The effect of palivizumab prophylaxis on respiratory syncytial virus-associated hospitalizations in infants with congenital diaphragmatic hernia
Journal
Pediatrics and Neonatology
Journal Volume
59
Journal Issue
2
Date Issued
2018
Author(s)
Abstract
We read with great interest the article authored by Resch et al.1Resch B. Liziczai K. Reiterer F. Freidl T. Haim M. Urlesberger B. Respiratory syncytial virus associated hospitalizations in children with congenital diaphragmatic hernia.Pediatr Neonatol. 2018; 59: 184-188Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar [1] that reported a moderate risk of respiratory syncytial virus (RSV)-associated hospitalizations in infants with congenital diaphragmatic hernia (CDH) and that palivizumab prophylaxis resulted in a nonsignificant reduction in the number of RSV-associated hospitalizations. Although this is an important finding having clinical implications, this study has some limitations, and we would like to make some comments on this article. Palivizumab prophylaxis is currently recommended for preterm infants born before 29 weeks of gestation and for preterm infants born before 32 weeks of gestation with chronic lung disease at prematurity.2American Academy of Pediatrics Committee on Infectious Diseases American Academy of Pediatrics Bronchiolitis Guidelines Committee Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection.Pediatrics. 2014; 134: 415-420Crossref PubMed Scopus (130) Google Scholar Palivizumab prophylaxis may also be beneficial and can be administered to certain infants with hemodynamically significant heart disease.2American Academy of Pediatrics Committee on Infectious Diseases American Academy of Pediatrics Bronchiolitis Guidelines Committee Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection.Pediatrics. 2014; 134: 415-420Crossref PubMed Scopus (130) Google Scholar The efficacy of palivizumab prophylaxis in other high-risk populations, such as those with pulmonary abnormality or neuromuscular disease, is of concern. Resch et al.1Resch B. Liziczai K. Reiterer F. Freidl T. Haim M. Urlesberger B. Respiratory syncytial virus associated hospitalizations in children with congenital diaphragmatic hernia.Pediatr Neonatol. 2018; 59: 184-188Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar have reported a trend of reduction in the number of RSV-associated hospitalizations in infants with CDH receiving palivizumab prophylaxis, although the reduction was not statistically significant. However, this study has reported about only two proven RSV infections. The majority of RSV-associated hospitalizations were actually hypothetical cases, without RSV test being performed. Resch et al.1Resch B. Liziczai K. Reiterer F. Freidl T. Haim M. Urlesberger B. Respiratory syncytial virus associated hospitalizations in children with congenital diaphragmatic hernia.Pediatr Neonatol. 2018; 59: 184-188Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar have speculated that 70% of severe lower respiratory tract admissions were attributed to RSV infection. This proportion was inferred from the literature reporting that RSV accounts for 50%–80% of all hospitalizations for bronchiolitis during seasonal epidemics.3Meissner H.C. Viral bronchiolitis in children.N Engl J Med. 2016; 374: 62-72Crossref PubMed Scopus (348) Google Scholar It is worth mentioning that this rate may be not appropriate for different types of underlying conditions, especially pulmonary abnormality and/or CDH. For instance, Metz et al.4Metz J. Eber E. Resch B. Respiratory syncytial virus infection-associated hospitalization rates in infants and children with cystic fibrosis.Pediatr Infect Dis J. 2017; 36: 545-548Crossref PubMed Scopus (7) Google Scholar have recently reported a low rate of RSV-associated hospitalizations in infants and children with cystic fibrosis. Infants with CDH are susceptible to respiratory tract infections. Since CDH is a relatively rare disease, it is difficult to collect large number of cases and to conduct clinical studies. It would be great if a prospective study can be performed in the future. The author has no conflicts of interest relevant to this article.
SDGs
Type
editorial