Wingert Aireen, Pillay Jennifer, Moore Dorothy L, Guitard Samantha, Vandermeer Ben, Dyson Michele P, Sinilaite Angela, Tunis Matthew, Hartling Lisa
Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB.
Public Health Agency of Canada, Ottawa, ON.
Can Commun Dis Rep. 2021 Sep 10;47(9):381-396. doi: 10.14745/ccdr.v47i09a05.
Respiratory syncytial virus (RSV) infections are common among young children and represent a significant burden to patients, their families and the Canadian health system. Here we conduct a rapid review of the burden of RSV illness in children 24 months of age or younger. Four databases (Medline, Embase, Cochrane Database of Clinical Trials, ClinicalTrials.gov from 2014 to 2018), grey literature and reference lists were reviewed for studies on the following: children with or without a risk factor, without prophylaxis and with lab-confirmed RSV infection. Of 29 studies identified, 10 provided within-study comparisons and few examined clinical conditions besides prematurity. For infants of 33-36 weeks gestation (wGA) versus term infants, there was low-to-moderate certainty evidence for an increase in RSV-hospitalizations (n=599,535 infants; RR 2.05 [95% CI 1.89-2.22]; 1.3 more per 100 [1.1-1.5 more]) and hospital length of stay (n=7,597 infants; mean difference 1.00 day [95% CI 0.88-1.12]). There was low-to-moderate certainty evidence of little-to-no difference for infants born at 29-32 versus 33-36 wGA for hospitalization (n=12,812 infants; RR 1.20 [95% CI 0.92-1.56]). There was low certainty evidence of increased mechanical ventilation for hospitalized infants born at 29-32 versus 33-35 wGA (n=212 infants; RR 1.58, 95% CI 0.94-2.65). Among infants born at 32-35 wGA, hospitalization for RSV in infancy may be associated with increased wheeze and asthma-medication use across six-year follow-up (RR range 1.3-1.7). Children with versus without Down syndrome may have increased hospital length of stay (n=7,206 children; mean difference 3.00 days, 95% CI 1.95-4.05; low certainty). Evidence for other within-study comparisons was of very low certainty. In summary, prematurity is associated with greater risk for RSV-hospitalization and longer hospital length of stay, and Down syndrome may be associated with longer hospital stay for RSV. Respiratory syncytial virus-hospitalization in infancy may be associated with greater wheeze and asthma-medication use in early childhood. Lack of a comparison group was a major limitation for many studies.
呼吸道合胞病毒（RSV）感染在幼儿中很常见，给患者及其家庭以及加拿大医疗系统带来了沉重负担。在此，我们对24个月及以下儿童RSV疾病的负担进行了快速综述。检索了四个数据库（2014年至2018年的Medline、Embase、Cochrane临床试验数据库、ClinicalTrials.gov）、灰色文献和参考文献列表，以查找关于以下方面的研究：有或无风险因素、未进行预防且实验室确诊为RSV感染的儿童。在确定的29项研究中，10项提供了研究内比较，除了早产外，很少有研究考察临床情况。对于孕33 - 36周（wGA）的婴儿与足月儿，有低至中等确定性证据表明RSV住院率增加（n = 599,535名婴儿；RR 2.05 [95% CI 1.89 - 2.22]；每100名婴儿增加1.3例[增加1.1 - 1.5例]）以及住院时间延长（n = 7,597名婴儿；平均差异1.00天[95% CI 0.88 - 1.12]）。对于孕29 - 32周与33 - 36周出生的婴儿，住院方面有低至中等确定性证据表明差异很小或无差异（n = 12,812名婴儿；RR 1.20 [95% CI 0.92 - 1.56]）。对于孕29 - 32周与33 - 35周出生的住院婴儿，有低确定性证据表明机械通气增加（n = 212名婴儿；RR 1.58，95% CI 0.94 - 2.65）。在孕32 - 35周出生的婴儿中，婴儿期因RSV住院可能与六年随访期间喘息和哮喘药物使用增加有关（RR范围为1.3 - 1.7）。患有与未患有唐氏综合征的儿童可能住院时间延长（n = 7,206名儿童；平均差异3.00天，95% CI 1.95 - 4.05；低确定性）。其他研究内比较的证据确定性非常低。总之，早产与RSV住院风险增加和住院时间延长相关，唐氏综合征可能与RSV住院时间延长有关。婴儿期因RSV住院可能与儿童早期喘息和哮喘药物使用增加有关。缺乏对照组是许多研究的主要局限性。
