title: Community-acquired respiratory infections in young children with congenital heart diseases in the palivizumab era: the Spanish 4-season civic epidemiologic study.
abstract: BACKGROUND
  To investigate the epidemiology of acute respiratory tract infections (ARIs) in children younger than 24 months old with hemodynamically significant congenital heart diseases. Primary aim: incidence of hospital admission due to ARI. Secondary aims: risk factors, etiologic agents, clinical outcomes, and usefulness of preventive measures.
  
  
  METHODS
  Prospective, multicenter, epidemiologic study conducted in 57 Spanish hospitals covering four 7-month seasons (2004-2008).
  
  
  RESULTS
  A total of 2613 patients were eligible for the study. Three hundred fifty-four patients (13.5%) (95% confidence interval: 12.3-14.9) required a total of 453 hospital admissions. Clinical diagnoses: bronchiolitis (54.1%), upper respiratory tract infection (21%), pneumonia (19.9%), and others (17.4%). Median length of hospital stay: 7.0 days. No etiologic agent was identified in two-thirds of the patients. In the remaining patients either a single agent (26.8%) or polymicrobial infection (5%) was identified. Respiratory syncytial virus (RSV) was the agent that was most commonly found (3.8% specific hospitalization rate). Children receiving adequate RSV prophylaxis (90.5%) had a 58.2% (95% confidence interval: 37.6-78.3) reduction in RSV hospitalization. Risk factors for admission included malnourishment, infant age, male gender, chromosome alterations, wheezing, inadequate RSV prophylaxis fulfillment, and siblings <11 years of age. Pediatric intensive care unit care was required in 21.8% of the admissions and 9 patients (0.34%) died.
  
  
  CONCLUSIONS
  Hospital admission rate and severity of ARI remain as important issues in hemodynamically significant congenital heart disease patients. The strict fulfillment of prophylactic recommendations against RSV is the only protective factor that can be modulated to decrease the ARI hospital admission rate.
authors.affiliation: Pediatric Cardiology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain. consmelu@yahoo.es
authors.forename: Constancio
authors.initials: C
authors.lastname: Medrano López
authors.forename: Luis
authors.initials: L
authors.lastname: García-Guereta
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000151:congenital*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000069455:Palivizumab; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000473:pathology; D013030:Spain / Q000453:epidemiology; D014777:Virus Diseases / Q000453:epidemiology* / Q000473:pathology
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab