Respiratory syncytial virus-associated hospitalizations over three consecutive seasons in children with congenital heart disease

  • B. ReschEmail author
  • S. Kurath-Koller
  • J. Hahn
  • W. Raith
  • M. Köstenberger
  • A. Gamillscheg
Original Article


The purpose of this investigation was to analyze the burden of respiratory syncytial virus (RSV)-related hospitalizations in infants and children with congenital heart disease (CHD) over three consecutive RSV seasons. Retrospectively, all children with hemodynamically significant (HS-CHD) and not significant (HNS-CHD) CHD born between 2004 and 2008 at a tertiary care university hospital and identified by ICD-10 diagnoses were included. Data on RSV-related hospitalizations over the first three years of life covering at least three RSV seasons (November–April) were analyzed. The overall incidence of RSV-related hospitalization was 9.6 % (58/602), without a statistically significant difference between HS-CHD and HNS-CHD (7.3 % vs. 10.4 %; p = 0.258). Recommendation of palivizumab prophylaxis did not influence the RSV hospitalization rates between groups. Patients with HS-CHD and early surgery were significantly less often hospitalized due to RSV compared to those with delayed surgery (1.3 % vs. 14.3 %; p = 0.003). The median duration of hospitalization was 8.5 days (HS-CHD: 14 vs. HNS-CHD: 7 days; p = 0.003). Thirteen patients (22.4 %) were admitted to the intensive care unit (ICU), for a median of 10 days. The median age at admission was 2 months, with a significant difference between HS-CHD and HNS-CHD (6 vs. 2 months; p = 0.001). The majority (97 %) of RSV-related hospitalizations occurred before 12 months of age. Patients with HS-CHD had a significantly more severe course of RSV disease and were older at the time of hospitalization. Early surgery seemed to significantly reduce the risk of RSV hospitalization during the first RSV season.


Congenital Heart Disease Respiratory Syncytial Virus Lower Respiratory Tract Infection Respiratory Syncytial Virus Infection Palivizumab 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Compliance with ethical standards

Conflict of interest




Ethical approval

By the Ethics Committee of the Medical University of Graz, number 26-391 ex 13/14.

Informed consent

Not applicable due to the retrospective design of the study.


  1. 1.
    MacDonald NE, Hall CB, Suffin SC, Alexson C, Harris PJ, Manning JA (1982) Respiratory syncytial viral infection in infants with congenital heart disease. N Engl J Med 307:397–400CrossRefPubMedGoogle Scholar
  2. 2.
    Moler FW, Khan AS, Meliones JN, Custer JR, Palmisano J, Shope TC (1992) Respiratory syncytial virus morbidity and mortality estimates in congenital heart disease patients: a recent experience. Crit Care Med 20:1406–1413CrossRefPubMedGoogle Scholar
  3. 3.
    Navas L, Wang E, de Carvalho V, Robinson J (1992) Improved outcome of respiratory syncytial virus infection in a high-risk hospitalized population of Canadian children. Pediatric Investigators Collaborative Network on Infections in Canada. J Pediatr 121:348–354CrossRefPubMedGoogle Scholar
  4. 4.
    Wang EE, Law BJ, Stephens D (1995) Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. J Pediatr 126:212–219CrossRefPubMedGoogle Scholar
  5. 5.
    Simoes EA, Sondheimer HM, Top FH Jr, Meissner HC, Welliver RC, Kramer AA, Groothuis JR (1998) Respiratory syncytial virus immune globulin for prophylaxis against respiratory syncytial virus disease in infants and children with congenital heart disease. The Cardiac Study Group. J Pediatr 133:492–499CrossRefPubMedGoogle Scholar
  6. 6.
    Feltes TF, Cabalka AK, Meissner HC, Piazza FM, Carlin DA, Top FH Jr, Connor EM, Sondheimer HM; Cardiac Synagis Study Group (2003) Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr 143:532–540CrossRefPubMedGoogle Scholar
  7. 7.
    Kristensen K, Stensballe LG, Bjerre J, Roth D, Fisker N, Kongstad T, Svendsen AL, Nielsen BW (2009) Risk factors for respiratory syncytial virus hospitalisation in children with heart disease. Arch Dis Child 94:785–789CrossRefPubMedGoogle Scholar
  8. 8.
    Kristensen K, Hjuler T, Ravn H, Simões EA, Stensballe LG (2012) Chronic diseases, chromosomal abnormalities, and congenital malformations as risk factors for respiratory syncytial virus hospitalization: a population-based cohort study. Clin Infect Dis 54:810–817CrossRefPubMedGoogle Scholar
  9. 9.
    Meberg A, Bruu AL (2006) Respiratory syncytial virus infections in congenital heart defects—hospitalizations and costs. Acta Paediatr 95:404–406CrossRefPubMedGoogle Scholar
  10. 10.
    Simon A, Müller A, Khurana K, Engelhart S, Exner M, Schildgen O, Eis-Hübinger AM, Kamin W, Schaible T, Wadas K, Ammann RA, Wilkesmann A; DSM RSV Paed Study Group (2008) Nosocomial infection: a risk factor for a complicated course in children with respiratory syncytial virus infection—results from a prospective multicenter German surveillance study. Int J Hyg Environ Health 211:241–250CrossRefPubMedGoogle Scholar
  11. 11.
    Duppenthaler A, Ammann RA, Gorgievski-Hrisoho M, Pfammatter JP, Aebi C (2004) Low incidence of respiratory syncytial virus hospitalisations in haemodynamically significant congenital heart disease. Arch Dis Child 89:961–965CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Chiu SN, Shao PL, Chen HC, Lin MT, Huang LM, Kao FY, Huang SK, Wang JK, Wu MH (2016) Risk of respiratory syncytial virus infection in cyanotic congenital heart disease in a subtropical area. J Pediatr 171:25–30.e1. doi: 10.1016/j.jpeds.2015.12.029 CrossRefPubMedGoogle Scholar
  13. 13.
    Resch B, Michel-Behnke I (2013) Respiratory syncytial virus infections in infants and children with congenital heart disease: update on the evidence of prevention with palivizumab. Curr Opin Cardiol 28:85–91CrossRefPubMedGoogle Scholar
  14. 14.
    Altman CA, Englund JA, Demmler G, Drescher KL, Alexander MA, Watrin C, Feltes TF (2000) Respiratory syncytial virus in patients with congenital heart disease: a contemporary look at epidemiology and success of preoperative screening. Pediatr Cardiol 21:433–438CrossRefPubMedGoogle Scholar
  15. 15.
    Resch B, Sommer C, Nuijten MJ, Seidinger S, Walter E, Schoellbauer V, Mueller WD (2012) Cost-effectiveness of palivizumab for respiratory syncytial virus infection in high-risk children, based on long-term epidemiologic data from Austria. Pediatr Infect Dis J 31:e1–e8CrossRefPubMedGoogle Scholar
  16. 16.
    Pinter M, Geiger R (2005) Recommendations for RSV immune prophylaxis in infants and children with congenital heart disease (in German). Monatsschr Kinderheilkd 153:878–880CrossRefGoogle Scholar
  17. 17.
    Groothuis JR, Simoes EAF, Levin MJ, Hall CB, Long CE, Rodriguez WJ, Arrobio J, Meissner HC, Fulton DR, Welliver RC, Tristram DA, Siber GR, Prince GA, van Raden M, Hemming VG (1993) Prophylactic administration of respiratory syncytial virus immune globulin to high-risk infants and young children. The Respiratory Syncytial Virus Immune Globulin Study Group. N Engl J Med 329:1524–1530CrossRefPubMedGoogle Scholar
  18. 18.
    Medrano López C, García-Guereta L; CIVIC Study Group (2010) Community-acquired respiratory infections in young children with congenital heart diseases in the palivizumab era: the Spanish 4-season civic epidemiologic study. Pediatr Infect Dis J 29:1077–1082CrossRefPubMedGoogle Scholar
  19. 19.
    Cabalka AK (2004) Physiologic risk factors for respiratory viral infections and immunoprophylaxis for respiratory syncytial virus in young children with congenital heart disease. Pediatr Infect Dis J 23(1 Suppl):S41–S45CrossRefPubMedGoogle Scholar
  20. 20.
    Szabo SM, Gooch KL, Bibby MM, Vo PG, Mitchell I, Bradt P, Levy AR (2013) The risk of mortality among young children hospitalized for severe respiratory syncytial virus infection. Paediatr Respir Rev 13(Suppl 2):S1–S8CrossRefPubMedGoogle Scholar
  21. 21.
    Cohen SA, Zanni R, Cohen A, Harrington M, VanVeldhuisen P, Boron ML; Palivizumab Outcomes Registry Group (2008) Palivizumab use in subjects with congenital heart disease: results from the 2000–2004 Palivizumab Outcomes Registry. Pediatr Cardiol 29:382–387CrossRefPubMedGoogle Scholar
  22. 22.
    American Academy of Pediatrics Committee on Infectious Diseases; American Academy of Pediatrics Bronchiolitis Guidelines Committee (2014) Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics 134:415–420CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • B. Resch
    • 1
    • 2
    Email author
  • S. Kurath-Koller
    • 1
    • 2
  • J. Hahn
    • 2
  • W. Raith
    • 1
  • M. Köstenberger
    • 3
  • A. Gamillscheg
    • 3
  1. 1.Division of Neonatology, Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
  2. 2.Research Unit for Neonatal Infectious Diseases and EpidemiologyMedical University of GrazGrazAustria
  3. 3.Division of Pediatric Cardiology, Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria

Personalised recommendations