We read with interest the study by Heikkinen et al [1] and the letter
by Bala, Ryan and Murphy [2] on bronchiolitis hospital admissions and of
Palivizumab prophylaxis. We would like to add our experience on the issue.
Our retrospective study covered the period from 01.01.1995 to 31.12.2000
i.e. a 6-year period before Palivizumab prophylaxis became available in
Greece. We looked into hosp...
We read with interest the study by Heikkinen et al [1] and the letter
by Bala, Ryan and Murphy [2] on bronchiolitis hospital admissions and of
Palivizumab prophylaxis. We would like to add our experience on the issue.
Our retrospective study covered the period from 01.01.1995 to 31.12.2000
i.e. a 6-year period before Palivizumab prophylaxis became available in
Greece. We looked into hospital admissions with the clinical diagnosis of
bronchiolitis of infants born less than 32 weeks of gestation within one
year after discharge from our NICU. We did not specifically look for RSV
diagnosis as in Greece rapid laboratory testing for this virus became
widely available as late as 1999.
Information was collected and analysed
using NICU and follow up medical notes; medical notes of the hospital
the infants were admitted in case of bronchiolitis as well as parental
questionnaire and direct telephone contact.
During the study period 289 infants were discharged and 5 deaths (1.7%)
occurred following discharge, all unrelated to respiratory disease. Of the
remaining 284 infants, 242 (85%) were traced and were included in this
analysis. The median gestational age was 29 weeks (24-31 weeks) and the
median birthweight was 1200g (550-1810g). Mechanical ventilation received
161 (66.5%) and oxygen administration at 36 weeks required 11 (4.5%). No
infant was discharged home on oxygen. Total admissions to hospital within
one year of discharge involved 56 infants (23.1%), while 25 (10.3%) were
admitted with the clinical diagnosis of bronchiolitis. None of these
infants required intensive care including mechanical ventilation and the
median length of hospitalisation was 7 days (5-14 days). There were no
deaths.
Using logistic regression analysis of probable factors influencing
bronchiolitis hospital admission revealed that the presence of older
siblings at home significantly increased the chance of admission (OR 5.5
95%CI 2.69 13.82, p<_0.001 particularly="particularly" if="if" the="the" older="older" sibling="sibling" was="was" attending="attending" nursery="nursery" or="or" school="school" _6.25="_6.25" _95ci="_95ci" _2.63="_2.63" _16.67="_16.67" p0.001.="p0.001." eighty="eighty" percent="percent" of="of" _25="_25" infants="infants" had="had" siblings.="siblings." no="no" association="association" found="found" with="with" other="other" factors="factors" such="such" as="as" peri="peri" neonatal="neonatal" gestational="gestational" age="age" birthweight="birthweight" prenatal="prenatal" administration="administration" steroids="steroids" mechanical="mechanical" ventilation="ventilation" surfactant="surfactant" oxygen="oxygen" dependency="dependency" at="at" _28="_28" days="days" _36="_36" weeks="weeks" maternal="maternal" milk="milk" family="family" history="history" asthma="asthma" parental="parental" smoking="smoking" pet="pet" in="in" household="household" sleeping="sleeping" arrangement.="arrangement." p="p"/>
Since no information regarding RSV infection was available we hypothesised
that all episodes of bronchiolitis necessitating admission to hospital
were due to RSV. Using American Academy recommendations [3] and the
results of the Impact Study [4], prophylaxis of 17.1 infants with the
monoclonal antibody (Palivizumab) would be required to avert 1 hospital
admission. It was estimated that Palivizumab prophylaxis would reduce
hospital costs by 29400€ but would have cost 575000€. Prophylaxis of the
infants with older sibling(s) i.e. 36% of 242 infants of this study would
have included 20 out of 25 hospitalised infants (80%) because of
bronchiolitis.
We entirely endorse the conclusions by Heikkinen et al [1] and Bala et al
[2]
References
(1). Heikkinen T, Valkonen H, Lehtonen L et al. Hospital admission of
high risk infants for respiratory syncytial virus infection: implications
for palivizumab prophylaxis. Arch Dis Child Fetal Neonatal Ed 2005; 90:F64
-F68
(2). Bala P, Ryan CA, Murphy BP. Hospital admissions for bronchiolitis
in preterm infants in the absence of respiratory syncytial virus
prophylaxis. Arch Dis Child Feta Neonatal Ed 2005;90:92
(3). American Academy of Pediatrics. Prevention of respiratory
syncytial virus infections: indications for the use of palivizumab and
update on the use of RSV-IGIV. Pediatrics 1998;102:1211-16
(4). The Impact-RSV Study Group. Palivizumab, a humanized respiratory
syncytial virus monoclonal antibody, reduces hospitalisation from
respiratory syncytial virus infection in high risk infants. Pediatrics
1998;102:531-7
Dear Editor,
We read with interest the study by Heikkinen et al [1] and the letter by Bala, Ryan and Murphy [2] on bronchiolitis hospital admissions and of Palivizumab prophylaxis. We would like to add our experience on the issue.
Our retrospective study covered the period from 01.01.1995 to 31.12.2000 i.e. a 6-year period before Palivizumab prophylaxis became available in Greece. We looked into hosp...
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