Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection

doi:10.1016/S0022-3476(95)70547-3

The Journal of Pediatrics

Volume 126, Issue 2, February 1995, Pages 212-219

Presented in part at the Society for Pediatric Research Meeting, Seattle, Washington, May 2, 1994.

https://doi.org/10.1016/S0022-3476(95)70547-3 Get rights and content

Abstract

Objective: To provide information on disease attributable to respiratory syncytial viral lower respiratory tract infection (RSV LRI) and to quantify the morbidity associated with various risk factors. Design: Prospective cohort study. Subjects: Patients hospitalized with RSV LRIs at seven centers were eligible for study if they were younger than 2 years of age, or hospitalized patients of any age if they had underlying cardiac or pulmonary disease or immunosuppression. Measurements and results: Enrolled (n = 689) and eligible but not enrolled (n = 191) patients were similar in age, duration of illness and proportion with underlying illness, use of intensive care, and ventilation. Of the enrolled patients, 156 had underlying illness. The isolates from 353 patients were typeable: 102 isolates were subgroup A, 250 were subgroup B, and one isolated grouped with both antisera. The mean hospital stay attributable to respiratory syncytial virus (RSV) was 7 days; 110 patients were admitted to intensive care units, 63 were supported by mechanical ventilation, and 6 patients died. Regression models were developed for the prediction of three outcomes: RSV-associated hospital duration, intensive care unit admission, and ventilation treatment. In addition to previously described risk factors for an increased morbidity, such as underlying illness, hypoxia, prematurity and young age, three other factors were found to be significantly associated with complicated hospitalization: aboriginal race (defined by maternal race), a history of apnea or respiratory arrest during the acute illness before hospitalization, and pulmonary consolidation as shown on the chest radiograph obtained at admission. The RSV subgroup, family income, and day care attendance were not significantly associated with these outcomes. Conclusions: Hypoxia on admission, a history of apnea or respiratory arrest, and pulmonary consolidation should be considered in the management of children with RSV LRIs. Vaccine trials should target patients with underlying heart or lung disease or of aboriginal race. (J PEDIATR 1995;126:212-9)

Section snippets

Patients

The study population consisted of children admitted between Jan. 1 and April 30, 1993, to one of the following seven pediatric tertiary care hospitals in Canada: Izaak Walton Killam Hospital, Halifax; Le Centre Hospitalier de l'Université Laval, Québec City; Montreal Children's Hospital, Montreal; Children's Hospital of Eastern Ontario, Ottawa; Hospital for Sick Children, Toronto; Winnipeg Children's Hospital, Winnipeg; and British Columbia's Children's Hospital, Vancouver. Because of the

RESULTS

A total of 698 children were enrolled from Jan. 1 to April 30, 1993, at all centers except Winnipeg Children's Hospital, where enrollment continued until June 30, 1993. Nine patients were excluded because they did not have lower respiratory tract illness associated with the RSV infection. Thus 689 patients were included in the analysis.

There was variation in the type of nasopharyngeal specimen submitted for diagnosis. In addition, there was variation in the ability to isolate and subgroup

DISCUSSION

In our previous retrospective study, it was not possible to separate morbidity attributable to RSV infection from that caused by underlying disease.¹ Thus this prospective study was performed to determine morbidity attributable to RSV. In addition, we wished to compare prospectively the morbidity in those with underlying illness with that in patients without underlying disease.

The reduced morbidity in a population with underlying heart and lung disease noted in our previous retrospective study,¹

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^☆: From the Clinical Epidemiology Unit, Hospital for Sick Children, Toronto, Ontario, Canada

^☆☆: Supported by a grant from Lederle, Canada Inc.

^★: Reprint requests: Elaine E. L. Wang, MCDM, Clinical Epidemiology Unit, Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada.

^★★: 0022-3476/95/$3.00 + 09/20/59781

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Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection☆,☆☆,★,★★

Abstract

Section snippets

Patients

RESULTS

DISCUSSION

J PEDIATR

J PEDIATR

Lancet

Respiratory syncytial virus infection in infants with congenital heart disease

N Engl J Med

Respiratory syncytial virus infection in children with bronchopulmonary dysplasia

Pediatrics

Severe respiratory syncytial virus infection in older children

Am J Dis Child

Ribavirin therapy of respiratory syncytial virus

Prophylactic administration of respiratory syncytial virus immune globulin to high-risk infants and young children

N Engl J Med

Antigenic characterization of respiratory syncytial virus strains with monoclonal antibodies

J Infect Dis

Prediction of the duration of hospitalization in patients with respiratory syncytial virus infection: use of clinical parameters

Pediatrics

Clinical characteristics of respiratory syncytial virus infections in healthy versus previously compromised host

Pediatr Pulmonol

Intensive care course and outcome of patients infected with respiratory syncytial virus

Pediatr Pulmonol

Risk factors for mechanical ventilation in respiratory syncytial virus infection

Eur J Pediatr

Duration of hospitalization in previously well infant with respiratory syncytial virus infection

Pediatr Infect Dis J