title: Respiratory syncytial virus prophylaxis in children with cardiac disease: a retrospective single-centre study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: 1 School of Nursing, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Butt
authors.affiliation: 2 Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Symington
authors.affiliation: 2 Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Janes
authors.affiliation: 3 Department of Pediatrics (Neonatology and Cardiac Divisions), McMaster University, Hamilton, Ontario, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Steele
authors.affiliation: 2 Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Louann
authors.initials: L
authors.lastname: Elliott
authors.affiliation: 2 Neonatal Division, McMaster Children's Hospital, Hamilton, Ontario, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chant-Gambacort
authors.affiliation: 3 Department of Pediatrics (Neonatology and Cardiac Divisions), McMaster University, Hamilton, Ontario, Canada.
authors.forename: Tapas
authors.initials: T
authors.lastname: Mondal
authors.affiliation: 3 Department of Pediatrics (Neonatology and Cardiac Divisions), McMaster University, Hamilton, Ontario, Canada.
authors.forename: Bosco
authors.initials: B
authors.lastname: Paes
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005334:Fever / Q000209:etiology; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D000069455:Palivizumab; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012128:Respiratory Distress Syndrome / Q000209:etiology; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000517:prevention & control* / Q000628:therapy; D012189:Retrospective Studies
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab