Abstract

Background

Respiratory syncytial virus (RSV) is among the most important causes of acute lower respiratory tract infection (ALRI) in young children. We assessed the severity of RSV-ALRI in children less than 5 years old with bronchopulmonary dysplasia (BPD).

Methods

We searched for studies using EMBASE, Global Health, and MEDLINE. We assessed hospitalization risk, intensive care unit (ICU) admission, need for oxygen supplementation and mechanical ventilation, and in-hospital case fatality (hCFR) among children with BPD compared with those without (non-BPD). We compared the (1) length of hospital stay (LOS) and (2) duration of oxygen supplementation and mechanical ventilation between the groups.

Results

Twenty-nine studies fulfilled our inclusion criteria. The case definition for BPD varied substantially in the included studies. Risks were higher among children with BPD compared with non-BPD: RSV hospitalization (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7–4.2; P < .001), ICU admission (OR, 2.9; 95% CI, 2.3–3.5; P < .001), need for oxygen supplementation (OR, 4.2; 95% CI, .5–33.7; P = .175) and mechanical ventilation (OR, 8.2; 95% CI, 7.6–8.9; P < .001), and hCFR (OR, 12.8; 95% CI, 9.4–17.3; P < .001). Median LOS (range) was 7.2 days (4–23) (BPD) compared with 2.5 days (1–30) (non-BPD). Median duration of oxygen supplementation (range) was 5.5 days (0–21) (BPD) compared with 2.0 days (0–26) (non-BPD). The duration of mechanical ventilation was more often longer (>6 days) in those with BPD compared with non-BPD (OR, 11.9; 95% CI, 1.4–100; P = .02).

Conclusions

The risk of severe RSV disease is considerably higher among children with BPD. There is an urgent need to establish standardized BPD case definitions, review the RSV prophylaxis guidelines, and encourage more specific studies on RSV infection in BPD patients, including vaccine development and RSV-specific treatment.

中文翻译：

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呼吸道合胞病毒相关的支气管肺发育不良儿童的急性下呼吸道感染：系统评价和荟萃分析

摘要

背景

呼吸道合胞病毒（RSV）是幼儿急性下呼吸道感染（ALRI）的最重要原因之一。我们评估了5岁以下支气管肺发育不良（BPD）儿童的RSV-ALRI的严重程度。

方法

我们使用EMBASE，Global Health和MEDLINE搜索研究。我们评估了BPD患儿与非BPD患儿（非BPD患儿）的住院风险，重症监护病房（ICU）入院，氧气补充和机械通气的需求以及院内病死率（hCFR）。我们比较了两组之间的（1）住院时间（LOS）和（2）增氧和机械通气时间。

结果

二十九项研究符合我们的纳入标准。在纳入的研究中，BPD的病例定义存在很大差异。与非BPD儿童相比，BPD儿童的风险更高：RSV住院（几率[OR]为2.6； 95％置信区间[CI]为1.7–4.2；P <.001），ICU入院（OR为2.9； 95） ％CI，2.3–3.5；P <0.001），需要补充氧气（OR，4.2； 95％CI，0.5–33.7；P = .175）和机械通气（OR，8.2； 95％CI，7.6– 8.9；P <.001）和hCFR（OR为12.8； 95％CI为9.4-17.3；P<.001）。平均LOS（范围）为7.2天（4-23）（BPD），而2.5天（1-30）（非BPD）。补充氧气的中位数持续时间（范围）为5.5天（0-21）（BPD），而2.0天（0-26）（非BPD）。与非BPD患者相比，BPD患者的机械通气时间通常更长（> 6天）（OR，11.9； 95％CI，1.4-100；P = .02）。

结论

BPD儿童患严重RSV疾病的风险较高。迫切需要建立标准化的BPD病例定义，审查RSV预防指南，并鼓励对BPD患者的RSV感染进行更具体的研究，包括疫苗开发和RSV特异性治疗。