title: Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database.
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, CLD(plus), 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.
authors.affiliation: Department of Pediatric Hematology and Oncology, Children's Hospital Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany. asimon@ukb.uni-bonn.de
authors.forename: Arne
authors.initials: A
authors.lastname: Simon
authors.forename: Roland A
authors.initials: RA
authors.lastname: Ammann
authors.forename: Anja
authors.initials: A
authors.lastname: Wilkesmann
authors.forename: Anna M
authors.initials: AM
authors.lastname: Eis-Hübinger
authors.forename: Oliver
authors.initials: O
authors.lastname: Schildgen
authors.forename: Edda
authors.initials: E
authors.lastname: Weimann
authors.forename: Hans U
authors.initials: HU
authors.lastname: Peltner
authors.forename: Peter
authors.initials: P
authors.lastname: Seiffert
authors.forename: Angela
authors.initials: A
authors.lastname: Süss-Grafeo
authors.forename: Jessie R
authors.initials: JR
authors.lastname: Groothuis
authors.forename: Johannes
authors.initials: J
authors.lastname: Liese
authors.forename: Ralf
authors.initials: R
authors.lastname: Pallacks
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D008297:Male; D000069455:Palivizumab; D011024:Pneumonia, Viral / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D011446:Prospective Studies; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy / Q000453:epidemiology*; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab