Respiratory Failure and Death in Vulnerable Premature Children With Lower Respiratory Tract Illness

• Published in: The Journal of infectious diseases Vol. 222; no. 7; pp. 1129 - 1137
• Main Authors: Ofman, Gaston, Pradarelli, Brad, Caballero, Mauricio T, Bianchi, Alejandra, Grimaldi, Luciano Alva, Sancilio, Andrea, Duenas, Karina, Rodriguez, Andrea, Ferrero, Fernando, Ferretti, Adrian, Coviello, Silvina, Ferolla, Fausto M, Acosta, Patricio L, Bergel, Eduardo, Libster, Romina, Polack, Fernando P
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.09.2020
• Subjects: Apnea; Argentina - epidemiology; Breast feeding; Child, Preschool; Children; Coronary artery disease; Cross-Sectional Studies; Death; Developing countries; Editor's Choice; Fatalities; Female; Heart diseases; Hematocrit; Hospitalization; Humans; Infant; Infant, Newborn; Infant, Premature; Infants; LDCs; Major and Brief Reports; Male; Malnutrition; Metapneumovirus - genetics; Metapneumovirus - isolation & purification; Paramyxoviridae Infections - diagnosis; Paramyxoviridae Infections - epidemiology; Paramyxoviridae Infections - virology; Pneumothorax; Population studies; Prospective Studies; Respiratory diseases; Respiratory failure; Respiratory Insufficiency - etiology; Respiratory Insufficiency - mortality; Respiratory syncytial virus; Respiratory Syncytial Virus Infections - diagnosis; Respiratory Syncytial Virus Infections - epidemiology; Respiratory Syncytial Virus Infections - virology; Respiratory Syncytial Virus, Human - genetics; Respiratory Syncytial Virus, Human - isolation & purification; Respiratory tract diseases; Respiratory Tract Infections - virology; Risk Factors; Sepsis; Viral infections; Argentina; respiratory failure; prematurity; respiratory infection
• ISSN: 0022-1899; 1537-6613; 1537-6613
• DOI: 10.1093/infdis/jiaa046

Abstract Background Efforts to better understand the risk factors associated with respiratory failure (RF) and fatal lower respiratory tract infection (LRTI) in premature children in developing countries are necessary to elaborate evidenced-based preventive interventions. We aim to characterize the burden of respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) LRTI in premature children and determine risk factors for RF and fatal illness in a vulnerable population. Methods This is a prospective, population-based, cross-sectional study. Subjects with severe LRTI were enrolled during respiratory season. Risk factors for RF and death in premature infants were investigated. Results A total of 664 premature children participated. Infant’s hospitalization rate due to LRTI was 82.6/1000 (95% confidence interval [CI], 68.6–96.7/1000). Infant’s RSV and hMPV rates were 40.9/1000 (95% CI, 36.3–45.6/1000) and 6.6/1000 (95% CI, 3.9–9.2/1000), respectively. The RF rate was 8.2/1000 (95% CI, 4.9–11.5/1000). The LRTI mortality was 2.2/1000 (95% CI, 0.7–3.7/1000); for RSV, the rate was 0.8/1000 (95% CI, 0–1.7/1000) with a case-fatality ratio of 1.8%. Never breastfeeding, malnutrition, younger than 6 months, congenital heart disease, and lower hematocrit were risk factors for RF. Experiencing pneumonia, pneumothorax, sepsis, or apnea were clinical determinants of poor outcomes. Conclusions Premature children under 2 years old in vulnerable environments experience RF and death more often than term counterparts. Modifiable risk factors associated with poor outcomes should prompt evidence-based interventions. This prospective, population-based, cross-sectional studied factors associated with respiratory failure and fatal LRTI in premature infants in developing countries. Six hundred sixty-four premature children participated, 60 developed respiratory failure, and 15 died. Several risk factors were identified for future interventions.