Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Pulmonol. 2021 Jul;56(7):2204-2211. doi: 10.1002/ppul.25435. Epub 2021 May 7.
Respiratory syncytial virus (RSV) bronchiolitis is the most common lower respiratory tract disorder causing hospitalization in infants. Due to decreased hospitalization rates of premature infants following Palivizumab immune prophylaxis, the proportion of infants with chronic diseases not eligible for Palivizumab has increased.
To characterize infants hospitalized during 2014-2018 with RSV bronchiolitis, to compare between those with and without chronic conditions, and to identify risk factors for severe disease.
This retrospective study analyzed demographic and clinical data of patients younger than 2 years admitted with bronchiolitis during four consecutive RSV seasons.
Of 1124 hospitalizations due to RSV bronchiolitis, 244 (22%) were in infants with chronic diseases. Although 20/1124 qualified for RSV prophylaxis, only eight received immune prophylaxis. Compared to otherwise healthy infants, children with chronic diseases had longer hospitalizations, median 4.8 days (interquartile range [IQR]: 3.4-8.3) versus 3.7 days (IQR: 2.7-5.1), p < .001; and higher pediatric intensive care unit (PICU) and readmission rates (9% vs. 4.5%, p = .007% and 3% vs. 1%, p = .055, respectively). Children with Down's syndrome comprised 2% of all hospitalizations, but 8% of PICU admissions; their median length of hospitalization was 10.7 days (IQR: 6.6-17.6). Respiratory tract malformations were present in 2% of hospitalizations, and comprised 4% of PICU admissions.
Among infants admitted with RSV bronchiolitis, those with chronic diseases had longer hospitalizations and higher rates of transfer to the PICU. Children with multiple comorbidities, and especially those with Down's syndrome, are at particularly high risk for severe hospitalization and may benefit from RSV immune prophylaxis.
呼吸道合胞病毒（RSV）细支气管炎是导致婴儿住院的最常见下呼吸道疾病。由于帕利珠单抗免疫预防后早产儿的住院率下降，不符合帕利珠单抗使用条件的患有慢性病的婴儿比例增加。
描述 2014 年至 2018 年期间因 RSV 细支气管炎住院的婴儿，并比较有和无慢性病的婴儿，确定严重疾病的危险因素。
本回顾性研究分析了连续四个 RSV 季节因细支气管炎住院的 2 岁以下患者的人口统计学和临床数据。
在 1124 例因 RSV 细支气管炎住院的患者中，244 例（22%）为患有慢性病的婴儿。尽管有 20/1124 例符合 RSV 预防条件，但只有 8 例接受了免疫预防。与无慢性病的婴儿相比，患有慢性病的儿童住院时间更长，中位数为 4.8 天（四分位距 [IQR]：3.4-8.3）与 3.7 天（IQR：2.7-5.1），p<0.001；入住儿科重症监护病房（PICU）和再次入院的比例也更高（9%比 4.5%，p=0.007%和 3%比 1%，p=0.055）。唐氏综合征患儿占所有住院患儿的 2%，但占 PICU 入院患儿的 8%；他们的中位住院时间为 10.7 天（IQR：6.6-17.6）。呼吸道畸形在住院患儿中占 2%，在 PICU 入院患儿中占 4%。
在因 RSV 细支气管炎住院的婴儿中，患有慢性病的婴儿住院时间更长，转入 PICU 的比例更高。患有多种合并症的儿童，尤其是唐氏综合征患儿，患严重住院的风险极高，可能受益于 RSV 免疫预防。
