Carbonell-Estrany X, Bont L, Doering G, Gouyon J-B, Lanari M
Hospital Clínic, Institut Clínic de Ginecologia Obstetricia i Neonatologia, Neonatology Service, Barcelona, Spain.
Eur J Clin Microbiol Infect Dis. 2008 Oct;27(10):891-9. doi: 10.1007/s10096-008-0520-8. Epub 2008 Jul 16.
Premature infants are vulnerable to severe respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) resulting in hospitalisation and the potential for longer-term respiratory morbidity. Whilst the severity and consequence of RSV LRTI are generally accepted and recognised in infants born <or=32 weeks gestational age (GA), there is less acknowledgment of the potential consequences in infants born 33-35 weeks GA. However, there is a growing body of evidence suggesting that infants born between 33 and 35 weeks GA may be equally at risk for RSV LRTI as infants born <32 weeks GA. Interrupted lung development and an immature immune system have been linked with an increased susceptibility for RSV LRTI, along with other environmental, social, and physiological risk factors. Currently, the only effective method of preventing RSV LRTI is prophylaxis with palivizumab. Often with limited healthcare resources, identifying infants at greatest risk of RSV LRTI who would potentially benefit most from prophylaxis is highly desirable, particularly in the 33-35-week GA group. The purpose of this article is to examine the causes and consequences of RSV LRTI in infants born 33-35 weeks GA, and look at the potential for using risk factors to identify high risk infants and, thereby, optimise prophylaxis. The causes and consequences of RSV LRTI in infants born 33-35 weeks GAA were determined via literature review. A number of underlying risk factors that significantly increase the risk of severe RSV LRTI and subsequent hospitalisation in this group of infants have been identified, most notably from the FLIP and PICNIC studies. A European predictive model based on the risk factors in the FLIP study has recently been developed and validated, which will aid identification of infants born between 33 and 35 weeks GA with the highest risk of RSV hospitalisation. Implementation of this model and prophylaxis of infants born between 33 and 35 weeks GA should be a national or regional decision, taken in perspective of other public health needs.
早产儿易患严重的呼吸道合胞病毒（RSV）下呼吸道感染（LRTI），这会导致住院，并有可能引发长期的呼吸道疾病。虽然RSV LRTI的严重程度和后果在孕周小于或等于32周（GA）的婴儿中已得到普遍认可，但对于孕周为33 - 35周GA的婴儿，其潜在后果却较少受到关注。然而，越来越多的证据表明，孕周在33至35周GA之间的婴儿患RSV LRTI的风险可能与孕周小于32周GA的婴儿相同。肺发育中断和免疫系统不成熟与RSV LRTI易感性增加有关，同时还有其他环境、社会和生理风险因素。目前，预防RSV LRTI的唯一有效方法是使用帕利珠单抗进行预防。由于医疗资源往往有限，确定哪些婴儿患RSV LRTI风险最高且可能从预防中获益最大非常重要，特别是在孕周为33 - 35周GA的婴儿群体中。本文旨在探讨孕周为33 - 35周GA的婴儿发生RSV LRTI的原因和后果，并研究利用风险因素识别高危婴儿从而优化预防措施的可能性。通过文献综述确定了孕周为33 - 35周GA的婴儿发生RSV LRTI的原因和后果。已经确定了一些显著增加该组婴儿发生严重RSV LRTI及随后住院风险的潜在风险因素，最值得注意的是来自FLIP和PICNIC研究的结果。最近基于FLIP研究中的风险因素开发并验证了一种欧洲预测模型，这将有助于识别孕周在33至35周GA之间患RSV住院风险最高的婴儿。该模型的实施以及对孕周为33 - 35周GA的婴儿进行预防应根据其他公共卫生需求，由国家或地区做出决策。
