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Indian Pediatr 2021;58: 1091-1092 |
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Clinical Manifestations
and Outcomes of Respiratory Syncytial Virus Infection in
Children Less Than Two Years in Colombia
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Jefferson Antonio Buendía,1
Fernando P Polack,2 Diana Guerrero Patiño*
Grupo de Investigación en farmacología y toxicología,
Centro de Información y Estudio de Medicamentos y
Tóxicos (CIEMTO), Departamento de Farmacología y Toxicología, Facultad
de Medicina, Universidad de Antioquia. 2Fundación
Infant, Buenos Aires, Argentina.
Email: [email protected]
Published online: August 29, 2020;
PII: S097475591600235
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This retrospective study describes
the epidemiology and risk factors associated with severe complications
in lower respiratory tract infection (LRTI) due to respiratory syncytial
virus (RSV) in a population of infants hospitalized in a tertiary care
hospital in a tropical region of Colombia. RSV was detected in 193
(46.3%) of 417 patients with LRTI. The average hospital stay lasted for
5.9 days. Severe hypoxemia (SpO2 £90%
in the emergency department) was present in 57.5% of the patients. After
controlling for potential confounders, comorbidities bronchopulmonary
dysplasia, congenital heart disease, length of hospital stay, and
alveolar infiltrates in X-ray were independent predictors of severe
complications in RSV LRTI.
Keywords: Complications, Outcome, Predictors.
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The epidemiology and severity of lower respiratory
tract (LRTI) due to respiratory syncytial virus (RSV) in tropical
regions may differ from that in other climates [1]. This study aims to
describe the epidemiology and identify risk factors associated with
severe complications in RSV LRTI in a population of infants hospitalized
in a tertiary care hospital in a tropical region of Colombia.
This review of medical records included all infants
under two years of age in tertiary centers, in Rionegro, Colombia
admitted with RSV LRTI (ICD-10 code: J21.0) according to the National
clinical guideline of bronchiolitis (first wheezing episode younger than
24 months of age) [5] from January, 2015 to December, 2016. Inclusion
criteria were defined as children younger than two years of age admitted
to the pediatric ward with a diagnosis of RSV confirmed using direct
immuno-fluorescence (Light Diagnostics Respiratory Panel 1 DFA,
Merck-Millipore Laboratory). Patients without lower respiratory
compromise, with positive bacterial cultures on admission, confirmed
whooping cough (culture or PCR), referred from another hospital center
were excluded. The study protocol was reviewed and approved by the
institutional review board.
We collected the following variables: age, sex,
weight, height, signs and symptoms on admission (including fever, chest
in drawing, chest auscultation, oxygen saturation, respiratory rate),
history of prematurity, comorbidities [congenital heart disease (CHD),
neurological disease, bronchopulmonary dysplasia (BPD)], results of
chest X-rays and other medical test, drugs and other treatments,
adverse drug reactions, and complications, (pneumonia (5), atelectasis,
sepsis, respiratory failure/ICU).
A composite outcome was used to define severe
complications associated with RSV (SCRSV). This composite outcome was
defined as the presence of oxygen saturation (SpO2)
£90% in the emergency
room and/or pneumonia and/or atelectasis and/or sepsis and/or
respiratory failure during hospitalization.
A sample size of 123 patients was estimated to find
an OR of at least 1.5 between the presence of complicated RSV and the
history of comorbidities with a 95% confidence level, 90% accuracy, and
a minimum comorbidity frequency in patients without complicated RSV of
1% [3].
To identify factors independently associated with
SCRSV, we used ordered logistic regression models to adjust for
potential confounding variables. All statistical tests were two-tailed,
and the significance level used was P<0.05. The data were
analyzed with Statistical Package Stata 15.0 (Stata Corporation).
RSV was detected in 193 (46.3%) of 417 patients with
LRTI and 16% patients were younger than 6 months of age. Only 1 patient
(with a history of congenital heart disease) had received palivizumab.
The majority (92%) required oxygen, and more than half had chest
retractions in the emergency department. A third of all patients had a
radiological abnormality (Table I). On analyzing the data about
seasonal distribution of RSV infections, there was two peaks of cases,
the first between April and August, and the second between November to
January; corresponding to the two rainy season in this region.
Table I Characteristics of Children with Respiratory Syncytial Virus Pneumonia (N=193)
| Variable |
Frequency |
| Age (mo) , median (IQR) |
5.66 (6) |
| Male |
113 (58.55) |
| Premature birth |
28 (14.51) |
| Comorbidities (CHD or
neurological) |
11 (5.71) |
| BPD |
7 (3.6) |
| Atopy |
21 (10.88) |
| SpO2%, median (IQR) |
88 (0.93) |
| O2 support |
178 (92.33) |
| Clinical and laboratory
parameters |
|
| Fever |
53 (27.46) |
|
Chest indrawing |
102 (52.85) |
| Tachypnea |
30 (15.54) |
| Rhonchi |
78 (40.41) |
| Crepitation |
36 (18.65) |
| Leucocytosis (>15000/mm3) |
31 (16.76) |
| Increased CRP (>4 mg/L) |
59 (44.81) |
| Chest X-ray |
|
| Normal |
22 (12.36) |
| Peribronchial thickening |
63 (35.39) |
| Hyperinflation |
33 (18.54) |
| Atelectasis |
5 (2.81) |
| Bilateral interstitial
infiltrates |
33 (18.54) |
| Alveolar infiltrates |
22 (12.36) |
| All values in no(%) or
as stated. CRP: C-reactive protein. |
The median hospital stay was 5.88 days [6].
Severe hypoxemia (SpO2 £90%
in the emergency department) was present in 57.5% of the patients.
Twenty three patients (11.9%) had pneumonia, and 9 (4.7%) patients
experienced sepsis, 5 (2.6%) had atelectasis and 3 (1.5%) had
respiratory failure. No patient had pneumothorax or died.
On bivariate analysis, the following variables
presented a significant association with SCRSV: age (OR 1.06, 95%CI
1.08-1.13), O2 support (OR 22.6, 95% CI 2.91-176.12), chest in drawing
(OR 2.43, 95% CI 1.35-4.37), crackles in lung auscultation (OR 8.78, 95%
CI 2.51-30.70), and alveolar infiltrates in X-ray (OR 8.78, 95%
CI 2.51-30.70), length of hospital stay (OR 1.19, 95% CI 1.06-1.33),
comorbidities (BPD, CHD, neurological) (OR 0.59, 95% CI 0.59-1.77).
After controlling for these potential confounders, comorbidities (BPD,
CHD, neurological), length of hospital stay, and alveolar infiltrates in
X-ray were independent predictors of SCRSV in our patients (Table
II).
Table II Independent Predictors of Severe Complications Associated With RSV
| Variable |
OR (95% CI) |
P value |
| Age (mo) |
0.91 (0.76-1.08) |
0.340 |
| Comorbidities (CHD, |
21.45 (1.80-254) |
0.015 |
| neurological) |
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| Length of hospital stay |
1.57 (1.26-1.94) |
0.001 |
| O2 supportive |
0.72 (0.38-13.77) |
0.832 |
|
Chest indrawing |
1.07 (0.26-4.43) |
0.918 |
| Alveolar infiltrates |
12.93 (8.93-18.76) |
0.001 |
In our study, the clinical characteristics and
seasonal distribution was similar to previous reports from tropical
regions [1,7,9]. Risk factors, including prematurity and underlying
chronic illness were similar to those observed in others populations
[8-12]. The reported complications were similar to those in previous
studies ranging between 6.5-23% [3, 9-11].
Since this study was based on medical records review,
we cannot included others variables such as passive smoking, maternal
breastfeeding, environmental pollution. The study was conducted in a
tertiary referral hospital and therefore the patients included represent
the high severity, limiting the generalization of results to other
contexts. However, the similarity of our population in term of clinical
characteristics, risk factors and seasonality of RSV with previous
reports suggest strength and consistency in our results.
RSV is an important cause of morbidity in children
with bronchiolitis in tropical areas during the rainy season.
Identifying groups at high-risk for severe complications, such patients
with underlying chronic illnesses are essential to plan future
interventions to reduce the burden of disease in these regions.
Ethics approval: The Universidad de Antioquia’s
Medicine Faculty Ethics Committee; No. 018/2015. 25/11/2015.
Contributors: All authors contributed equally in
manuscript preparation and approved the manuscript.
Funding: None; Competing interest: None
stated.
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