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Hospitalized Children With Respiratory Syncytial Virus Infection and Neuromuscular Impairment Face an Increased Risk of a Complicated Course

Wilkesmann, Anja MD*; Ammann, Roland A. MD; Schildgen, Oliver PhD; Eis-Hübinger, Anna M. PhD; Müller, Andreas MD*; Seidenberg, Jürgen MD§; Stephan, Volker MD; Rieger, Christian MD; Herting, Egbert MD; Wygold, Thorsten MD; Hornschuh, Friedeman MD**; Groothuis, Jessie R. MD, PhD; Simon, Arne MD*the DSM RSV Ped Study Group

The Pediatric Infectious Disease Journal: June 2007 - Volume 26 - Issue 6 - p 485-491
doi: 10.1097/INF.0b013e31805d01e3
Original Studies

Background: Respiratory syncytial virus (RSV) infection is an important cause of viral respiratory tract infection in children. In contrast to other confirmed risk factors that predispose to a higher morbidity and mortality, the particular risk of a preexisting neuromuscular impairment (NMI) in hospitalized children with RSV infection has not been prospectively studied in a multicenter trial.

Methods: The DMS RSV Paed database was designed for the prospective multicenter documentation and analysis of all clinically relevant aspects of the management of inpatients with RSV infection. Patients with clinically relevant NMI were identified according to the specific comments of the attending physicians and compared with those without NMI.

Results: This study covers 6 consecutive seasons; the surveillance took place in 14 pediatric hospitals in Germany from 1999 to 2005. In total, 1568 RSV infections were prospectively documented in 1541 pediatric patients. Of these, 73 (4.7%) patients displayed a clinically relevant NMI; 41 (56%) NMI patients had at least 1 additional risk factor for a severe course of the infection (multiple risk factors in some patients; prematurity in 30, congenital heart disease in 19, chronic lung disease 6 and immunodeficiency in 8). Median age at diagnosis was higher in NMI patients (14 vs. 5 months); NMI patients had a greater risk of seizures (15.1% vs. 1.6%), and a higher proportion in the NMI group had to be mechanically ventilated (9.6% vs. 1.9%). Eventually, the attributable mortality was significantly higher in the NMI group (5.5% vs. 0.2%; P < 0.001 for all). Multivariate logistic regression confirmed that NMI was independently associated with pediatric intensive care unit (PICU) admission (OR, 4.94; 95% CI, 2.69–8.94; P < 0.001] and mechanical ventilation (OR, 3.85; 95% CI, 1.28–10.22; P = 0.017).

Conclusion: This is the first prospective multicenter study confirming the hypothesis that children with clinically relevant NMI face an increased risk for severe RSV-disease. It seems reasonable to include NMI as a cofactor into the decision algorithm of passive immunization.

From the *Children's Hospital Medical Center, University of Bonn, Germany; †University Children's Hospital, Bern, Switzerland; ‡Institute for Medical Microbiology, Immunology and Parasitology, University of Bonn, Germany; §Elisabeth Children's Hospital Medical Center, Oldenburg, Germany; ∥St. Josef-Children's Hospital, University of Bochum; ¶Children's Hospital Medical Center, University of Luebeck; **Children's Hospital Datteln, University of Witten-Herdecke, Germany; and ††Hollis-Eden Pharmaceuticals Inc., San Diego, California.

Accepted for publication March 15, 2007.

Supported by Abbott GmbH, Wiesbaden, Germany, and Else Kröner-Fresenius Stiftung (Grant No. A 01/05//F 00) and the BONFOR program of the Medical Faculty of the University of Bonn (Grant No. O_151.0028).

Address for correspondence: Arne Simon, MD, Children's Hospital Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.