Analysis of Palivizumab Prophylaxis in Patients with Acute Lower Respiratory Tract Infection Caused by Respiratory Syncytial Virus

Sung Ju Min; Jung Sook Song; Jang Hwan Choi; Han Su Seon; Eun Kyeong Kang; Do Hyun Kim; Hee Sup Kim

doi:10.14776/kjpid.2011.18.2.154

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Min, Song, Choi, Seon, Kang, Kim, and Kim: Analysis of Palivizumab Prophylaxis in Patients with Acute Lower Respiratory Tract Infection Caused by Respiratory Syncytial Virus

Original Article

Korean J Pediatr Infect Dis 2011;18(2):154-162.

Published online: 10 January 2011

DOI: https://doi.org/10.14776/kjpid.2011.18.2.154

Analysis of Palivizumab Prophylaxis in Patients with Acute Lower Respiratory Tract Infection Caused by Respiratory Syncytial Virus

Sung Ju Min, M.D., Jung Sook Song, M.D., Jang Hwan Choi, M.D., Han Su Seon, M.D., Eun Kyeong Kang, M.D., Do Hyun Kim, M.D., Hee Sup Kim, M.D.

Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea

책임저자:김희섭, 동국대학교 일산병원 소아청소년과 Tel: 031)961-7181, Fax: 031)961-7188 E-mail: kimhs@dumc.or.kr

Received 11 June 2011 Revised 27 July 2011 Accepted 9 September 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study was to identify the clinical characteristics of lower respiratory tract infection due to respiratory syncytial virus (RSV) in young children and to provide information for an effective guideline for palivizumab administration in Korea.

Methods

We reviewed medical charts of 167 patients under 3 years of age who were hospitalized in Dongguk University Ilsan Hospital for lower respiratory tract infection between January 2007 and February 2011. Diagnosis of the virus was made based on the multiplex real time polymerase chain reaction.

Results

There were 113 patients who were infected by respiratory syncytial virus. 90 patients were term infants and 23 patients were preterm infants. No difference was shown between term and preterm infants except the days of admission ± ± which was 9.0 6.0 days and 12.6 21.0 days respectively. In the preterm group their mean age at the time of admission was 5.21 4.9 months and the mean gestational age was 33.1 4.3 weeks, and the mean birth weight was 2,152 950 g.±±± Only 4 patients were born under 28 weeks gestational age and were candidates for palivizumab administration.

Conclusion

Most of the patients with severe RSV lower respiratory tract infection were term or near term infants who were not candidates for palivizumab prophylaxis. A nationwide study is needed to make a new risk stratified guideline for RSV prophylaxis for our country. (Korean J Pediatr Infect Dis 2011;18:154–162)

Keywords: Respiratory syncytial virus, Lower respiratory tract infection, Palivizumab

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Fig. 1.

Monthly occurrence of acute lower respiratory tract infections associated with respiratory syncytial virus (RSV).

Table 1.

Clinical Characteristics of 167 Patients and Comparisons of the Term Group and the Preterm Group

	Total (n=167)	Term (n=131)	Preterm (n=36)	P value
Sex, M:F	101:66	88:43	13:23	NS
Age, months	7.1±8.3	6.8±8.6	8.3±7.4	NS
GA, weeks	37.7±3.8	39.3±1.1	31.9±4.4	<0.001
Birth weight, g	2,963±824	3,272±423	1,848±951	<0.001
Days of admission	10.5±14.1	9.4±7.3	14.6±26.8	0.001
WBC count/ Lμ	12,578±4,656	12,621±4,709	12,419±4,518	NS
Neutrophil, %	35.2±18.7	34.5±18.7	38.0±18.7	NS
Lymphocyte, %	50.0±17.0	50.3±17.0	49.1±17.1	NS

Data expressed as mean±standard deviation Abbreviations: GA, gestational age; WBC, white blood cell; CRP, C-reactive protein; NS, not significant

Table 2.

Comparisons of Clinical Characteristics between the Term Group and Preterm Group in Patients with Respiratory Syncytial Virus Infection

	Term (n=90)	Preterm (n=23)	P value
Sex, M:F	58:32	10:13	NS
Age, months	4.3±6.9	5.1±4.8	NS
GA, weeks	39.2±1.1	32.9±4.2	<0.001
Birth weight, g	3,274±428	2,010±960	<0.001
Days of admission	9.0±6.0	12.6±21.0	0.034
WBC count/ Lμ	12,362±4,905	11,421±3,888	NS
Neutrophil, %	31.4±17.1	36.6±19.6	NS
Lymphocyte, %	52.6±15.9	49.5±17.2	NS
CRP, mg/dL	1.2±2.7	1.1±1.2	NS

Data expressed as mean±standard deviation Abbreviations: GA, gestational age; WBC, white blood cell; CRP, C-reactive protein; NS, not significant

Table 3.

Clinical Characteristics of the 4 Patients with Respiratory Syncytial Virus Infection who Received Palivizumab Prophylaxis

	Patient 1	Patient 2	Patient 3	Patient 4
Age, months	21.7	9.0	6.9	7.7
Sex	male	female	female	male
GA, weeks	24.9	24.6	27.6	23.7
Birth weight, g	694	696	1,084	650
Days of admission	10	11	4	14
ICU care	no	no	no	yes
Ventilator care	no	no	no	yes
O2 inhalation	yes	no	yes	yes
WBC count/ Lμ	17,030	12,740	8,130	11,140
Neutrophil, %	71.9	35.4	25.2	41.1
Lymphocyte, %	19.1	51.3	64.9	42.2
CRP, mg/dL	1.025	1.194	0.026	0.783
Number of Palivizumab administration	1	5	5	5

Abbreviations: GA, gestational age; WBC, white blood cell; CRP, C-reactive protein

Table 4.

Comparisons of Clinical Characteristics between the Term Group and Preterm Group in Patients with Severe Respiratory Syncytial Virus Infection

	Term (n=21)	Preterm (n=3)	P value
Age, months	2.8±2.6	4.9±2.5	NS
GA, weeks	38.9±1.2	30.5±5.6	<0.001
Birth weight, g	3,379±443	1,469±711	NS
Days of admission	15.0±9.0	12.7±3.2	NS
Days in ICU	8.3±8.1	7.3±3.2	NS
Days of ventilator care	5.1±3.9	3.3±1.2	NS
WBC count/ Lμ	12,440±5,554	11,553±2,199	NS
Neutrophil, %	34.9±18.4	61.7±18.1	NS
Lymphocyte, %	47.6±16.3	29.2±12.3	NS
CRP, mg/dL	1.7±3.6	0.6±0.5	NS

Data expressed as mean±standard deviation Abbreviations: GA, gestational age; ICU, intensive care unit; WBC, white blood cell; CRP, C-reactive protein; NS, not significant

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