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Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database

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Abstract

Premature birth, chronic lung disease of prematurity (CLD), congenital heart disease and immunodeficiency predispose to a higher morbidity and mortality in respiratory syncytial virus (RSV) infection. This study describes the preterms hospitalised with RSV infection from the prospective German DSM RSV Paed database. The DMS RSV Paed database was designed for the prospective multicentre documentation and analysis of clinically relevant aspects of the management of inpatients with RSV infection. This study covers six consecutive RSV seasons (1999–2005); the surveillance took place in 14 paediatric hospitals in Germany. Of the 1,568 prospectively documented RSV infections, 26% (n = 406) were observed in preterms [vs. 1,162 children born at term (74%)] and 3% (n = 50) had CLD, of which 49 had received treatment in the last 6 months (‘CLDplus’). A significantly higher proportion in the preterm group had congenital heart disease, nosocomial infection, and neuromuscular impairment. There were significantly more children older than 24 months in the preterm group. The attributable mortality was 0.2% (n = 2) in children born at term vs. 1.2% (n = 5) in the preterm group (p = 0.015) [preterm plus CLD 8.0% (n = 4 of 50); McIntosh grade 1, 8.6% (n = 3 of 35) and McIntosh Grade 4, 15% (n = 3 of 20)]. Eight patients were categorized as ‘palivizumab failures’. In the multivariate analysis, premature birth, CLDplus, and nosocomial infection were significantly and independently associated with the combined outcome ‘complicated course of disease’. In conclusion, this is the first prospective multicentre study from Germany that confirms the increased risk for severe RSV disease in preterms, in particular in those with CLD treated in the last 6 months before the onset of the infection. From the perspective of our results, the statements of the German Society of Paediatric Infectious Diseases considering the use of passive immunisation (2003) seem reasonable.

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Abbreviations

AAP:

American Academy of Paediatrics

CG:

control group

CHD:

congenital heart disease

CLD:

chronic lung disease of prematurity

CLDplus :

CLD with treatment within the last 6 months

CPAP:

continuous positive airway pressure

DSM RSV Paed:

database for the inpatient management of RSV-infected children

NI:

nosocomial infection

NPA:

nasopharyngeal aspirate

PT:

preterm (gestational age at birth <37 weeks)

RSV:

respiratory syncytial virus

RTI:

respiratory tract infection

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Acknowledgement

We gratefully acknowledge the contribution of all local investigators (see attachment) of the participating centres. In addition, this work was partially supported by grants from the Else Kröner-Fresenius Foundation (grant no. A 01/05//F 00) and the BONFOR programme of the Medical Faculty of the University of Bonn (grant no. O-151.0028).

Potential conflict of interest

The development of the DSM RSV Paed software tool was supported by an educational grant from Abbott GmbH, Wiesbaden, Germany.

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Authors and Affiliations

  1. Department of Pediatric Hematology and Oncology, Children’s Hospital Medical Center, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany

    Arne Simon, Anja Wilkesmann & Andreas Müller

  2. University Children’s Hospital, Bern, Switzerland

    Roland A. Ammann

  3. Institute for Medical Microbiology, Immunology and Parasitology, University of Bonn, Bonn, Germany

    Anna M. Eis-Hübinger & Oliver Schildgen

  4. Pediatric Center, St.-Bernward Hospital, Hildesheim, Germany

    Edda Weimann

  5. Children’s Hospital Medical Center, Salzgitter, Germany

    Hans U. Peltner

  6. St. Johannis Hospital, Duisburg, Germany

    Peter Seiffert

  7. Children’s Hospital Medical Center, University of Mannheim-Heidelberg, Heidelberg, Germany

    Angela Süss-Grafeo

  8. Hollis-Eden Pharmaceuticals Inc., San Diego, CA, 902121, USA

    Jessie R. Groothuis

  9. von Hauner Children’s University Hospital, Munich, Germany

    Johannes Liese

  10. Children’s Hospital, Memmimngen, Germany

    Ralf Pallacks

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  1. Arne Simon
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DSM RSV Paed Study Group

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Correspondence to Arne Simon.

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Simon, A., Ammann, R.A., Wilkesmann, A. et al. Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database. Eur J Pediatr 166, 1273–1283 (2007). https://doi.org/10.1007/s00431-007-0426-y

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  • DOI: https://doi.org/10.1007/s00431-007-0426-y

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