Atkins J T, Karimi P, Morris B H, McDavid G, Shim S
Department of Pediatrics, University of Texas Health Science Center, Houston 77030, USA.
Pediatr Infect Dis J. 2000 Feb;19(2):138-43. doi: 10.1097/00006454-200002000-00012.
To determine the impact of respiratory syncytial virus (RSV) prophylaxis among preterm infants of < or =32 weeks gestation by comparing the severity of illness and cost of RSV-related care during the two winter seasons before (1994 to 1995, 1995 to 1996) with the two seasons after initiation of prophylaxis (1996 to 1997, 1997 to 1998).
Preterm infants of < or =32 weeks gestation at risk for hospitalization with RSV infection were identified retrospectively from the infants hospitalized in our neonatal units. Infants were included if they (1) were born 6 months before or during four winter seasons (1994 to 1998), (2) were discharged from the neonatal unit and (3) had remained in the university outpatient clinic system during at least the first winter of life. Preterm infants of < or =32 weeks gestation hospitalized with RSV were identified from our RSV database (which includes cost of hospitalization, duration of hospital stay, pediatric intensive care unit stay and intubation). Infants receiving prophylaxis were identified prospectively.
The incidence of hospitalization with RSV was significantly lower among the cohort of infants born after initiation of prophylaxis: 8.7% (17 of 195) vs. 22% (35 of 159), P = 0.00049 by two tailed Fisher's exact test. Among the cohort of infants born after initiation of prophylaxis (n = 195), 100 infants received prophylaxis. The gestational and chronologic ages of the prophylaxis-treated infants were significantly lower than those of the non-prophylaxis-treated infants (n = 95). The prophylaxis-treated infants also were more likely to have bronchopulmonary dysplasia. Only 1 (1%) of the prophylaxis-treated infants required hospitalization for RSV. Comparison of the cohort of infants born before initiation of prophylaxis to the cohort born after initiation of prophylaxis (includes prophylaxis-treated and non-prophylaxis-treated infants) revealed a significant reduction in severity of illness and cost. The length of stay in the cohort born before initiation of prophylaxis was reduced 83.8%: 373.6 days per 100 infants at risk vs. 60.5 (P = 0.00055). The length of stay in the pediatric intensive care unit was reduced 92.7%: 218.2 days per 100 infants at risk vs. 15.9 (P = 0.00029). The duration of intubation was reduced 95.6%: 187.4 days per 100 infants at risk vs. 8.2 (P = 0.00024). The dollars spent for RSV-related care (hospitalizations and prophylaxis) per 100 infants at risk for RSV was reduced 65% in the cohort of infants born after prophylaxis: $670,590 per 100 infants at risk vs. $234,596 (P = 0.00056). This reduction remained significant (64.9%) if the cost of ribavirin (drug and administration fees) was excluded from the cost of hospitalization.
These data reveal that RSV prophylaxis significantly reduced the incidence of RSV hospitalizations and severity of illness as well as the cost of RSV-related care among these infants.
通过比较在预防措施实施前的两个冬季（1994至1995年、1995至1996年）与开始预防后的两个季节（1996至1997年、1997至1998年）呼吸道合胞病毒（RSV）相关疾病的严重程度和护理费用，确定对妊娠≤32周的早产儿进行RSV预防的影响。
从我们新生儿病房住院的婴儿中回顾性确定有因RSV感染住院风险的妊娠≤32周的早产儿。纳入标准为：（1）在四个冬季（1994至1998年）中的6个月前或期间出生；（2）从新生儿病房出院；（3）至少在出生后的第一个冬季仍在大学门诊系统中。从我们的RSV数据库（包括住院费用、住院时间、儿科重症监护病房住院时间和插管情况）中确定因RSV住院的妊娠≤32周的早产儿。前瞻性确定接受预防的婴儿。
在开始预防措施后出生的婴儿队列中，RSV住院发生率显著降低：8.7%（195例中的17例）对22%（159例中的35例），双侧Fisher精确检验P = 0.00049。在开始预防措施后出生的婴儿队列（n = 195）中，100例婴儿接受了预防。接受预防治疗的婴儿的胎龄和月龄显著低于未接受预防治疗的婴儿（n = 95）。接受预防治疗的婴儿也更可能患有支气管肺发育不良。接受预防治疗的婴儿中只有1例（1%）因RSV需要住院治疗。将预防措施实施前出生的婴儿队列与实施后出生的婴儿队列（包括接受预防治疗和未接受预防治疗的婴儿）进行比较，发现疾病严重程度和费用显著降低。预防措施实施前出生的队列中的住院时间减少了83.8%：每100名有风险的婴儿为373.6天对60.5天（P = 0.00055）。儿科重症监护病房的住院时间减少了92.7%：每100名有风险的婴儿为218.2天对15.9天（P = 0.00029）。插管时间减少了95.6%：每100名有风险的婴儿为187.4天对8.2天（P = 0.00024）。在预防措施实施后出生的婴儿队列中，每100名有RSV感染风险的婴儿用于RSV相关护理（住院和预防）的费用减少了65%：每100名有风险的婴儿为670,590美元对234,596美元（P = 0.00056）。如果将利巴韦林（药物和给药费用）从住院费用中排除，这种减少仍然显著（64.9%）。
这些数据表明，RSV预防显著降低了这些婴儿中RSV住院的发生率、疾病严重程度以及RSV相关护理的费用。
