Chang Ruey-Kang R, Chen Alex Y
Division of Cardiology, Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 491, Torrance, CA 90509, USA.
Pediatr Cardiol. 2010 Jan;31(1):90-5. doi: 10.1007/s00246-009-9577-0. Epub 2009 Nov 14.
The objective of this study was to evaluate the impact of palivizumab prophylaxis on respiratory syncytial virus (RSV) hospitalizations among children with hemodynamically significant congenital heart disease (CHD). In 2003, the American Academy of Pediatrics (AAP) revised the bronchiolitis policy statement and recommended the use of palivizumab in children <24 months old with hemodynamically significant CHD (HS-CHD). California statewide hospital discharge data from years 2000-2002 (pre-AAP policy revision) were compared to those from years 2004-2006 (post-AAP policy revision). Hospitalizations due to RSV bronchiolitis for children <2 years of age were identified by IDC-9 CM codes 4661.1, 480.1, and 079.6 as the Principal Diagnosis. Children with CHD and children with HS-CHD were identified by the codiagnoses. The overall RSV hospitalization rate was 71 per 10,000 children <2 years of age. Of all RSV hospitalizations, 3.0% were among children with CHD, and 0.50% among children with HS-CHD. HS-CHD patients accounted for 0.56% of RSV hospitalizations in 2000-2002, compared to 0.46% RSV hospitalizations in 2004-2006. That represents a 19% reduction in RSV hospitalizations among HS-CHD patients after 2003. The 19% decrease in RSV hospitalizations equates to seven fewer hospitalizations (76 hospital days) per year among HS-CHD patients. We conclude that, since the recommendation of palivizumab for children with HS-CHD in 2003, the impact on RSV hospitalizations in California among HS-CHD patients has been limited. Considering the high cost of palivizumab administration, the cost-benefit of RSV prophylaxis with palivizumab warrants further investigation.
本研究的目的是评估帕利珠单抗预防对患有血流动力学显著先天性心脏病（CHD）儿童呼吸道合胞病毒（RSV）住院率的影响。2003年，美国儿科学会（AAP）修订了细支气管炎政策声明，并建议在患有血流动力学显著CHD（HS-CHD）的24个月以下儿童中使用帕利珠单抗。将2000 - 2002年（AAP政策修订前）加利福尼亚州全州的医院出院数据与2004 - 2006年（AAP政策修订后）的数据进行比较。通过国际疾病分类第九版临床修正版（IDC-9 CM）编码4661.1、480.1和079.6作为主要诊断来确定2岁以下儿童因RSV细支气管炎导致的住院情况。通过联合诊断来确定患有CHD的儿童和患有HS-CHD的儿童。2岁以下儿童的总体RSV住院率为每10,000名儿童中有71例。在所有RSV住院病例中，3.0%为患有CHD的儿童，0.50%为患有HS-CHD的儿童。HS-CHD患者在2000 - 2002年占RSV住院病例的0.56%，而在2004 - 2006年占RSV住院病例的0.46%。这表明2003年后HS-CHD患者的RSV住院率降低了19%。RSV住院率降低19%相当于HS-CHD患者每年减少7次住院（76个住院日）。我们得出结论，自2003年建议对患有HS-CHD的儿童使用帕利珠单抗以来，其对加利福尼亚州HS-CHD患者RSV住院率的影响有限。考虑到帕利珠单抗给药成本高昂，使用帕利珠单抗预防RSV的成本效益值得进一步研究。
