title: Viral respiratory infections in children with technology dependence and neuromuscular disorders.
abstract: BACKGROUND
  Viral acute respiratory infections represent a significant cause of morbidity and mortality across all ages, especially in patients with chronic underlying conditions. Although recognized anecdotally, the risks of viral infection to those children with chronic underlying conditions rendering them technology dependent, or to those children with neuromuscular disorders, have not been well studied.
  
  
  METHODS
  Studies of children with underlying conditions that result in technology dependence and those with neuromuscular disorders who required hospitalization for respiratory syncytial virus infection are reviewed. Additionally surveys of physician perceptions toward risk factors for severe viral illness and prevention in this population of patients are reported. Possible mechanisms to explain the increased risk of disease severity with viral respiratory infections are explored as well.
  
  
  RESULTS
  Current or recent use of supplemental oxygen is associated with more severe disease in children with chronic underlying conditions, especially bronchopulmonary dysplasia. Supplemental oxygen use may be a marker for several factors known to increase the severity of viral respiratory illnesses. Children with neuromuscular weakness are also likely to experience more severe disease, most likely resulting from compromised airway clearance.
  
  
  CONCLUSIONS
  Although the number of children who are technology-dependent or have severe neuromuscular weakness is small, their risk of severe disease after viral respiratory infection may be similar to that of premature infants or other high risk groups. A better understanding of the factors responsible for severe viral disease in these children would help create better strategies for treatment and prevention.
authors.affiliation: University of Pennsylvania School of Medicine, Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Howard B
authors.initials: HB
authors.lastname: Panitch
mesh_terms: D002675:Child, Preschool; D002908:Chronic Disease; D019988:Children with Disabilities; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity; D018908:Muscle Weakness; D009468:Neuromuscular Diseases / Q000150:complications* / Q000821:virology*; D010102:Oxygen Inhalation Therapy; D018357:Respiratory Syncytial Virus Infections / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index