Respiratory Syncytial Virus Associated Hospitalizations in Infants of 33 to 42 Weeksʼ Gestation: Does Gestational Age Matter?

Abstract

Background To evaluate rates and characteristics of respiratory syncytial virus hospitalizations (RSV-H) in infants of 33 to 42 weeks of gestational age (GA).

Patients All infants with a history of neonatal hospitalization and a GA of 33 to 42 weeks born between 2005 and 2015 and follow-up at least over one RSV season (first year of life). Infants with congenital heart disease and other congenital anomalies were excluded.

Methods Retrospective single-center cohort STROBE compliant study. Data were collected regarding demographic data and re-hospitalization characteristics due to respiratory illness and due to RSV infection; and data were compared between moderate-late preterm, near term, term, and post term infants, respectively.

Results A total of 81.656 live born infants were registered in our catchment area with gestational age from 33 to 42 weeks during the study period; and 2188 of 2356 preterm infants and 1004 of 1168 term infants with history of neonatal hospitalization were included for analysis. Rehospitalizations due to respiratory illness occurred in 301 preterm (13.8%) and 136 term (13.5%) infants for 381 and 183 times, respectively. In total 84 of 3192 infants (2.6%) were tested RSV positive, 61 of 2188 preterm (2.8%) and 23 of 1004 term (2.3%). Preterm infants without history of neonatal hospitalization had a RSV hospitalization (RSV-H) rate of 1.7% (61/3488) and term infants of 1.3% (967/74.644) that were significantly lower compared to study infants (p=0.004 and 0.002, respectively). Moderate and late preterm (2.8%), near term (3.1%) and post term (3.5%) infants had significantly higher RSV-H rates compared to term infants (1.2%). Risk factors for RSV-H in preterm infants included discharge during RSV season (4.2 vs. 2.0%, p=0.017) and presence of older siblings (4.2 vs. 2.1%, p=0.023), in term infants presence of older siblings (p=0.019). The course of RSV disease did not differ between groups.

Discussion Interestingly, we did not observe decreasing RSV-H rates with increasing GA. Term infants represented the group with lowest RSV-H rates. Neonatal hospitalization was a risk factor for RSV-H for both preterm and term infants. Near term infants do more resemble the late preterm than term infants regarding RSV-H rates.

Conclusion We found comparable higher RSV-H rates in all groups compared to term infants without differences in the course of disease and identified neonatal hospitalization as an independent risk factor.

Zusammenfassung

Hintergrund Evaluation und Charakteristika der durch Respiratory Snycytial Virus bedingten Hospitalisierung (RSV-H) bei Kindern mit einem Gestationsalter (GA) von 33 bis 42 SSW.

Patienten Alle Säuglinge, die als Neugeborene einen Aufenthalt auf der Neugeborenen-Intensiv- oder Intermediate-care-Station und ein GA von 33 bis 42 Wochen aus den Jahren 2005 bis 2015 hatten und bei denen eine Nachverfolgung zumindest über eine RSV-Saison (erstes Lebensjahr) gewährleistet war. Kinder mit angeborenen Herzfehlern wurden ausgeschlossen, ebenso solche mit kongenitalen Fehlbildungen.

Methoden Retrospektive Einzelzentrumsstudie nach den internationalen STROBE Kriterien. Daten wurden hinsichtlich Demografik und Charakteristika der respiratorisch und RSV bedingten Rehospitalisierung gesammelt und analysiert, und zwischen den Gestationsgruppen moderat-späte Frühgeborene, nahe am Termin Geborene, Termingeborene und übertragene Neugeborene verglichen.

Ergebnisse Im Studienzeitraum wurden insgesamt 81.656 Lebendgeborene mit einem Gestationsalter von 33 bis 42 Wochen verzeichnet; 2188 von 2356 Früh (FG) - und 1004 von 1168 Reifgeborene (RG) wurden den Einschlusskriterien entsprechend analysiert. 301 FG (13,8%) und136 RG (13,6%) wurden je 381- und 183-mal wegen einer respiratorischen Erkrankung hospitalisiert. Insgesamt waren 84 von 3192 Säuglinge (2,6%) RSV positiv; 61 von 2188 FG (2,8%) und 23 von 1004 RG (2.3%). FG ohne neonatale Hospitalisierung hatten eine RSV-H Rate von 1.7% (61/3488) und RG von 1.3% (967/74.644), die signifikant niedriger als die Raten der Studienkinder waren (p=0.004 und 0.002). Moderat-späte FG (2.8%), nahe am Termin geborene RG (3.1%) und übertragene RG (3.5%) hatten eine signifikant höhere RSV-H Rate als Termingeborene (1.2%). Risikofaktoren für RSV-H bei FG waren Entlassung während der RSV Saison (4.2 vs. 2.0%, p=0.017) und ältere Geschwister (4.2 vs. 2.1%, p=0.023), bei RG waren es nur die älteren Geschwister (p=0.019). Der Krankheitsverlauf durch RSV war nicht unterschiedlich zwischen FG und RG.

Diskussion Interessanterweise konnten wir nicht abnehmende RSV-H mit steigendem GA beobachten. Wie bekannt hatten Termingeborene die niedrigste Rate trotz Vorbelastung eines neonatalen Intensivaufenthaltes mit allfälliger mechanischer Belastung. Nahe am Termin geborene Kinder ähneln hinsichtlich der RSV-H Rate eher den späten FG als den Termingeborenen.

Schlussfolgerung Wir fanden vergleichbar höhere RSV-H Raten bei allen GA-Gruppen verglichen mit den Termingeborenen ohne Unterschied im Schweregrad und Verlauf der RSV Erkrankung und identifizierten neonatale Hospitalisierung als Riskiskofaktor for RSV-H.

Key words

Respiratory syncytial virus - hospitalization - late preterm - term infant

Schlüsselworte

Respiratory Syncytial Virus - Hospitalisierung - späte Frühgeborene - Reifgeborene

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