Mulot Gwenaelle, Benchaib Mehdi, Plaisant Frank, Ploin Dominique, Gillet Yves, Javouhey Etienne, Claris Olivier, Picaud Jean-Charles, Casalegno Jean-Sebastien, Butin Marine
Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service de Réanimation Néonatale, Bron, France.
Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Service de Médecine de la Reproduction, Bron, France.
Front Pediatr. 2022 Jul 7;10:884120. doi: 10.3389/fped.2022.884120. eCollection 2022.
Preterm infants are at risk of lower respiratory tract infections (LRTI), including Respiratory Syncytial Virus (RSV) associated bronchiolitis, for which palivizumab prophylaxis can be proposed. Our aim was to determine risk factors of very severe RSV disease in children born before 34 weeks of gestation.
Among 2,101 infants born before 34 weeks of gestation in 3 maternity wards between 2012 and 2017, the laboratory confirmed RSV-infected patients requiring hospitalization before 12 months of corrected age were retrospectively included. We collected data about the neonatal period, the palivizumab prophylaxis and the hospitalization for a RSV-related LRTI. LRTI was considered as very severe (VS-LRTI) when patients required invasive or non-invasive positive pressure ventilation.
Among 86 included patients, 31 met the criteria of VS-LRTI. The VS-LRTI patients had a higher birth gestational age and weight but less heart disease and bronchopulmonary dysplasia. They received palivizumab prophylaxis less frequently than the other patients but the difference was not significant. At the onset of infection, VS-LRTI patients had a younger corrected age for prematurity and presented more frequently with apnea, bradycardia, life-threatening event, hemodynamic failure, hypercapnia. Using logistic regression, the main factor associated with VS-LRTI was a younger corrected age for prematurity at the onset of infection [Odd ratio for each month of corrected age = 0.77 (0.62; 0.93), = 0.012].
Infants at the highest risk of VS-LRTI were infants with a younger corrected age for prematurity. Therefore, a better targeting of infants requiring palivizumab prophylaxis and early interventions at hospital discharge could limit VS-LRTI in these infants.
早产婴儿有患下呼吸道感染（LRTI）的风险，包括呼吸道合胞病毒（RSV）相关的细支气管炎，对此可考虑使用帕利珠单抗进行预防。我们的目的是确定妊娠34周前出生的儿童发生非常严重的RSV疾病的危险因素。
回顾性纳入2012年至2017年间在3个产科病房出生的2101例妊娠34周前出生的婴儿中，实验室确诊的在矫正年龄12个月前因RSV感染需要住院治疗的患者。我们收集了有关新生儿期、帕利珠单抗预防以及因RSV相关LRTI住院的资料。当患者需要有创或无创正压通气时，LRTI被视为非常严重（VS-LRTI）。
在纳入的86例患者中，31例符合VS-LRTI标准。VS-LRTI患者的出生孕周和体重较高，但患心脏病和支气管肺发育不良的情况较少。他们接受帕利珠单抗预防的频率低于其他患者，但差异不显著。在感染发作时，VS-LRTI患者的早产矫正年龄较小，且更频繁地出现呼吸暂停、心动过缓、危及生命的事件、血流动力学衰竭、高碳酸血症。使用逻辑回归分析，与VS-LRTI相关的主要因素是感染发作时早产矫正年龄较小[矫正年龄每增加1个月的比值比=0.77（0.62；0.93），P=0.012]。
早产矫正年龄较小的婴儿发生VS-LRTI的风险最高。因此，更好地确定需要帕利珠单抗预防的婴儿，并在出院时进行早期干预，可以减少这些婴儿发生VS-LRTI的情况。
