Respiratory Syncytial Virus Related Readmission in Preterm Infants Less than 34 weeks' Gestation Following Discharge from a Neonatal Intensive Care Unit in Korea

Abstract

This study was done to evaluate respiratory syncytial virus (RSV) related readmission (RRR) and risk factors of RRR in preterm infants < 34 weeks gestational age (GA) within 1 yr following discharge from the neonatal intensive care unit (NICU). Infants (n = 1,140) who were born and admitted to the NICUs of 46 hospitals in Korea from April to September 2012, and followed up for > 1 yr after discharge from the NICU, were enrolled. The average GA and birth weight of the infants was 30(+5) ± 2(+5) weeks and 1,502 ± 474 g, respectively. The RRR rate of enrolled infants was 8.4% (96/1,140), and RSV accounted for 58.2% of respiratory readmissions of infants who had laboratory tests confirming etiological viruses. Living with elder siblings (odd ratio [OR], 2.68; 95% confidence interval [CI], 1.68-4.28; P < 0.001), and bronchopulmonary dysplasia (BPD) (OR, 2.95; 95% CI, 1.44-6.04; P = 0.003, BPD vs. none) increased the risk of RRR. Palivizumab prophylaxis (OR, 0.06; 95% CI, 0.03-0.13; P < 0.001) decreased the risk of RRR. The risk of RRR of infants of 32-33 weeks' gestation was lower than that of infants < 26 weeks' gestation (OR, 0.11; 95% CI, 0.02-0.53; P = 0.006). This was a nationwide study that evaluated the rate and associated risk factors of RRR in Korean preterm infants. Preterm infants with BPD or living with siblings should be supervised, and administration of palivizumab to prevent RRR should be considered.

Keywords: Bronchopulmonary Dysplasia; Infants; Palivizumab; Patient Readmission; Premature; Respiratory Syncytial Virus.

Fig. 1. Study population. Out of the cohort that included all preterm infants less than 34 weeks' gestation who were born and survived at the NICUs of 46 hospitals in Korea from April 2012 to September 2012 (n = 1,867), the infants who were followed up for > 1 yr after discharge from the NICU, or who had readmission after discharge from the NICU were enrolled in this study (n = 1,140).

Fig. 2. Days to first respiratory syncytial virus related readmission (RRR) following discharge from the neonatal intensive care unit (Kaplan-Meier curve). No significant difference in RRR was observed when the GA was divided into five groups in all infants (n = 1,140, P = 0.159, Log-rank test for trend) (A) and in the infants with BPD (n = 326, P = 0.445, Log-rank test for trend) (B).