Seasonal peaks and risk factors of respiratory syncytial virus infections related hospitalization of preterm infants in Taiwan

PLOS ONE, Nov 2019

Objectives To assess the nationwide seasonal peaks, risk factors, and utilization of medical resources of respiratory syncytial virus-associated hospitalization (RSVH) in preterm infants in Taiwan. Study design A Taiwan nationwide birth cohort was extracted from the Birth Certificate Application Database during 2007–2009 and prospectively linked to the National Health Insurance database. We evaluated the seasonal peaks and risk factors (gestational age [GA], chronologic age [CA], and bronchopulmonary dysplasia [BPD]) associated with the RSVH of preterm infants. The length of hospital stays (LOS), care in intensive care unit (ICU), and use of mechanical ventilation (MV) were also analyzed. Results There is a total duration of 9 months of RSVH season in Taiwan, three seasonal peaks and two seasonal peaks of RSVH in preterm infants with BPD and without BPD, respectively. Preterm infants had significantly higher RSVH rate than term infants (2.6% vs 0.9%, p<0.0001). Preterm infants born at 29–35 weeks of gestational age (wGA) with BPD had significantly higher RSVH rate than those without BPD (p<0.0001). Preterm infants without BPD born at < 32 wGA had higher RSVH rate than those born at 33–35 wGA (p<0.0001). Overall, 56.4% of RSVH occurred within 9 months of CA. Preterm infants with BPD had significantly higher ICU admission rate within 18 months of CA (p<0.0001), MV usage within 12 months of CA (p<0.0001) and LOS within 18 months of CA (p<0.001) than those without BPD. RSVH occurred within 6 months of CA was significantly associated with higher ICU admission rate (p<0.0001), MV usage (p = 0.0002) and longer LOS (p<0.001) in preterm infants without BPD. Conclusions There is a total duration of 9 months of RSVH season in Taiwan. Preterm < 32 wGA, BPD, and CA within 6 months were risk factors of RSVH which also contribute to higher utilization of medical resources.

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Seasonal peaks and risk factors of respiratory syncytial virus infections related hospitalization of preterm infants in Taiwan

May Seasonal peaks and risk factors of respiratory syncytial virus infections related hospitalization of preterm infants in Taiwan Hsin Chi 0 1 2 Ching-Hu Chung 0 2 Yuh-Jyh Lin 2 Chyi-Her Lin 2 0 Department of Medicine, Mackay Medical College , New Taipei City, Taiwan , 3 Department of Pediatrics, National Cheng Kung University Hospital and College of Medicine, National Cheng Kung University , Tainan , Taiwan 1 Department of Pediatrics, Mackay Memorial Hospital and Mackay Children's Hospital , Taipei , Taiwan 2 Editor: Chih-Jung Chen, Chang Gung Memorial Hospital , TAIWAN - Data Availability Statement: The ownership of the data underlying this study belong to the National Health Insurance Research Database (NHIRD) of Taiwan and cannot be made publicly available due to legal restrictions. However, the data are available through formal application to the Health and Welfare Data Science Center at Ministry of Health and Welfare, Taiwan (https://dep.mohw.gov.tw/ DOS/np-2500-113.html) and require a signed affirmation regarding data confidentiality. The authors have no special privilege of access to the database. Objectives To assess the nationwide seasonal peaks, risk factors, and utilization of medical resources of respiratory syncytial virus-associated hospitalization (RSVH) in preterm infants in Taiwan. Study design A Taiwan nationwide birth cohort was extracted from the Birth Certificate Application Database during 2007±2009 and prospectively linked to the National Health Insurance database. We evaluated the seasonal peaks and risk factors (gestational age [GA], chronologic age [CA], and bronchopulmonary dysplasia [BPD]) associated with the RSVH of preterm infants. The length of hospital stays (LOS), care in intensive care unit (ICU), and use of mechanical ventilation (MV) were also analyzed. Results There is a total duration of 9 months of RSVH season in Taiwan, three seasonal peaks and two seasonal peaks of RSVH in preterm infants with BPD and without BPD, respectively. Preterm infants had significantly higher RSVH rate than term infants (2.6% vs 0.9%, p<0.0001). Preterm infants born at 29±35 weeks of gestational age (wGA) with BPD had significantly higher RSVH rate than those without BPD (p<0.0001). Preterm infants without BPD born at < 32 wGA had higher RSVH rate than those born at 33±35 wGA (p<0.0001). Overall, 56.4% of RSVH occurred within 9 months of CA. Preterm infants with BPD had significantly higher ICU admission rate within 18 months of CA (p<0.0001), MV usage within 12 months of CA (p<0.0001) and LOS within 18 months of CA (p<0.001) than those without BPD. RSVH occurred within 6 months of CA was significantly associated with higher ICU admission rate (p<0.0001), MV usage (p = 0.0002) and longer LOS (p<0.001) in preterm infants without BPD. Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Conclusions There is a total duration of 9 months of RSVH season in Taiwan. Preterm < 32 wGA, BPD, and CA within 6 months were risk factors of RSVH which also contribute to higher utilization of medical resources. Introduction Respiratory syncytial virus (RSV) is an important virus for lower respiratory tract infections among infants and young children [ 1,2 ]. Nearly all children have been infected at least once by 2 years of age, with 1±2% requiring hospitalization [ 3,4 ]. Populations at risk for RSV-associated hospitalization (RSVH) include infants who are born before 35 weeks of gestational age (wGA), with bronchopulmonary dysplasia (BPD), and who have hemodynamically significant congenital heart disease (HS-CHD) [ 5 ]. Chronologic age (CA) is one of the most important risk factor for RSVH and most of pediatric RSVH occur in the first 5 months after birth [ 5,6 ]. Since 1998, the American Academy of Pediatrics (AAP) has recommended palivizumab prophylaxis guidelines against RSV according to their BPD status, gestational age(GA) and CA at the beginning of the RSV season to prevent the respiratory complication [7]. Because of the high costs of RSV prophylaxis [ 8 ] and additional data regarding seasonality of RSV infection, AAP revised its policy and restricted the palivizumab prophylaxis to preterm infants who were born before 32 wGA and infants born at 32 to 35 wGA with certain risks in 2009 [ 9 ]. In 2014, the AAP further evolved palivizumab prophylaxis to preterm infants born before 29 wGA, born at <32 weeks with BPD of prematurity, and infants with HS-CHD [ 10 ]. Prevention of RSV is complicated by considerable variation in RSV seasonality across geographic locations [ 11 ]. The current AAP guideline recommends a series of 5 monthly injections which simply reflects the average length of the RSV season across the United States, Canada, and the United Kingdom without considering the variation in regional seasonality [ 12 ]. The RSV infection has been reported to be ongoing t (...truncated)


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Hsin Chi, Ching-Hu Chung, Yuh-Jyh Lin, Chyi-Her Lin. Seasonal peaks and risk factors of respiratory syncytial virus infections related hospitalization of preterm infants in Taiwan, PLOS ONE, 2018, Volume 13, Issue 5, DOI: 10.1371/journal.pone.0197410