Cardiology in the Young

Original Articles

Respiratory syncytial virus prophylaxis in children with cardiac disease: a retrospective single-centre study

Michelle Butta1, Amanda Symingtona2, Marianne Janesa2, Susan Steelea3, LouAnn Elliotta2, Catherine Chant-Gambacorta2, Tapas Mondala3 and Bosco Paesa3 c1

a1 School of Nursing, McMaster University, Hamilton, Ontario, Canada

a2 Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada

a3 Department of Pediatrics (Neonatology and Cardiac Divisions), McMaster University, Hamilton, Ontario, Canada

Abstract

Objectives To examine the characteristics of congenital heart disease patients hospitalised with respiratory syncytial virus infection after prophylaxis and determine the associated comorbidities and the incidence of breakthrough respiratory syncytial virus infections.

Study design This is a retrospective, single-centre study that was conducted over a period of 7 years. Respiratory syncytial virus infection was identified by classification codes and confirmed by virological tests. Data on baseline demographics, cardiac anomalies, other underlying disease, criteria for hospitalisation, type of respiratory illness and management, complications, and palivizumab prophylaxis were analysed by standard descriptive methods and comparative statistics.

Results A total of 30 patients were enrolled. The majority were ≤2 years (n = 24). The mean admission age was 15.1 months (standard deviation = 18.3). In all, 90% were acyanotic, 40% had haemodynamically significant disease, and 60% had ≥1 underlying medical illness. Patients were admitted with: respiratory distress (86.7%), hypoxaemia (66.7%), fever (60%), inability to maintain oral intake (36.7%), and apnoea (16.7%). More than 50% required mechanical ventilation and intensive care with a median stay of 11 days (range: 1–43); the length of hospital stay for all children was 10 days (range: 1–65). Complications included: concurrent bacterial sepsis (20%), electrolyte abnormalities (16.7%), and worsening pulmonary hypertension (13.3%). Of 10 infants ≤2 years with haemodynamically significant heart disease, four had received prophylaxis. There was one death, which was attributed to respiratory syncytial virus infection.

Conclusions Overall, 185 infants ≤2 years with haemodynamically significant cardiac disease received prophylaxis. In all, six qualifying infants missed immunisation and were hospitalised. Breakthrough respiratory syncytial virus infections occurred in 2.2%, demonstrating good efficacy of palivizumab in this population compared with the original, multi-centre, randomised trial.

(Received December 11 2012)

(Accepted March 17 2013)

(Online publication April 29 2013)

Keywords

  • Respiratory syncytial virus;
  • infection;
  • haemodynamically significant cardiac disease;
  • palivizumab

Correspondence

c1 Correspondence to: Dr B. Paes, MBBS, FRCPC, Department of Pediatrics (Room HSC-3A), McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. Tel: (905) 521-2100×73672; Fax: (905) 521-5007; E-mail: paes@mcmaster.ca