Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of SynagisⓇ (palivizumab) prophylaxis on readmission due to respiratory syncytial virus in very low birth weight infants

극소 저체중 출생아에서 SynagisⓇ (palivizumab) 접종이 respiratory syncytial virus 감염으로 인한 재입원에 미치는 영향

  • Park, Soo Kyoung (Department of Pediatrics, Samsung Medical Center) ;
  • Jung, Yu Jin (Department of Pediatrics, Kosin University College of Medicine) ;
  • Yoo, Hye Soo (Department of Pediatrics, Samsung Medical Center) ;
  • Ahn, So Yoon (Department of Pediatrics, Samsung Medical Center) ;
  • Seo, Hyun Joo (Department of Pediatrics, Samsung Medical Center) ;
  • Choi, Seo Hui (Department of Pediatrics, Samsung Medical Center) ;
  • Kim, Myo Jing (Department of Pediatrics, Dong-A University College of Medicine) ;
  • Jeon, Ga Won (Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine) ;
  • Koo, Soo Hyun (Department of Pediatrics, Masan Samsung Hospital) ;
  • Lee, Kyung-Hoon (Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine) ;
  • Chang, Yun Sil (Department of Pediatrics, Samsung Medical Center) ;
  • Park, Won Soon (Department of Pediatrics, Samsung Medical Center)
  • 박수경 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 정유진 (고신대학교 의과대학 소아과학교실) ;
  • 유혜수 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 안소윤 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 서현주 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 최서희 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 김묘징 (동아대학교 의과대학 소아과학교실) ;
  • 전가원 (인제대학교 의과대학 부산백병원 소아청소년과) ;
  • 구수현 (마산산삼성병원 소아청소년과) ;
  • 이경훈 (성균관대학교 의과대학 분자세포생물학교실) ;
  • 장윤실 (성균관대학교 의과대학 삼성서울병원 소아청소년과) ;
  • 박원순 (성균관대학교 의과대학 삼성서울병원 소아청소년과)
  • Received : 2009.10.16
  • Accepted : 2010.02.14
  • Published : 2010.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : The aim of this study was to determine the efficacy of $Synagis^{(R)}$ (palivizumab) in reducing the respiratory syncytial virus (RSV) readmission rate in very low birth weight infants (VLBWI ) and the subgroup that showed the most effective vaccination. Methods : We enrolled 350 VLBWI who had been discharged alive from the neonatal intensive care unit of Samsung Medical Center from January 2005 to December 2007 and were followed up for at least one year. A retrospective study based on medical records was performed for a period of one year after discharge. RSV readmission rate was investigated according to BPD (bronchopulmonary dysplasia, requiring oxygen at postnatal day 28) and $Synagis^{(R)}$ prophylaxis. We categorized the subgroups by the severity of BPD gestational age, and birth weight and compared the RSV readmission rates between subgroups. Results : Eleven VLBWI were readmitted. $Synagis^{(R)}$ prophylaxis resulted in a 86% reduction in the rate of readmission due to RSV infection (prophylaxis group, 0.7% and no prophylaxis group, 5.0%; P =0.02). Readmission rate in BPD patients was also reduced in the prophylaxis group (0.7% in the prophylaxis group vs. 5.2% in the no prophylaxis group, P =0.03). The readmission rate in patients without BPD was reduced in the prophylaxis group (0% in the prophylaxis group vs. 4.9% in the no prophylaxis group, P =1.00), but this was not statistically significant.Conclusion : $Synagis^{(R)}$ prophylaxis was effective at reducing RSV readmission in VLBWI. Its efficacy was verified irrespective of BPD, gestational age, or birth weight.

목 적 : 본 연구에서 저자들은 $Synagis^{(R)}$ 접종으로 극소 저체중 출생아에서 respiratory syncytial virus 감염으로 인한 재입원이 감소하는지 여부와 이러한 접종이 특히 효과적인 세부 그룹을 알아보고자 하였다. 방 법 : 2005년 1월부터 2007년 12월까지 3년간 서울 삼성병원 신생아 중환자실에서 입원 치료 후 생존하여 퇴원한 출생체중 1,500 g 미만의 극소 저체중 출생아 350명을 대상으로 퇴원후 1년까지 후향적으로 조사하여 생후 28일째 보조적 산소투여가 필요하였던 기관지폐이형성증 유무 및 $Synagis^{(R)}$ 접종 여부에 따라 RSV 재입원율을 비교하였고, BPD의 중증도 와 재태연령 및 출생체중을 세분하여 각 군별 RSV 재입원율의 차이를 비교 분석하였다. 결 과 : 전체 350명중 11명(3.1%)가 RSV로 인해 재입원하였고, 시나지스 미접종군에서 재입원율이 5.0%였던 반면, 접종군에 서 재입원율은 0.7%로 시나지스 접종에 의해 RSV 재입원율이 86% 감소하였다(P =0.02). 기관지폐이형성증이 있는 환아에서의 재입원율은 접종군에서 0.7%, 미접종군에서 5.2%로 접종군에서 유의하게 감소되었고(P =0.045), 기관지폐이형성증이 없는 환아에서의 재입원율 또한 통계학적 유의성은 확인할 수 없었으나(P =0.35), 접종군에서는 0%, 미접종군에서는 4.9%로 접종군에서 감소하였다. 결 론 : 극소 저체중 출생아에서 시나지스 접종은 RSV로 인한 재입원율을 감소시켰고, 기관지폐이형성증 유무 및, 출생주수, 출생체중에 상관없이 재입원율의 감소 추세가 확인되었다.

Keywords

References

  1. Chien YH, Tsao PN, Chou HC, Tang JR, Tsou KI. Rehospi talization of extremely low birth weight infants in first 2 years of life. Early Hum Dev 2002;66:33-40 https://doi.org/10.1016/S0378-3782(01)00233-X
  2. McCormick MC, Shapiro S, Starfield BH. Rehospitalization in the first year of life high risk survivors. Pediatrics 1980;66:991-9
  3. Kim SJ, Chae SH, Lee JH, Kim YJ, Koo SH, Jeon GW, et al. Rehospitalization of very low birth weight infants in first year after discharge from NICU and risk factor of rehospitalization caused by respiratory illness. J Korean Soc Neonatol 2006;13:17-23
  4. Shay DK, Holman RC, Newman RD, Liu LL, Stout JW, Anderson LJ. Bronchiolitis-associated hospitalizations among US children, 1980-1996. JAMA 1999;282:1440-6 https://doi.org/10.1001/jama.282.15.1440
  5. Simoes EA, Carbonell-Estrany X. Impact of severe disease caused by respiratory syncytial virus in children living in developed countries. Pediatr Infect Dis J 2003;22 Suppl 2:S13-20
  6. Stensballe LG, Devasundaram JK, Simoes EA. Respiratory syncytial virus epidemics: the ups and downs of a seasonal virus. Pediatr Infect Dis J 2003;22 Suppl 2:S21-32
  7. Weisman LE. Populations at risk for developing respiratory syncytial virus and risk factors for respiratory syncytial virus severity: infants with predisposing condition. Pediatr Infect Dis J 2003;22 Suppl 2:S33-9
  8. Meissner HC. Selected populations at increased risk from respiratory syncytial virus infection. Pediatr Infect Dis J 2003;22 Suppl 2:S40-5
  9. Pedersen O, Herskind AM, Kamper J, Neilsen JP, Kristensen K. Rehospitalization for respiratory syncytial virus infectionin infants with extremely low gestational age or birth weight in Denmark. Acta Paediatr 2003;92:240-2 https://doi.org/10.1111/j.1651-2227.2003.tb00533.x
  10. Lee EA, Jeong JH, Yu ST, Lee CW, Yoon HS, Park DS, et al. Incidence and risk factors of rehospitalization with respiratory syncytial virus infection in premature infants. Korean J Pediatr 2004;47:510-4
  11. Embleton IN, Harkensee C, Mckean MC. Palivizumab for preterm infants is it worth it? Arch Dis Child Fetal Neonatal Ed 2005;90:286-9 https://doi.org/10.1136/adc.2004.058081
  12. Roeckle-Wiedmann I, Liese JG, Grill E, Fischer B, Carr D, Belohradsky BH. Economic evaluation of possible prevention of RSV-related hospitalizations in premature infants in Germany. Eur J Pediatr 2003;162:237-44
  13. Carbonell EX, Quero JJ. Recommendations for the prevention of respiratory syncytial virus infections. standards committee of the Spanish society of neonatology. board of directors of the Spanish society of neonatology. An Esp Pediatr 2000;52:372-4
  14. The IMPACT-RSV Study Group. Palivizumab, a humanized repiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants. Pediatrics 1998;102:531-7 https://doi.org/10.1542/peds.102.3.531
  15. Bj$\"{o}$rklund LJ, Lindroth M, Polberger ö S, Selander B. Prophylaxis against respiratory syncytial virus in premature infants. Lancet 2000;355:235-6
  16. Vogel AM, Lennon DR, Broadbent R, Byrnes CA, Grimwood K, Mildenhall L, et al. Palivizumab prophylaxis of respiratory syncytial virus infection in high-risk infants. J Pediatr Child Health 2002;38:550-4 https://doi.org/10.1046/j.1440-1754.2002.00057.x
  17. McCormick J, Tubman R. Readmission with respiratory syncytial virus (RSV) infection among graduates from a neonatal intensive care unit. Pediatr Pulmonol 2002;34:262-6 https://doi.org/10.1002/ppul.10169
  18. Hall CB. Respiratory syncytial virus and parainfluenza virus. N Engl J Med 2001;344:1917-28 https://doi.org/10.1056/NEJM200106213442507
  19. Handforth J, Friedland JS, Sharland M. Basic epidemiology and immunopathology of RSV in children. Paediatr Respir Rev 2000;1:210-4 https://doi.org/10.1053/prrv.2000.0050
  20. Groothuis JR, Simoes EA, Levin MJ, Hall CB, Long CE, Rodriguez WJ, et al. Prophylactic administration of respiratory syncytial virus immune globulin to high risk infants and young children. N Engl J Med 1993;329:1524-30 https://doi.org/10.1056/NEJM199311183292102
  21. The prevent Study Group. Reduction of respiratory syncytial virus hospitalization among premature infants and infants with bronchopulmonary dysplasia using respiratory syncytial virus immune globulin prophylaxis. Pediatrics 1997;99:93-9 https://doi.org/10.1542/peds.99.1.93
  22. simoes EA, Sondheimer HM, Top FH, Meissner HC, Welliver RC, Kramer AA, et al. Respiratory syncytial virus immune globulin for prophylaxis against respiratory syncytial virus disease in infants and children with congenital heart disease. The Cardiac Study Group. J Pediatr 1998;133;492-9 https://doi.org/10.1016/S0022-3476(98)70056-3
  23. American Academy of Pediatrics, Committee on Infectious Diseases and Committee of fetus and newborn. Revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous for the prevention of respiratory syncytial virus infections. Pediatrics 2003;112:1442-6 https://doi.org/10.1542/peds.112.6.1442
  24. Morris SK, Dzolganovski B, Beyene J, Sung L. A meta-analysis of the effect of antibody therapy for the prevention of severe respiratory syncytial virus infection. BMC Infect Dis 2009;9:106 https://doi.org/10.1186/1471-2334-9-106
  25. Pedraz C, Carbonell-Estrany X, Figueras-Aloy J, Quero J. IRIS study group. Effect of palivizumab prophylaxis in decreasing respiratory syncytial virus hospitalizations in premature infants. Pediatr Infect Dis J 2003;22:823-7 https://doi.org/10.1097/01.inf.0000086403.50417.7c
  26. Kusuda S, Koizumi T, Sakai T, Fujimura M, Nishida H, Togari H. Results of clnical surveillance during the Japanese first palivizumab season in 2002-2003. Pediatr Int 2006;48:362-8 https://doi.org/10.1111/j.1442-200X.2006.02222.x

Cited by

  1. Clinical Characteristics of Patients with Bronchopulmonary Dysplasia Admitted to Pediatric Intensive Care Unit vol.23, pp.3, 2010, https://doi.org/10.5385/nm.2016.23.3.151