Predictors of RSV LRTI Hospitalization in Infants Born at 33 to 35 Weeks Gestational Age: A Large Multinational Study (PONI).
BACKGROUND
Preterm infants are at high risk of developing respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRTI). This observational epidemiologic study evaluated RSV disease burden and risk factors for RSV-associated LRTI hospitalization in preterm infants 33 weeks+0 days to 35 weeks+6 days gestational age not receiving RSV prophylaxis.


METHODS
Preterm infants ≤6 months of age during RSV season (1 October 2013-30 April 2014) were followed at 72 sites across 23 countries from September 2013-July 2014 (study period). RSV testing was performed according to local clinical practice. Factors related to RSV-associated hospitalization for LRTI were identified using multivariable logistic regression with backward selection.


RESULTS
Of the 2390 evaluable infants, 204 and 127 were hospitalized for LRTI during the study period and RSV season, respectively. Among these subjects, 64/204 and 46/127, respectively, were hospitalized for confirmed RSV LRTI. Study period and RSV season normalized RSV hospitalization rates (per 100 infant years) were 4.1 and 6.1, respectively. Factors associated with an increased risk of RSV-related LRTI hospitalization in multivariable analyses were smoking of family members (P<0.0001), non-hemodynamically significant congenital heart disease diagnosis (P = 0.0077), maternal age of ≤25 years at delivery (P = 0.0009), low maternal educational level (P = 0.0426), household presence of children aged 4 to 5 years (P = 0.0038), age on 1 October ≤3 months (P = 0.0422), and presence of paternal atopy (P<0.0001).


CONCLUSIONS
During the 2013-2014 RSV season across 23 countries, for preterm infants 33-35 weeks gestation ≤6 months old on 1 October not receiving RSV prophylaxis, confirmed RSV LRTI hospitalization incidence was 4.1 per 100 infant years during the study period and 6.1 per 100 infant years during the RSV season. This study enhances the findings of single-country studies of common risk factors for severe RSV infection in preterm infants and suggests that combinations of 4-6 risk factors may be used to accurately predict risk of RSV hospitalization. These findings may be useful in the identification of infants most at risk of severe RSV infection.
Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Zbyněk
http://orcid.org/0000-0001-7095-3198
Z
Straňák
Inserm U930, Université François Rabelais, and Department of Neonatology, University Hospital Clocheville, Tours, France.
Elie
E
Saliba
Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.
Paraskevi
P
Kosma
Department of Pediatrics, Geneva Medical School and University Hospitals of Geneva, Geneva, Switzerland.
Klara
K
Posfay-Barbe
Department of Pediatrics and Adolescent Medicine, American University of Beirut, Riad El Solh, Beirut, Lebanon.
Khalid
K
Yunis
Department of Pediatrics, Akershus University Hospital, Lørenskog, Norway.
Teresa
T
Farstad
Data and Statistical Sciences, AbbVie Deutschland GmbH & Co. KG, Ludwigshafen, Germany.
Kristina
K
Unnebrink
Virology, AbbVie Inc., North Chicago, IL, United States of America.
Jean
J
van Wyk
Neonatology, AbbVie Inc., North Chicago, IL, United States of America.
Colleen
C
Wegzyn
Virology, AbbVie Inc., North Chicago, IL, United States of America.
Gerard
G
Notario
Biostatistics, GKM Gesellschaft für Therapieforschung mbH, Munich, Germany.
Stefanie
S
Kalus
Neonatology and HIV, AbbVie Ltd, Dublin, Ireland.
Fiona J
FJ
Campbell
D004522:Educational Status; D005060:Europe / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital / Q000150:complications; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008423:Maternal Age; D008877:Middle East / Q000453:epidemiology; D015999:Multivariate Analysis; D011379:Prognosis; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification / Q000472:pathogenicity / Q000502:physiology; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D012307:Risk Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D014481:United States / Q000453:epidemiology
D014028:Tobacco Smoke Pollution