Respiratory Morbidity in Prematurely Born Children Receiving Palivizumab Prophylaxis of Respiratory Syncytial Virus Disease

Document Type : Original Article

Authors

1 1. Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia 2. Pediatric Clinic, Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia

2 Pediatric Clinic, Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia

10.22038/ijn.2024.76446.2482

Abstract

Background: Preterm delivery is a risk factor for increased respiratory morbidity in early childhood. This study aimed to quantify respiratory morbidity in preterm survivors, comparing incidence rates among different gestational ages, birth weighst, and current age groups. Additionally, we sought to evaluate variations in respiratory outcomes between groups with and without bronchopulmonary dysplasia (BPD).
Methods: Our study included 89 prematurely born children who were receiving palivizumab prophylaxis for respiratory syncytial virus infection. We categorized the patients based on four criteria: 1) current age of less and more than 1 year, 2) gestational age (GA) of less and more than 30 weeks, 3) birth weight (BW) of less than 1000 g, between 1000 g and 1500 g, and more than 1500 g, 4) with and without BPD. We compared these groups in terms of respiratory morbidity and respiratory therapy.
Results: The average age was 11.9 months, the average GA was 28.9 weeks and the average BW was 1202.4 g. According to the 28-day definition of BPD 75.3% patients had BPD. Around one-third (35.9%) of patients experienced wheezing episodes, 7.8% had pneumonia, 10.1% were hospitalized due to respiratory exacerbation and just 1.1% had RSV infection. There were no statistically significant differences between the different age, GA, BW, or BPD/non-BPD groups in the number of hospitalizations or pneumonia. On the other hand, children older than 12 months and children with BPD had significantly more wheezing episodes. Fifty-nine (66.3%) patients had been receiving inhaled corticosteroids (ICS), all of whom had BPD.
Conclusion: Prematurely-born children receiving palivizumab had significant respiratory morbidity, but majority did not have RSV infection. Further clinical studies are necessary to improve our understanding of the role of ICS in patients with established BPD.
 

Keywords

References

  1. Tan S, Szatkowski L, Moreton W, Fiaschi L, McKeever T, Gibson J, et al. Early childhood respiratory morbidity and antibiotic use in ex-preterm infants: a primary care population-based cohort study. Eur Respir J. 2020;56(1):2000202.
  2. Houben E, Siffel C, Overbeek J, Penning-van Beest F, Niklas V, Sarda SP. Respiratory morbidity, healthcare resource use, and cost burden associated with extremely preterm birth in The Netherlands. J Med Econ. 2021;24(1):1290-129
  3. Lapcharoensap W, Bennett MV, Xu X, Lee HC, Dukhovny D. Hospitalization costs associated with bronchopulmonary dysplasia in the first year of life. J Perinatol. 2020;40(1):130-137.
  4. McGrath-Morrow SA, Ryan T, Riekert K, Lefton-Greif MA, Eakin M, Collaco JM. The impact of bronchopulmonary dysplasia on caregiver health related quality of life during the first 2 years of life. Pediatr Pulmonol. 2013;48(6):579-586.
  5. Wang DY, Li A, Paes B, Mitchell I, Lanctôt KL; CARESS Investigators. First versus second year respiratory syncytial virus prophylaxis in chronic lung disease (2005-2015). Eur J Pediatr. 2017;176(3):413-422.
  6. Skromme K, Leversen KT, Eide GE, Markestad T, Halvorsen T. Respiratory illness contributed significantly to morbidity in children born extremely premature or with extremely low birthweights in 1999-2000. Acta Paediatr. 2015;104(11):1189-1198.
  7. Vrijlandt EJ, Kerstjens JM, Duiverman EJ, Bos AF, Reijneveld SA. Moderately preterm children have more respiratory problems during their first 5 years of life than children born full term. Am J Respir Crit Care Med. 2013;187(11):1234-1240.
  8. Colin AA, McEvoy C, Castile RG. Respiratory morbidity and lung function in preterm infants of 32 to 36 weeks' gestational age. Pediatrics. 2010; 126(1):115-128.
  9. Rhoads E, Montgomery GS, Ren CL. Wheezing in preterm infants and children. Pediatr Pulmonol. 2021;56(11):3472-3477. 
  10. Prais D, Kaplan E, Klinger G, Mussaffi H, Mei-Zahav M, Bar-Yishay E, et al. Short- and long-term pulmonary outcome of palivizumab in children born extremely prematurely. Chest. 2016;149(3):801-808.
  11. Simões MCRDS, Inoue Y, Matsunaga NY, Carvalho MRV, Ribeiro GLT, Morais EO, et al. Recurrent wheezing in preterm infants: Prevalence and risk factors. J Pediatr (Rio J). 2019;95(6):720-727.
  12. Raguž MJ, Božić T, Nikše T. Is immunization with palivizumab really effective in high-risk children? J Mother Child. 2023;26(1):87-92.
  13. Fauroux B, Gouyon JB, Roze JC, Guillermet-Fromentin C, Glorieux I, Adamon L, et al. Respiratory morbidity of preterm infants of less than 33 weeks gestation without bronchopulmonary dysplasia: a 12-month follow-up of the CASTOR study cohort. Epidemiol Infect. 2014;142(7):1362-1374.
  14. Smith VC, Zupancic JA, McCormick MC, Croen LA, Greene J, Escobar GJ, et al. Rehospitalization in the first year of life among infants with bronchopulmonary dysplasia. J Pediatr. 2004; 144(6):799-803.
  15. Shin JE, Jang H, Han JH, Park J, Kim SY, Kim YH, et al. Association between bronchopulmonary dysplasia and early respiratory morbidity in children with respiratory distress syndrome: a case-control study using nationwide data. Sci Rep. 2022;12(1):7578.
  16. Gilfillan M, Bhandari A, Bhandari V. Diagnosis and management of bronchopulmonary dysplasia. 2021;375:n1974.
  17. Hennelly M, Greenberg RG, Aleem S. An Update
    on the Prevention and Management of Bronchopulmonary Dysplasia. Pediatric Health Med Ther. 2021;12:405-419.
  18. Yuksel B, Greenough A. Randomised trial of inhaled steroids in preterm infants with respiratory symptoms at follow up. Thorax. 1992;47(11):910-913. 
  19. Bassler D. Inhaled budesonide for the prevention of bronchopulmonary dysplasia. J Matern Fetal Neonatal Med. 2017;30(19):2372-2374. 
  20. Shinwell ES, Portnov I, Meerpohl JJ, Karen T, Bassler D. Inhaled corticosteroids for bronchopulmonary dysplasia: A meta-analysis. Pediatrics. 2016; 138(6):e20162511.
  21. Clouse BJ, Jadcherla SR, Slaughter JL. Systematic review of inhaled bronchodilator and corticosteroid therapies in infants with bronchopulmonary dysplasia: Implications and future directions. PLoS One. 2016;11(2):e0148188.
  22. Bassler D, Plavka R, Shinwell ES, Hallman M, Jarreau PH, Carnielli V, et al. NEUROSIS trial group. early inhaled budesonide for the prevention of bronchopulmonary dysplasia. N Engl J Med. 2015;373(16):1497-1506. 
  23. Nuytten A, Behal H, Duhamel A, Jarreau PH, Mazela J, Milligan D, et al; EPICE (Effective perinatal intensive care in Europe) Research Group. Correction: Evidence-based neonatal unit practices and determinants of postnatal corticosteroid-use in preterm births below 30 weeks ga in europe. A population-based cohort study. PLoS One. 2017;12(2):e0172408.
  24. Cummings JJ, Pramanik AK, Committee on Fetus and Newborn. Postnatal corticosteroids to prevent or treat chronic lung disease following preterm birth. Pediatrics. 2022;149(6):e2022057530.
  25. Bhandari A, Panitch H. An update on the post-NICU discharge management of bronchopulmonary dysplasia. Semin Perinatol. 2018;42(7):471-477.
  26. Shah VS, Ohlsson A, Halliday HL, Dunn M. Early administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates. Cochrane Database Syst Rev. 2007;(4):CD001969.
  27. Onland W. Offringa M, van Kaam A. Late (≥7 days) inhalation corticosteroids to reduce broncho-pulmonary dysplasia in preterm infants (review). Cochrane Database Syst Rev. 2021;11(11): CD001145.
  28. Duijts L, van Meel ER, Moschino L, Baraldi E, Barnhoorn M, Bramer WM, et al. European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia. Eur Respir J. 2020;55(1):1900788.
  29. Hofhuis W, de Jongste JC, Merkus PJ. Adverse health effects of prenatal and postnatal tobacco smoke exposure on children. Arch Dis Child. 2003; 88(12):1086-1090.
  30. Valizadeh A, Akbarian-rad Z, Qanbari Qalehsari M, Zabihi A, Jafarian-amiri SR, Aziznejadroshan P, et al. Exposure to secondhand smoke during pregnancy and neonatal-related outcomes. Iran J of Neonatol. 2024:15(1):33.
  31. Brady JM, Zhang H, Kirpalani H, DeMauro SB. Living with severe bronchopulmonary dysplasia-parental views of their child's quality of life. J Pediatr. 2019;207:117-122.
Iranian Journal of Neonatology
Volume 15, Issue 2
April 2024
Pages 3-12

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