Jung Jo Won
Division of Pediatric Cardiology, Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea.
Korean J Pediatr. 2011 May;54(5):192-6. doi: 10.3345/kjp.2011.54.5.192. Epub 2011 May 31.
Respiratory syncytial virus (RSV) is a main cause of hospitalization for bronchiolitis and pneumonia in infants worldwide. Children with hemodynamically significant congenital heart disease (HS-CHD), as well as premature infants are at high risk for severe RSV diseases. Mortality rates for CHD patients hospitalized with RSV have been reported as about 24 times higher compared with those without RSV infection. Recently with advances in intensive care, mortality rates in CHD patients combined with RSV have decreased below 2%. The requirements of intensive care and mechanical ventilation for CHD patients with RSV infection were still higher than those without RSV infection or with non-CHD children. RSV infection has frequently threatened CHD infants with congestive heart failure, cyanosis, or with pulmonary hypertension. As a progressive RSV pneumonitis in those infants develops, the impairment of oxygen uptake, the breathing workload gradually increases and eventually causes to significant pulmonary hypertension, even after the operation. Preventing RSV infection as much as possible is very important, especially in infants with HS-CHD. A humanized monoclonal antibody, palivizumab, has effective in preventing severe RSV disease in high-risk infants, and progressive advances in supportive care including pulmonary vasodilator have dramatically decreased the mortality (<1%). Depending on the global trend, Korean Health Insurance guidelines have approved the use of palivizumab in children <1 year of age with HS-CHD since 2009. Korean data are collected for RSV prophylaxis in infants with CHD.
呼吸道合胞病毒（RSV）是全球范围内导致婴儿毛细支气管炎和肺炎住院的主要原因。患有血流动力学显著先天性心脏病（HS-CHD）的儿童以及早产儿患严重RSV疾病的风险很高。据报道，因RSV住院的CHD患者的死亡率比未感染RSV的患者高约24倍。最近，随着重症监护技术的进步，合并RSV的CHD患者的死亡率已降至2%以下。感染RSV的CHD患者对重症监护和机械通气的需求仍高于未感染RSV的患者或非CHD儿童。RSV感染经常威胁患有充血性心力衰竭、紫绀或肺动脉高压的CHD婴儿。随着这些婴儿中进行性RSV肺炎的发展，即使在手术后，氧摄取受损、呼吸负荷逐渐增加，最终导致严重的肺动脉高压。尽可能预防RSV感染非常重要，尤其是在患有HS-CHD的婴儿中。一种人源化单克隆抗体帕利珠单抗可有效预防高危婴儿的严重RSV疾病，包括肺血管扩张剂在内的支持治疗的不断进步已显著降低了死亡率（<1%）。根据全球趋势，自2009年以来，韩国健康保险指南已批准在1岁以下患有HS-CHD的儿童中使用帕利珠单抗。韩国收集了关于CHD婴儿RSV预防的数据。
