. It is important to establish clear national guidelines for the treatment of RSV infection.