Top

Published in:

Open Access 01-12-2015 | Research

Risk factors for bronchiolitis hospitalization during the first year of life in a multicenter Italian birth cohort

Authors: Marcello Lanari, Federica Prinelli, Fulvio Adorni, Simona Di Santo, Silvia Vandini, Michela Silvestri, Massimo Musicco, and the Study Group of Italian Society of Neonatology on Risk Factors for RSV Hospitalization

Published in: Italian Journal of Pediatrics | Issue 1/2015

Abstract

Background

Respiratory Syncytial Virus (RSV) is one of the main causes of respiratory infections during the first year of life. Very premature infants may contract more severe diseases and ‘late preterm infants’ may also be more susceptible to the infection.

The aim of this study is to evaluate the risk factors for hospitalization during the first year of life in children born at different gestational ages in Italy.

Methods

A cohort of 33-34 weeks gestational age (wGA) newborns matched by sex and age with two cohort of newborns born at 35-37 wGA and > 37 wGA were enrolled in this study for a three-year period (2009-2012).

Hospitalization for bronchiolitis (ICD-9 code 466.1) during the first year of life was assessed through phone interview at the end of the RSV season (November–March) and at the completion of the first year of life.

Results

The study enrolled 2314 newborns, of which 2210 (95.5 %) had a one year follow-up and were included in the analysis; 120 (5.4 %) were hospitalized during the first year of life for bronchiolitis. Children born at 33-34 wGA had a higher hospitalization rate compared to the two other groups. The multivariate analysis carried out on the entire population associated the following factors with higher rates for bronchiolitis hospitalization: male gender; prenatal treatment with corticosteroids; prenatal exposure to maternal smoking; singleton delivery; respiratory diseases in neonatal period; surfactant therapy; lack of breastfeeding; siblings <10 years old; living in crowded conditions and/or in unhealthy households and early exposure to the epidemic RSV season. When analysis was restricted to preterms born at 33-34 wGA the following variables were associated to higher rates of bronchiolitis hospitalization: male gender, prenatal exposure to maternal smoking, neonatal surfactant therapy, having siblings <10 years old, living in crowded conditions and being exposed to epidemic season during the first three months of life.

Conclusion

Our study identified some prenatal, perinatal and postnatal conditions proving to be relevant and independent risk factors for hospitalization for bronchiolitis during the first year of life. The combination of these factors may lead to consider palivizumab prophylaxis in Italy.

Boyce TG, Mellen BG, Mitchel EF, Wright PF, Griffin MR. Rates of hospitalization for respiratory syncytial virus infec-tion among children in medicaid. J Pediatr. 2000;137(6):865–70.PubMedCrossRef

Leader S, Kohlhase K. Recent trends in severe respiratory syncytial virus (RSV) among US infants; 1997 to 2000. J Pediatr. 2003;143(5 Suppl):S127–32.PubMedCrossRef

Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singletoni RJ, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375(9725):1545–55.PubMedCentralPubMedCrossRef

Hall CB, Weinberg GA, Iwane MK, Blumkin AK, Edwards KM, Staat MA, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009;360(6):588–98.PubMedCrossRef

Thorburn K. Pre-existing disease is associated with a significantly higher risk of death in severe respiratory syncytial virus infection. Arch Dis Child. 2009;94(2):99–103.PubMedCrossRef

Park HW, Lee BS, Kim AR, Yoon HS, Kim BI, Song ES, et al. Epidemiology of respiratory syncytial virus infection in infants born at less than thirty-five weeks of gestational age. Pediatr Infect Dis. 2012;31(8):99–104.CrossRef

Liese JG, Grill E, Fischer B, Roeckl-Wiedmann I, Carr D, Belohradsky BH. Incidence and risk factors of respiratory syncytial virus-related hospitalizations in premature infants in Germany. Eur J Pediatr. 2003;162:230–6.PubMed

Carbonell-Estrany X, Figueras-Aloy J, Law BJ. Infección Respiratoria Infantil por Virus Respiratorio Sincitial Study Group; Pediatric Investigators Collaborative Network on Infections in Canada Study Group. Identifying risk factors for severe respiratory syncytial virus among infants born after 33 through 35 completed weeks of gestation: different methodologies yield consistent findings. Pediatr Infect Dis J. 2004;23(11 Suppl):S193–201.PubMedCrossRef

Horn SD, Smout RJ. Effect of prematurity on respiratory syn-cytial virus hospital resource use and outcomes. J Pediatr. 2003;143(5 Suppl):S133–41.PubMedCrossRef

10.

Welliver RC. Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection. J Pediatr. 2003;143(5 Suppl):S112–7.PubMedCrossRef

11.

Sommer C, Resch B, Simões EAF. Risk factors for severe respiratory syncytial virus lower respiratory tract infection. Open Microbio J. 2011;5((Suppl 2-M4):144–15.CrossRef

12.

Figueras-Aloy J, Carbonell-Estrany X, Quero-Jiménez J, et al. FLIP-2 Study: risk factors linked to respiratory syncytial virus infection requiring hospitalization in premature infants born in Spain at a gestational age of 32 to 35 weeks. Pediatr Infect Dis J. 2008;27:788–93.PubMedCrossRef

13.

Figueras-Aloy J, Carbonell-Estrany X, Quero J, Group IS. Case-control study of the risk factors linked to respiratory syncytial virus infection requiring hospitalization in premature infants born at a gestational age of 33-35 weeks in Spain. Pediatr Infect Dis J. 2004;23:815–20.PubMedCrossRef

14.

Law B, Langley J, Allen U, Paes B, Lee DS, Mitchell I, et al. The Pediatric Investigators Collaborative Network on Infections in Canada study of predictors of hospitalization for respiratory syncytial virus infection for infants born at 33 through 35 completed weeks of gestation. Pediatr Infect Dis J. 2004;23:806–14.PubMedCrossRef

15.

Lanari M, Giovannini M, Giuffré L, Marini A, Rondini G, Rossi GA, et al. Prevalence of respiratory syncytial virus infection in Italian infants hospitalized for acute lower respiratory tract infections, and association between respiratory syncytial virus infection risk factors and disease severity. Ped Pulmonol. 2002;33:458–65.CrossRef

16.

American Academy of Pediatrics Committee on Infectious Diseases. American Academy of Pediatrics Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics. 2014;134(2):e620–38.CrossRef

17.

Raccomandazioni della Società Italiana di Neonatologia per la prevenzione delle malattie da virus respiratorio sinciziale (VRS). Acta Neonatologica e Pediatrica 2004;18:19-30

18.

Baraldi E, Carraro S, Filippone M. Bronchopulmonary dysplasia: definitions and long-term respiratory outcome. Early Hum Dev. 2009;85(10 Suppl):S1–3.PubMedCrossRef

19.

Medici MC, Arcangeletti MC, Rossi GA, Lanari M, Merolla R, Paparatti UD, et al. Osservatorio VRS Study Group. Four year incidence of respiratory syncytial virus infection in infants and young children referred to emergency departments for lower respiratory tract diseases in Italy: the ‘Osservatorio VRS’ Study (2000–2004). New Microbiol. 2006;29:35–43.PubMed

20.

Bertino E, Spada E, Occhi L, Coscia A, Giuliani F, Gagliardi L, et al. Neonatal anthropometric charts: the Italian neonatal study compared with other European studies. J Pediatr Gastroenterol Nutr. 2010;51(3):353–61.PubMed

21.

Baraldi E, Lanari M, Manzoni P, Rossi GA, Vandini S, Rimini A, et al. Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Ital J Pediatr. 2014;40:65.PubMedCentralPubMedCrossRef

22.

Shay DK, Holman RC, Roosevelt GE, Clarke MJ, Anderson LJ. Bronchiolitis-associated mortality and estimates of respiratory syncytial virus-associated deaths among US children; 1979–1997. J Infect Dis. 2001;183(1):16–22.PubMedCrossRef

23.

Simoes EAF. Environmental and demographic risk factors for respiratory syncytial virus lower respiratory tract disease. J Pediatr. 2003;143:S118–26.PubMedCrossRef

24.

Houben ML, Bont L, Wilbrink B, Belderbos ME, Kimpen JL, Visser GH, et al. Clinical prediction rule for RSV bronchiolitis in healthy newborns: prognostic birth cohort study. Pediatrics. 2011;127(1):35–41.PubMedCrossRef

25.

Kotecha SJ, Watkins WJ, Heron J, Henderson J, Dunstan FD, Kotecha S. Spirometric lung function in school-age children. Effect of intrauterine growth retardation and catch-up growth. Am J Respir Crit Care Med. 2010;181:969–74.PubMedCentralPubMedCrossRef

26.

Leslie FM. Multigenerational epigenetic effects of nicotine on lung function. BMC Med. 2013;11:27.PubMedCentralPubMedCrossRef

27.

Joss-Moore LA, Albertine KH, Lane RH. Epigenetics and the developmental origins of lung disease. Mol Genet Metab. 2011;104(1-2):61–6.PubMedCentralPubMedCrossRef

28.

Nielsen HE, Siersma V, Andersen S, Gahrn-Hansen B, Mordhorst CH, Norgaard-Pedersen B, et al. Respiratory syncytial virus infection: risk factors for hospital admission—a case control study. Acta Paediatr. 2003;92:1314–21.PubMedCrossRef

29.

Resch B, Pasnocht A, Gusenleitner W, Müller W. Rehospitalisations for respiratory disease and respiratory syncytial virus infection in preterm infants of 29-36 weeks gestational age. J Infect. 2005;50(5):397–403.PubMedCrossRef

30.

Medlock S, Ravelli AC, Tamminga P, Mol BW, Abu-Hanna A. Prediction of mortality in very premature infants: a systematic review of prediction models. PLoS One. 2011;6(9), e23441.PubMedCentralPubMedCrossRef

31.

Lanari M, Prinelli F, Adorni F, Di Santo S, Faldella G, Silvestri M, et al. Italian Neonatology Study Group on RSV Infections. Maternal milk protects infants against bronchiolitis during the first year of life. Results from an Italian cohort of newborns. Early Hum Dev. 2013;89 Suppl 1:S51–7.PubMedCrossRef

32.

Holberg CJ, Wright AL, Martinez FD, Ray CG, Taussig LM, Lebowitz MD. Risk factors for respiratory syncytial virus-associated lower respiratory illnesses in the first year of life. Am J Epidemiol. 1991;133(11):1135–51.PubMed

33.

Bulkow LR, Singleton RJ, DeByle C, Miernyk K, Redding G, Hummel KB, et al. Risk factors for hospitalization with lower respiratory tract infections in children in rural Alaska. Pediatrics. 2012;129(5):e1220–7.PubMedCrossRef

34.

Hall CB, Weinberg GA, Blumkin AK, Edwards KM, Staat MA, Schultz AF, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013;132(2):e341–8.PubMedCrossRef

35.

Olabarrieta I, Gonzalez-Carrasco E, Calvo C, Pozo F, Casas I, García-García ML. Hospital admission due to respiratory viral infections in moderate preterm, late preterm and term infants during their first year of life. Allergol Immunopathol (Madr). 2014 Nov 8. doi: 10.1016/j.aller.2014.06.006.

36.

Muller-Pebody B, Edmunds WJ, Zambon MC, Gay NJ, Crowcroft NS. Contribution of RSV to bronchiolitis and pneumonia-associated hospitalizations in English children, April 1995–March 1998. Epidemiol Infect. 2002;129(1):99–106.PubMedCentralPubMed

37.

Escobar GJ, Ragins A, Li SX, Prager L, Masaquel AS, Kipnis P. Recurrent wheezing in the third year of life among children born at 32 weeks’ gestation or later: relationship to laboratory-confirmed, medically attended infection with respiratory syncytial virus during the first year of life. Arch Pediatr Adolesc Med. 2010;164(10):915–22.PubMedCrossRef

38.

Chan KN, Noble Jamieson CM, Elliman A, Bryan EM, Silverman M. Lung function in children of low birth weight. Arch Dis Child. 1989;64:1284–9.PubMedCentralPubMedCrossRef

39.

Henderson J, Hilliard TN, Sherriff A, Stalker D, Al SN, Thomas HM. Hospitalization for RSV bronchiolitis before 12 months of age and subsequent asthma, atopy and wheeze: a longitudinal birth cohort study. Pediatr Allergy Immunol. 2005;16:386–92.PubMedCrossRef

40.

Bacharier LB, Cohen R, Schweiger T, Yin-Declue H, Christie C, Zheng J, et al. Determinants of asthma after severerespiratory syncytial virus bronchiolitis. J Allergy Clin Immunol. 2012;130:91–100.PubMedCentralPubMedCrossRef

41.

Stein RT, Sherrill D, Morgan WJ, Holberg CJ, Halonen M, Taussig LM, et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet. 1999;354:541–5.PubMedCrossRef

42.

Sigurs N, Aljassim F, Kjellman B, Robinson PD, Sigurbergsson F, Bjarnason R, et al. Asthma and allergy patterns over 18 years after severe RSV bronchiolitis in the first year of life. Thorax. 2010;65:1045–52.PubMedCrossRef

43.

Mai XM, Gaddlin PO, Nilsson L, Finnstrom O, Bjorksten B, Jenmalm MC. Asthma, lung function and allergy in 12-year-old children with very low birth weight: a prospective study. Pediatr Allergy Immunol. 2003;14:184–92.PubMedCrossRef

44.

Blanken MO, Rovers MM, Molenaar JM, Winkler-Seinstra PL, Meijer A, Kimpen JL, et al. Dutch RSV Neonatal Network. Respiratory syncytial virus and recurrent wheeze in healthy preterm infants. N Engl J Med. 2013;368(19):1791–9.PubMedCrossRef

Title: Risk factors for bronchiolitis hospitalization during the first year of life in a multicenter Italian birth cohort
Authors: Marcello Lanari
Federica Prinelli
Fulvio Adorni
Simona Di Santo
Silvia Vandini
Michela Silvestri
Massimo Musicco
and the Study Group of Italian Society of Neonatology on Risk Factors for RSV Hospitalization
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: Italian Journal of Pediatrics / Issue 1/2015
Electronic ISSN: 1824-7288
DOI: https://doi.org/10.1186/s13052-015-0149-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for bronchiolitis hospitalization during the first year of life in a multicenter Italian birth cohort

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2015

Italo-Swiss “Chalk and blackboard interactive 2-day workshop”—participants feedback

Multi-resistant gram negative enteric bacteria causing urinary tract infection among malnourished underfives admitted at a tertiary hospital, northwestern, Tanzania

NKX2.1-Related Disorders: a novel mutation with mild clinical presentation

Controlled peritoneal drainage improves survival in children with abdominal compartment syndrome

Early and late Iron supplementation for low birth weight infants: a meta-analysis

Status of gastric lavage in neonates born with meconium stained amniotic fluid: a randomized controlled trial