title: Hospitalized children with respiratory syncytial virus infection and neuromuscular impairment face an increased risk of a complicated course.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) infection is an important cause of viral respiratory tract infection in children. In contrast to other confirmed risk factors that predispose to a higher morbidity and mortality, the particular risk of a preexisting neuromuscular impairment (NMI) in hospitalized children with RSV infection has not been prospectively studied in a multicenter trial.
  
  
  METHODS
  The DMS RSV Paed database was designed for the prospective multicenter documentation and analysis of all clinically relevant aspects of the management of inpatients with RSV infection. Patients with clinically relevant NMI were identified according to the specific comments of the attending physicians and compared with those without NMI.
  
  
  RESULTS
  This study covers 6 consecutive seasons; the surveillance took place in 14 pediatric hospitals in Germany from 1999 to 2005. In total, 1568 RSV infections were prospectively documented in 1541 pediatric patients. Of these, 73 (4.7%) patients displayed a clinically relevant NMI; 41 (56%) NMI patients had at least 1 additional risk factor for a severe course of the infection (multiple risk factors in some patients; prematurity in 30, congenital heart disease in 19, chronic lung disease 6 and immunodeficiency in 8). Median age at diagnosis was higher in NMI patients (14 vs. 5 months); NMI patients had a greater risk of seizures (15.1% vs. 1.6%), and a higher proportion in the NMI group had to be mechanically ventilated (9.6% vs. 1.9%). Eventually, the attributable mortality was significantly higher in the NMI group (5.5% vs. 0.2%; P < 0.001 for all). Multivariate logistic regression confirmed that NMI was independently associated with pediatric intensive care unit (PICU) admission (OR, 4.94; 95% CI, 2.69-8.94; P < 0.001] and mechanical ventilation (OR, 3.85; 95% CI, 1.28-10.22; P = 0.017).
  
  
  CONCLUSIONS
  This is the first prospective multicenter study confirming the hypothesis that children with clinically relevant NMI face an increased risk for severe RSV-disease. It seems reasonable to include NMI as a cofactor into the decision algorithm of passive immunization.
authors.affiliation: Children's Hospital Medical Center, University of Bonn, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Wilkesmann
authors.forename: Roland A
authors.initials: RA
authors.lastname: Ammann
authors.forename: Oliver
authors.initials: O
authors.lastname: Schildgen
authors.forename: Anna M
authors.initials: AM
authors.lastname: Eis-Hübinger
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
authors.forename: Jürgen
authors.initials: J
authors.lastname: Seidenberg
authors.forename: Volker
authors.initials: V
authors.lastname: Stephan
authors.forename: Christian
authors.initials: C
authors.lastname: Rieger
authors.forename: Egbert
authors.initials: E
authors.lastname: Herting
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wygold
authors.forename: Friedeman
authors.initials: F
authors.lastname: Hornschuh
authors.forename: Jessie R
authors.initials: JR
authors.lastname: Groothuis
authors.forename: Arne
authors.initials: A
authors.lastname: Simon
mesh_terms: D002675:Child, Preschool; D005260:Female; D005858:Germany; D006760:Hospitalization; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009468:Neuromuscular Diseases / Q000150:complications* / Q000401:mortality / Q000473:pathology; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000401:mortality / Q000473:pathology; D012141:Respiratory Tract Infections / Q000150:complications* / Q000401:mortality / Q000473:pathology; D012307:Risk Factors