Respiratory Syncytial Virus-Associated Acute Lower Respiratory Infections in Children With Bronchopulmonary Dysplasia: Systematic Review and Meta-Analysis
Open Access
- 11 December 2019
- journal article
- review article
- Published by Oxford University Press (OUP) in The Journal of Infectious Diseases
- Vol. 222 (Supplement), S620-S627
- https://doi.org/10.1093/infdis/jiz492
Abstract
Background 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). Methods 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. Results 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). Conclusions 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.Funding Information
- Innovative Medicines Initiative 2 Joint Undertaking (116019)
- European Federation of Pharmaceutical Industries and Associations
- European Union’s Horizon
This publication has 38 references indexed in Scilit:
- Epidemiology of Respiratory Syncytial Virus Infection in Preterm InfantsThe Open Microbiology Journal, 2011
- Pathogenesis and treatment of bronchopulmonary dysplasiaCurrent Opinion in Pediatrics, 2011
- Respiratory Syncytial Virus Prophylaxis in a High-Risk Population in ArgentinaThe Pediatric Infectious Disease Journal, 2008
- Cost Effectiveness of Palivizumab for Respiratory Syncytial Virus Prophylaxis in High-Risk ChildrenPharmacoEconomics, 2007
- The Severity of Respiratory Syncytial Virus Bronchiolitis in Young Infants in the United Arab EmiratesJournal of Tropical Pediatrics, 2006
- Hospitalization for Respiratory Syncytial Virus Infection in Young ChildrenThe Pediatric Infectious Disease Journal, 2006
- Grading quality of evidence and strength of recommendationsBMJ, 2004
- Predisposition of infants with chronic lung disease to respiratory syncytial virus-induced respiratory failure: a vascular hypothesisThe Pediatric Infectious Disease Journal, 2004
- Hospitalisation for RSV infection in ex-preterm infants---implications for use of RSV immune globulinArchives of Disease in Childhood, 2000
- Palivizumab, a Humanized Respiratory Syncytial Virus Monoclonal Antibody, Reduces Hospitalization From Respiratory Syncytial Virus Infection in High-risk InfantsPEDIATRICS, 1998