Kang Ji-Man, Lee Jina, Kim Yun-Kyung, Cho Hye Kyung, Park Su Eun, Kim Kyung-Hyo, Kim Min-Ji, Kim Seonwoo, Kim Yae-Jean
Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, , Korea.
Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea.
Pediatr Int. 2019 Jul;61(7):688-696. doi: 10.1111/ped.13893.
We investigated the characteristics and clinical outcomes of respiratory syncytial virus (RSV)-related pediatric intensive care unit (PICU) hospitalization and assessed the palivizumab (PZ) prophylaxis eligibility according to different guidelines from Korea, EU, and USA.
In this multicenter study, children <18 years of age hospitalized in six PICU from different hospitals due to severe RSV infection between September 2008 and March 2013 were included. A retrospective chart review was performed.
A total of 92 patients were identified. The median length of PICU stay was 6 days (range, 1-154 days) and median PICU care cost was USD2,741 (range, USD556-98 243). Of 62 patients who were <2 years old at the beginning of the RSV season, 33 (53.2%) were high-risk patients for severe RSV infection. Hemodynamically significant congenital heart disease (22.6%) was the most common risk factor, followed by chronic lung disease (11.3%), neuromuscular disease or congenital abnormality of the airway (NMD/CAA) (11.3%), and prematurity (8.1%). The percentage of patients eligible for PZ prophylaxis ranged from 38.7% to 48.4% based on the guidelines, but only two (2.2%) received PZ ≤30 days prior to PICU admission. The median duration of mechanical ventilation was longer in children with NDM/CAA than in those without risk factors (26 days; range, 24-139 days vs 6 days, range, 2-68 days, P = 0.033). RSV-attributable mortality was 5.4%.
Children <2 years old with already well-known high risks represent a significant proportion of RSV-related PICU admissions. Increasing of the compliance for PZ prophylaxis practice among physicians is needed. Further studies are needed to investigate the burden of RSV infection in patients hospitalized in PICU, including children with NMD/CAA.
我们调查了呼吸道合胞病毒（RSV）相关的儿科重症监护病房（PICU）住院的特征和临床结局，并根据韩国、欧盟和美国的不同指南评估了帕利珠单抗（PZ）预防的适用性。
在这项多中心研究中，纳入了2008年9月至2013年3月期间因严重RSV感染在不同医院的6个PICU住院的18岁以下儿童。进行了回顾性病历审查。
共确定了92例患者。PICU住院时间中位数为6天（范围1 - 154天），PICU护理费用中位数为2741美元（范围556 - 98243美元）。在RSV季节开始时年龄小于2岁的62例患者中，33例（53.2%）是严重RSV感染的高危患者。血流动力学显著的先天性心脏病（22.6%）是最常见的危险因素，其次是慢性肺病（11.3%）、神经肌肉疾病或气道先天性异常（NMD/CAA）（11.3%）和早产（8.1%）。根据指南，符合PZ预防条件的患者百分比在38.7%至48.4%之间，但只有2例（2.2%）在PICU入院前≤30天接受了PZ治疗。NDM/CAA患儿的机械通气持续时间中位数比无危险因素的患儿更长（26天；范围24 - 139天 vs 6天，范围2 - 68天，P = 0.033）。RSV相关死亡率为5.4%。
年龄小于2岁且具有已知高风险的儿童在RSV相关的PICU入院中占很大比例。需要提高医生对PZ预防措施的依从性。需要进一步研究来调查PICU住院患者（包括NMD/CAA患儿）中RSV感染的负担。
