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Increased Risk for Respiratory Syncytial Virus-associated, Community-acquired Alveolar Pneumonia in Infants Born at 31–36 Weeks of Gestation

Greenberg, David MD*†; Dagan, Ron MD*†; Shany, Eilon MD†‡; Bar-Ziv, Jacob MD§; Givon-Lavi, Noga PhD*†

The Pediatric Infectious Disease Journal: April 2014 - Volume 33 - Issue 4 - p 381–386
doi: 10.1097/INF.0000000000000130
Original Studies

Background: We compared hospitalization and pediatric intensive care unit (PICU) admission rates for community-acquired alveolar pneumonia (CAAP) and respiratory syncytial virus (RSV)-associated CAAP (RSV-CAAP) in non-RSV–immunized children <24-month-old born at 31–36 weeks gestational age (GA) versus those born at term (>36 weeks GA).

Methods: Nasopharyngeal samples for RSV were obtained prospectively (2004–2011) during RSV season, from hospitalized children with radiographic-diagnosed CAAP. Soroka University Medical Center is the only hospital in the region, enabling population-based rate calculation. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated comparing RSV-CAAP incidence in 31–36 weeks GA with >36 weeks GA children.

Results: CAAP hospitalization incidences (per 1000 population) were 23.6 and 9.4 (RR: 2.52; 95% CI: 2.13–2.68), respectively; the respective incidences of PICU admission for overall CAAP were 1.8 and 0.2 (RR: 7.88; 95% CI: 4.59–11.83). The RRs (and 95% CI) for RSV-CAAP hospitalizations and PICU admission rates were (after extrapolation) 15.2 and 5.8 (RR: 2.79; 95% CI: 2.31–3.06) and 1.1 and 0.1 (RR: 9.14; 95% CI: 4.93–16.96), respectively. In a multiregression analysis in patients with RSV-CAAP versus CAAP, 31–36 weeks GA was an independent risk factor for hospitalization (RR: 1.485; 95% CI: 1.03–2.14).

Conclusions: Children <24-month-old born at 31–36 weeks GA are at increased risk for hospitalization and PICU admission for both overall CAAP and RSV-associated CAAP compared with those born at >36 weeks GA. Moreover, in late premature children, RSV represented a 50% increased risk for CAAP compared with infants born at term.

From the *Pediatric Infectious Disease Unit, Soroka University Medical Center; Ben-Gurion University of the Negev; Neonatal Department, Soroka University Medical Center, Beer-Sheva; and §Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel.

Accepted for publication October 10, 2013.

This study was supported by a grant from Abbott Ltd.

David Greenberg is the recipient of a grant from and has been a speaker for Abbott Ltd. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: David Greenberg, MD, The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.