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Respiratory Syncytial Virus-Associated Acute Lower Respiratory Infections in Children With Bronchopulmonary Dysplasia: Systematic Review and Meta-Analysis.

Pa Saidou Chaw, Lei Hua, Steve Cunningham, Harry Campbell, Rafael Mikolajczyk, Sciprofile linkHarish Nair, RESCEU Investigators, Ting Shi, Shanshan Zhang, You Li, Peter Openshaw, Jadwicha Wedzicha, Ann Falsey, Mark Miller, Louis Bont, Andrew Pollard, Eva Molero, Federico Martinon-Torres, Terho Heikkinen, Adam Meijer, Thea Kølsen Fischer, Maarten Van Den Berge, Carlo Giaquinto, Scott Gallichan, Alexia Kieffer, Clarisse Demont, Judy Hackett, Bing Cai, Charles Knirsch, Amanda Leach, Sonia Stoszek, Arnaud Cheret, Sandra Gavart, Jeroen Aerssens, Robert Fuentes, Brian Rosen
The Journal of Infectious Diseases ; doi:10.1093/infdis/jiz492

Abstract: Respiratory syncytial virus (RSV) is among the most important causes of acute lower respiratory tract infection (ALRI) in young children. We assessed the severity of RSV-ALRI in children less than 5 years old with bronchopulmonary dysplasia (BPD). We searched for studies using EMBASE, Global Health, and MEDLINE. We assessed hospitalization risk, intensive care unit (ICU) admission, need for oxygen supplementation and mechanical ventilation, and in-hospital case fatality (hCFR) among children with BPD compared with those without (non-BPD). We compared the (1) length of hospital stay (LOS) and (2) duration of oxygen supplementation and mechanical ventilation between the groups. Twenty-nine studies fulfilled our inclusion criteria. The case definition for BPD varied substantially in the included studies. Risks were higher among children with BPD compared with non-BPD: RSV hospitalization (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7-4.2; P < .001), ICU admission (OR, 2.9; 95% CI, 2.3-3.5; P < .001), need for oxygen supplementation (OR, 4.2; 95% CI, .5-33.7; P = .175) and mechanical ventilation (OR, 8.2; 95% CI, 7.6-8.9; P < .001), and hCFR (OR, 12.8; 95% CI, 9.4-17.3; P < .001). Median LOS (range) was 7.2 days (4-23) (BPD) compared with 2.5 days (1-30) (non-BPD). Median duration of oxygen supplementation (range) was 5.5 days (0-21) (BPD) compared with 2.0 days (0-26) (non-BPD). The duration of mechanical ventilation was more often longer (>6 days) in those with BPD compared with non-BPD (OR, 11.9; 95% CI, 1.4-100; P = .02). The risk of severe RSV disease is considerably higher among children with BPD. There is an urgent need to establish standardized BPD case definitions, review the RSV prophylaxis guidelines, and encourage more specific studies on RSV infection in BPD patients, including vaccine development and RSV-specific treatment.
Keywords: respiratory syncytial virus / Bronchopulmonary dysplasia / chronic lung disease / Acute Lower Respiratory Infections

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