Feltes Timothy F, Groothuis Jessie R
Section of Pediatric Cardiology, Ohio State University, Columbus, OH 43205, USA.
Cardiol Young. 2005 Jun;15(3):266-73. doi: 10.1017/S1047951105000557.
All newborn infants have limited pulmonary reserve compared with older children. This puts them at increased risk of respiratory complications, such as those associated with infection by the respiratory syncytial virus. Young children with congenital cardiac disease are particularly likely to suffer severe disease related to infection by the virus. In these children, the extreme vulnerability of the lung to pulmonary oedema is compounded by the additional burden caused by the respiratory syncytial virus. In addition to the well-documented acute pulmonary effects of infection with the respiratory syncytial virus, there may also be consequent long-term respiratory morbidity. Clinical studies have shown that infection by the virus in infancy is associated with a higher risk of developing subsequent bronchial obstructive disease. Much debate surrounds the mechanisms underlying this association. It is thought that a combined immunological and neurogenic response mechanism is likely. Prevention of severe respiratory disease in infants and young children with congenital heart disease due to infection by the virus may, therefore, offer both immediate and long-term benefits. Indeed, an increasing body of evidence supports this hypothesis, indicating a clinical rationale for prophylaxis against the virus in infancy, in order to reduce the chance of developing reactive airways disease and asthma in later life.
与大龄儿童相比，所有新生儿的肺储备功能都有限。这使他们发生呼吸并发症的风险增加，比如与呼吸道合胞病毒感染相关的并发症。患有先天性心脏病的幼儿尤其容易患上与该病毒感染相关的严重疾病。在这些儿童中，肺部对肺水肿的极度易损性因呼吸道合胞病毒造成的额外负担而加剧。除了呼吸道合胞病毒感染有充分记录的急性肺部影响外，还可能会有随之而来的长期呼吸道疾病。临床研究表明，婴儿期感染该病毒与日后发生支气管阻塞性疾病的风险较高有关。围绕这种关联背后的机制存在很多争论。人们认为可能是免疫和神经源性联合反应机制。因此，预防患有先天性心脏病的婴幼儿因该病毒感染而发生严重呼吸道疾病可能会带来即时和长期的益处。确实，越来越多的证据支持这一假设，表明在婴儿期预防该病毒有临床依据，以降低日后发生反应性气道疾病和哮喘的几率。
