Checchia Paul A, Paes Bosco, Bont Louis, Manzoni Paolo, Simões Eric A F, Fauroux Brigitte, Figueras-Aloy Josep, Carbonell-Estrany Xavier
Baylor College of Medicine, Texas Children's Hospital Houston, Houston, TX, USA.
Neonatal Division, Department of Paediatrics, McMaster University, Hamilton, Canada.
Infect Dis Ther. 2017 Mar;6(1):37-56. doi: 10.1007/s40121-016-0142-x. Epub 2017 Jan 9.
The REGAL (RSV Evidence-a Geographical Archive of the Literature) series provide a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This fourth publication covers the risk and burden of RSV infection in infants with congenital heart disease (CHD).
A systematic review was undertaken for articles published between January 1, 1995 and December 31, 2015 across PubMed, Embase, The Cochrane Library, and Clinicaltrials.gov. Studies reporting data for hospital visits/admissions for RSV infection among children with CHD as well as studies reporting RSV-associated morbidity, mortality, and healthcare costs were included. The focus was on children not receiving RSV prophylaxis. Study quality and strength of evidence (SOE) were graded using recognized criteria.
A total of 1325 studies were identified of which 38 were included. CHD, in particular hemodynamically significant CHD, is an independent predictor for RSV hospitalization (RSVH) (high SOE). RSVH rates were generally high in young children (<4 years) with CHD (various classifications), varying between 14 and 357/1000 (high SOE). Children (<6 years) with RSV infection spent 4.4-14 days in hospital, with up to 53% requiring intensive care (high SOE). Infants (<2 years) with CHD had a more severe course of RSVH than those without CHD (high SOE). Case fatality rates of up to 3% were associated with RSV infection in children with CHD (high SOE). RSV infection in the perioperative period of corrective surgery and nosocomial RSV infection in intensive care units also represent important causes of morbidity (moderate SOE).
CHD poses a significant risk for RSVH and subsequent morbidity and mortality. RSV infection often complicates corrective heart surgery. To reduce the burden and improve outcomes, further research and specific studies are needed to determine the longer-term effects of severe RSV infection in young children with CHD.
REGAL（呼吸道合胞病毒文献的地理证据库）系列全面回顾了过去20年西方国家呼吸道合胞病毒（RSV）领域已发表的证据。本第四篇出版物涵盖了先天性心脏病（CHD）婴儿中RSV感染的风险和负担。
对1995年1月1日至2015年12月31日期间在PubMed、Embase、Cochrane图书馆和Clinicaltrials.gov上发表的文章进行了系统综述。纳入了报告CHD患儿RSV感染住院就诊/入院数据的研究，以及报告RSV相关发病率、死亡率和医疗费用的研究。重点是未接受RSV预防的儿童。使用公认标准对研究质量和证据强度（SOE）进行分级。
共识别出1325项研究，其中38项被纳入。CHD，尤其是血流动力学显著的CHD，是RSV住院（RSVH）的独立预测因素（高SOE）。患有CHD（各种分类）的幼儿（<4岁）的RSVH率通常较高，在14至357/1000之间（高SOE）。感染RSV的儿童（<6岁）住院4.4 - 14天，高达53%需要重症监护（高SOE）。患有CHD的婴儿（<2岁）的RSVH病程比未患CHD的婴儿更严重（高SOE）。CHD患儿中高达3%的病死率与RSV感染相关（高SOE）。矫正手术围手术期的RSV感染和重症监护病房的医院内RSV感染也是发病的重要原因（中等SOE）。
CHD对RSVH以及随后的发病率和死亡率构成重大风险。RSV感染常使心脏矫正手术复杂化。为减轻负担并改善结局，需要进一步研究和具体研究来确定严重RSV感染对患有CHD的幼儿的长期影响。
