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Preterm Twins and Triplets: A High-Risk Group for Severe Respiratory Syncytial Virus Infection

Preterm Twins and Triplets: A High-Risk Group for Severe Respiratory Syncytial Virus Infection Abstract • Objective. —To assess the impact of multiple births and crowded homes on the severity of respiratory syncytial virus illness in preterm infants with bronchopulmonary dysplasia. Research Design. —Retrospective case-control chart review from a prospective longitudinal respiratory illness study. Setting. —Neonatal High-Risk Follow-Up Clinic (outpatient setting) and tertiary care hospitals (inpatient setting). Participants. —Fourteen sets of twins and two sets of triplets followed up between 1983 and 1989 and matched with 34 singleton infants for date of birth (within 3 months) and gestational age (within 1 month). Measurements/Main Results. —The risk of developing respiratory syncytial virus illness was significantly higher in multiple-birth infants than in singletons (53% vs 24%; P=.01 ). Multiple-birth infants were also at greater risk for developing pneumonia (24% vs 6%; P=.05) and requiring hospitalization (32% vs 18%; P=.05) than were singletons. Additional risk factors for developing pneumonia and bronchiolitis were examined in all 68 children. Multiple birth (P=.05), gestational age of less than 30 weeks (P=.02), and crowded homes (defined as more than one person living in 19 m2 of living space [P=.002] or more than one child living in 22 m2 of living space [P=.004]) were additional risk factors for developing pneumonia. Conclusions. —Multiple-birth preterm infants are at a higher risk of developing pneumonia than are singletons. Additional risk factors for developing pneumonia in preterm infants with bronchopulmonary dysplasia include gestational age of less than 30 weeks and crowded homes. At-risk infants with any of these risk factors should be targeted for prophylactic and therapeutic interventions against respiratory syncytial virus.(AJDC. 1993;147:303-306) References 1. Tristram DA, Welliver RC, Mohar CK. Immunogenicity and safety of respiratory syncytial virus (RSV) PFP-1 vaccine in 18 month old children . Pediatr Res. 1991;29:186A. 2. Groothuis JR, Levin MJ, Rodriguez W, et al. Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics . Antimicrob Agents Chemother . 1991;35:1469-1473.Crossref 3. Cunningham CK, McMillian JA, Gross SJ. Rehospitalization for respiratory illness in infants of less than 32 weeks gestation . Pediatrics . 1991;88: 527-532. 4. Groothuis JR, Gutierrez KM, Lauer BA. Respiratory syncytial virus infection in children with bronchopulmonary dysplasia . Pediatrics . 1988; 82:199-203. 5. Benirschke K, Kim CK. Multiple pregnancy . N Engl J Med. 1973;288( (pt 1) ):1276-1284.Crossref 6. Dubowitz LMS, Dubowitz V, Goldberg C. Clinical assessment of gestational age in the newborn infant . J Pediatr. 1970;77:1-10.Crossref 7. Northway WH, Rosen RC, Porter BY. Pulmonary disease following respiratory therapy of hyaline membrane disease . N Engl J Med. 1967;276:357-368.Crossref 8. Groothuis JR, Wooden K, Hall CB, et al. Early ribavirin intervention for respiratory syncytial viral infection in high-risk children . J Pediatr. 1990;117: 792-798.Crossref 9. John JT, Cherian T, Steinhoff MC, Simoes EAF, John M. Etiology of acute respiratory infections in children in tropical southern India . Rev Infect Dis. 1991;13( (suppl 6) ):463-469.Crossref 10. Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info, Version 5.01A: A Word Processing Database, and Statistics Program for Epidemiology on Microcomputers . Stone Mountain, Ga: USD Inc; 1990. 11. Greenland S, Robins JM. Estimation of a common parameter from sparse follow-up data . Biometrics . 1985;41:55-68.Crossref 12. McConnochie KM, Roghmann KJ. Parental smoking, presence of older siblings, and family history of asthma increase risk of bronchiolitis . AJDC . 1986;140:806-812. 13. Monto AS, Lim SK. The Tecumseh study of respiratory illness, Ill: incidence and periodicity of respiratory syncytial virus and mycoplasma pneumonia infections . Am J Epidemiol. 1971;94:290-298. 14. Parrott RH, Kim HW, Arrobio JO, Hodes DS. Epidemiology of respiratory syncytial virus infection in Washington, DC: infection and disease with respect to age, immunologic status, race and sex . Am J Epidemiol. 1973;98: 289-300. 15. Ogilvie MM, Vathenen S, Radford M, Codd J, Kay S. Maternal antibody and respiratory syncytial virus infection in infancy . J Med Virol. 1981;7:263-271.Crossref 16. Glezen WP, Paredes A, Allison JE, Taber LH, Frank AL. Risk of respiratory syncytial virus infection for infants from low income families in relationship to age, sex, ethnic group and maternal antibody levels . J Pediatr. 1981;98:708-715.Crossref 17. DeSierra TM, Kumar ML, Murphy BR, Subbaro EK. Respiratory syncytial virus (RSV)-specific antibodies in preterm infants. Presented at the 32nd Interscience Conference of Antimicrobial Agents and Chemotherapy; October 12, 1992; Anaheim, Calif. 18. Aaby P, Bulch J, Lisse IM, Smits AT. Overcrowding and intensive exposure as determinants of measles mortality . Am J Epidemiol. 1984; 120:49-63. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Preterm Twins and Triplets: A High-Risk Group for Severe Respiratory Syncytial Virus Infection

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1993.02160270065020
Publisher site
See Article on Publisher Site

Abstract

Abstract • Objective. —To assess the impact of multiple births and crowded homes on the severity of respiratory syncytial virus illness in preterm infants with bronchopulmonary dysplasia. Research Design. —Retrospective case-control chart review from a prospective longitudinal respiratory illness study. Setting. —Neonatal High-Risk Follow-Up Clinic (outpatient setting) and tertiary care hospitals (inpatient setting). Participants. —Fourteen sets of twins and two sets of triplets followed up between 1983 and 1989 and matched with 34 singleton infants for date of birth (within 3 months) and gestational age (within 1 month). Measurements/Main Results. —The risk of developing respiratory syncytial virus illness was significantly higher in multiple-birth infants than in singletons (53% vs 24%; P=.01 ). Multiple-birth infants were also at greater risk for developing pneumonia (24% vs 6%; P=.05) and requiring hospitalization (32% vs 18%; P=.05) than were singletons. Additional risk factors for developing pneumonia and bronchiolitis were examined in all 68 children. Multiple birth (P=.05), gestational age of less than 30 weeks (P=.02), and crowded homes (defined as more than one person living in 19 m2 of living space [P=.002] or more than one child living in 22 m2 of living space [P=.004]) were additional risk factors for developing pneumonia. Conclusions. —Multiple-birth preterm infants are at a higher risk of developing pneumonia than are singletons. Additional risk factors for developing pneumonia in preterm infants with bronchopulmonary dysplasia include gestational age of less than 30 weeks and crowded homes. At-risk infants with any of these risk factors should be targeted for prophylactic and therapeutic interventions against respiratory syncytial virus.(AJDC. 1993;147:303-306) References 1. Tristram DA, Welliver RC, Mohar CK. Immunogenicity and safety of respiratory syncytial virus (RSV) PFP-1 vaccine in 18 month old children . Pediatr Res. 1991;29:186A. 2. Groothuis JR, Levin MJ, Rodriguez W, et al. Use of intravenous gamma globulin to passively immunize high-risk children against respiratory syncytial virus: safety and pharmacokinetics . Antimicrob Agents Chemother . 1991;35:1469-1473.Crossref 3. Cunningham CK, McMillian JA, Gross SJ. Rehospitalization for respiratory illness in infants of less than 32 weeks gestation . Pediatrics . 1991;88: 527-532. 4. Groothuis JR, Gutierrez KM, Lauer BA. Respiratory syncytial virus infection in children with bronchopulmonary dysplasia . Pediatrics . 1988; 82:199-203. 5. Benirschke K, Kim CK. Multiple pregnancy . N Engl J Med. 1973;288( (pt 1) ):1276-1284.Crossref 6. Dubowitz LMS, Dubowitz V, Goldberg C. Clinical assessment of gestational age in the newborn infant . J Pediatr. 1970;77:1-10.Crossref 7. Northway WH, Rosen RC, Porter BY. Pulmonary disease following respiratory therapy of hyaline membrane disease . N Engl J Med. 1967;276:357-368.Crossref 8. Groothuis JR, Wooden K, Hall CB, et al. Early ribavirin intervention for respiratory syncytial viral infection in high-risk children . J Pediatr. 1990;117: 792-798.Crossref 9. John JT, Cherian T, Steinhoff MC, Simoes EAF, John M. Etiology of acute respiratory infections in children in tropical southern India . Rev Infect Dis. 1991;13( (suppl 6) ):463-469.Crossref 10. Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info, Version 5.01A: A Word Processing Database, and Statistics Program for Epidemiology on Microcomputers . Stone Mountain, Ga: USD Inc; 1990. 11. Greenland S, Robins JM. Estimation of a common parameter from sparse follow-up data . Biometrics . 1985;41:55-68.Crossref 12. McConnochie KM, Roghmann KJ. Parental smoking, presence of older siblings, and family history of asthma increase risk of bronchiolitis . AJDC . 1986;140:806-812. 13. Monto AS, Lim SK. The Tecumseh study of respiratory illness, Ill: incidence and periodicity of respiratory syncytial virus and mycoplasma pneumonia infections . Am J Epidemiol. 1971;94:290-298. 14. Parrott RH, Kim HW, Arrobio JO, Hodes DS. Epidemiology of respiratory syncytial virus infection in Washington, DC: infection and disease with respect to age, immunologic status, race and sex . Am J Epidemiol. 1973;98: 289-300. 15. Ogilvie MM, Vathenen S, Radford M, Codd J, Kay S. Maternal antibody and respiratory syncytial virus infection in infancy . J Med Virol. 1981;7:263-271.Crossref 16. Glezen WP, Paredes A, Allison JE, Taber LH, Frank AL. Risk of respiratory syncytial virus infection for infants from low income families in relationship to age, sex, ethnic group and maternal antibody levels . J Pediatr. 1981;98:708-715.Crossref 17. DeSierra TM, Kumar ML, Murphy BR, Subbaro EK. Respiratory syncytial virus (RSV)-specific antibodies in preterm infants. Presented at the 32nd Interscience Conference of Antimicrobial Agents and Chemotherapy; October 12, 1992; Anaheim, Calif. 18. Aaby P, Bulch J, Lisse IM, Smits AT. Overcrowding and intensive exposure as determinants of measles mortality . Am J Epidemiol. 1984; 120:49-63.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Mar 1, 1993

References

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