Wilkesmann Anja, Ammann Roland A, Schildgen Oliver, Eis-Hübinger Anna M, Müller Andreas, Seidenberg Jürgen, Stephan Volker, Rieger Christian, Herting Egbert, Wygold Thorsten, Hornschuh Friedeman, Groothuis Jessie R, Simon Arne
Children's Hospital Medical Center, University of Bonn, Germany.
Pediatr Infect Dis J. 2007 Jun;26(6):485-91. doi: 10.1097/INF.0b013e31805d01e3.
Respiratory syncytial virus (RSV) infection is an important cause of viral respiratory tract infection in children. In contrast to other confirmed risk factors that predispose to a higher morbidity and mortality, the particular risk of a preexisting neuromuscular impairment (NMI) in hospitalized children with RSV infection has not been prospectively studied in a multicenter trial.
The DMS RSV Paed database was designed for the prospective multicenter documentation and analysis of all clinically relevant aspects of the management of inpatients with RSV infection. Patients with clinically relevant NMI were identified according to the specific comments of the attending physicians and compared with those without NMI.
This study covers 6 consecutive seasons; the surveillance took place in 14 pediatric hospitals in Germany from 1999 to 2005. In total, 1568 RSV infections were prospectively documented in 1541 pediatric patients. Of these, 73 (4.7%) patients displayed a clinically relevant NMI; 41 (56%) NMI patients had at least 1 additional risk factor for a severe course of the infection (multiple risk factors in some patients; prematurity in 30, congenital heart disease in 19, chronic lung disease 6 and immunodeficiency in 8). Median age at diagnosis was higher in NMI patients (14 vs. 5 months); NMI patients had a greater risk of seizures (15.1% vs. 1.6%), and a higher proportion in the NMI group had to be mechanically ventilated (9.6% vs. 1.9%). Eventually, the attributable mortality was significantly higher in the NMI group (5.5% vs. 0.2%; P < 0.001 for all). Multivariate logistic regression confirmed that NMI was independently associated with pediatric intensive care unit (PICU) admission (OR, 4.94; 95% CI, 2.69-8.94; P < 0.001] and mechanical ventilation (OR, 3.85; 95% CI, 1.28-10.22; P = 0.017).
This is the first prospective multicenter study confirming the hypothesis that children with clinically relevant NMI face an increased risk for severe RSV-disease. It seems reasonable to include NMI as a cofactor into the decision algorithm of passive immunization.
呼吸道合胞病毒（RSV）感染是儿童病毒性呼吸道感染的重要原因。与其他已证实的导致更高发病率和死亡率的危险因素不同，RSV感染住院儿童中既往存在神经肌肉功能障碍（NMI）的特殊风险尚未在多中心试验中进行前瞻性研究。
DMS RSV儿科数据库旨在对RSV感染住院患者管理的所有临床相关方面进行前瞻性多中心记录和分析。根据主治医生的具体评论确定具有临床相关性NMI的患者，并与无NMI的患者进行比较。
本研究涵盖连续6个季节；监测于1999年至2005年在德国的14家儿科医院进行。总共1541例儿科患者中前瞻性记录了1568例RSV感染。其中，73例（4.7%）患者表现出具有临床相关性的NMI；41例（56%）NMI患者至少有1个感染严重病程的额外危险因素（部分患者有多个危险因素；30例早产，19例先天性心脏病，6例慢性肺病，8例免疫缺陷）。NMI患者诊断时的中位年龄较高（14个月对5个月）；NMI患者发生惊厥的风险更高（15.1%对1.6%），NMI组中需要机械通气的比例更高（9.6%对1.9%）。最终，NMI组的归因死亡率显著更高（5.5%对0.2%；所有P<0.001）。多因素逻辑回归证实，NMI与儿科重症监护病房（PICU）入院独立相关（比值比，4.94；95%置信区间，2.69-8.94；P<0.001）和机械通气（比值比，3.85；95%置信区间，1.28-10.22；P=0.017）。
这是第一项前瞻性多中心研究，证实了具有临床相关性NMI的儿童面临严重RSV疾病风险增加这一假设。将NMI作为辅助因素纳入被动免疫决策算法似乎是合理的。
