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Respiratory syncytial virus prophylaxis in children with cardiac disease: a retrospective single-centre study

Published online by Cambridge University Press:  29 April 2013

Michelle Butt ,
Amanda Symington ,
Marianne Janes ,
Susan Steele ,
LouAnn Elliott ,
Catherine Chant-Gambacort ,
Tapas Mondal  and
Bosco Paes
Michelle Butt
Affiliation:
School of Nursing, McMaster University, Hamilton, Ontario, Canada
Amanda Symington
Affiliation:
Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada
Marianne Janes
Affiliation:
Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada
Susan Steele
Affiliation:
Department of Pediatrics (Neonatology and Cardiac Divisions), McMaster University, Hamilton, Ontario, Canada
LouAnn Elliott
Affiliation:
Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada
Catherine Chant-Gambacort
Affiliation:
Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada
Tapas Mondal
Affiliation:
Department of Pediatrics (Neonatology and Cardiac Divisions), McMaster University, Hamilton, Ontario, Canada
Bosco Paes*
Affiliation:
Department of Pediatrics (Neonatology and Cardiac Divisions), McMaster University, Hamilton, Ontario, Canada
*
Correspondence to: Dr B. Paes, MBBS, FRCPC, Department of Pediatrics (Room HSC-3A), McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Tel: (905) 521-2100×73672; Fax: (905) 521-5007; E-mail: [email protected]
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Abstract

Objectives

To examine the characteristics of congenital heart disease patients hospitalised with respiratory syncytial virus infection after prophylaxis and determine the associated comorbidities and the incidence of breakthrough respiratory syncytial virus infections.

Study design

This is a retrospective, single-centre study that was conducted over a period of 7 years. Respiratory syncytial virus infection was identified by classification codes and confirmed by virological tests. Data on baseline demographics, cardiac anomalies, other underlying disease, criteria for hospitalisation, type of respiratory illness and management, complications, and palivizumab prophylaxis were analysed by standard descriptive methods and comparative statistics.

Results

A total of 30 patients were enrolled. The majority were ≤2 years (n = 24). The mean admission age was 15.1 months (standard deviation = 18.3). In all, 90% were acyanotic, 40% had haemodynamically significant disease, and 60% had ≥1 underlying medical illness. Patients were admitted with: respiratory distress (86.7%), hypoxaemia (66.7%), fever (60%), inability to maintain oral intake (36.7%), and apnoea (16.7%). More than 50% required mechanical ventilation and intensive care with a median stay of 11 days (range: 1–43); the length of hospital stay for all children was 10 days (range: 1–65). Complications included: concurrent bacterial sepsis (20%), electrolyte abnormalities (16.7%), and worsening pulmonary hypertension (13.3%). Of 10 infants ≤2 years with haemodynamically significant heart disease, four had received prophylaxis. There was one death, which was attributed to respiratory syncytial virus infection.

Conclusions

Overall, 185 infants ≤2 years with haemodynamically significant cardiac disease received prophylaxis. In all, six qualifying infants missed immunisation and were hospitalised. Breakthrough respiratory syncytial virus infections occurred in 2.2%, demonstrating good efficacy of palivizumab in this population compared with the original, multi-centre, randomised trial.

Keywords

Respiratory syncytial virusinfectionhaemodynamically significant cardiac diseasepalivizumab
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 2 , April 2014 , pp. 337 - 343
Copyright
Copyright © Cambridge University Press 2013 

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