Clinical Profile of Pediatric Patients Hospitalized With Respiratory Syncytial Virus Infection William V. La Via,

Steven W.

1,2 M.D.

Grant3

1,2 Harris R. Stutman, M.D. Melvin I. Marks, M.D. 1,2

Summary: To update the clinical profile of pediatric patients hospitalized with RSV infection, we retrospectively reviewed the records of 246 children (male:female ratio 1.44:1) admitted during one season to a tertiary-care hospital. The most common admitting diagnoses were bronchiolitis (37.4%), pneumonia (32.5%), and possible septicemia (13%). Median age was 3 months; median length of stay, three days. Twice as many minorities were admitted with RSV infection as all other admissions during the same year. Family history of asthma, while common (35%), did not affect length of stay or complications. Of the 38 (15%) patients requiring intensive care, 29 (76%) underwent ventilation. Patients with underlying cardiopulmonary disease had more complications, were more likely to require intensive care (about 50%), and had significantly longer hospital stays than others. All three patients (1.2%) who died had congenital heart disease. Common risk factors included young age, chronic cardiopulmonary disease, male sex, and possibly family history of asthma. Although the most typical clinical diagnoses remain bronchiolitis and pneumonia, a systemic illness resembling the sepsis syndrome has emerged at our institution as a significant clinical presentation.

Introduction virus is a ubiquitous ~~’ cause of respiratory tract infection. In adults, infection is primarily of the upper respiratory tract, usually manifested as a common cold, while in infants and early

espiratory syncytial (RSV)

childhood, upper and lower

tract

infections are often seen concomitandy. 1,2 The classic clinical presentation of this infection in infants remains bronchiolitis, although

pneumonia

and

bronchopneu-

monia are often described as well.22 RSV infection has been associated with considerable acute mor-

bidity in infants, many of whom are hospitalized, especially those aged 1 to 3 months and those with chronic

underlying conditions.3 Specifically, infants with chronic lung disease (cystic fibrosis, bronchopulmonary dysplasia [BPD] ,4,5 congenital heart disease (GHD),6 and immune defi-

ciency, are at increased risk of morbidity and mortality from RSV, which

1

Department of Pediatrics, University of California, Irvine, Irvine, California Memorial Miller Children’s Hospital, Long Beach, California 3 Jefferson Medical College, Philadelphia, Pennsylvania 2

Address correspondence to: William V. La Via, M.D., Division of Pediatric Infectious Diseases, Memorial Miller Children’s Hospital, 2801 Atlantic Avenue, Long Beach, CA 90801-1428

450

has also been associated with late sequelae.’ For example, Kattan et al9 demonstrated impaired pulmonary function in normal nonallergic hosts 10 years after infection in infancy and early childhood.

RSV-associated mortality due to apnea and hypoxemia has also been described in 0.5% to 1.5% of hospitalized patients and in 3.4% to 37% of infants hospitalized with congenital heart disease.3°6°lo Mortality is especially high (73%) in infants with CHD and pulmonary

hypertension.6 Recent clinical studies have focused on treatment modalities, such as bronchodilator therapy and human immunoglobulin administration, as well as specific antiviral therapy with ribavirin. The most recent review of the clinical features of RSV infection during a

single

season,

however,

was

pub-

Figure 1. Age distribution of 246 patients hospitalized at Memorial Miller Children’s Hospital (MMCH) Long Beach with RSV infection during the winter of 1989 to 1990.

of

lished more than a decade ago.33 Since then, the number of hosts at increased risk for complication due to RSV has increased. Moreover, new diagnostic tests and treatment modalities have been developed. Therefore, we reviewed the medical records of patients who had recently been hospitalized with RSV infection to update the clinical profile of such patients.

Methods Patients

identified by mirecords tabulated by crobiologic the Pediatric Infectious Diseases Division at Memorial Miller Children’s Hospital. We reviewed the records of all patients with a positive culture or a rapid diagnostic were

Figure 2A. Ethnicity of 246 patients hospitalized

at MMCH of

Long Beach

with RSV

infection, winter

1989-1990.

(enzyme immunoassay [EIA], Kallestad, Austin, Texas) for RSV test

from

nasopharyngeal secretions or tracheal aspirate over RSV season (September 1,

(NPS) one

1989, to March 31, 1990). Our institution is a large tertiary-care children’s hospital that serves a wide cross section of the pediatric population in southern Los Angeles and northern Orange Counties; approximately 45% of patients are in the low socioeconomic category.

Figure 2B. Ethnicity of all patients hospitalized at MMCH of Long Beach, July 1989-June 1990.

451

a

past history of wheezing respon-

bronchodilator therapy. Imdeficiency was defined as any previously diagnosed congenital or acquired immunodeficiency syn-

sive

to

mune

drome. Nosocomial infection was defined as any RSV infection that developed 72 hours or more after

hospitalization. Comparisons were made using the Mann-Whitney U test; P