Clin Infect Dis. 2018 Nov 30. doi: 10.1093/cid/ciy1010. [Epub ahead of print]
Respiratory syncytial virus prophylaxis in infants with congenital diaphragmatic hernia in the CARESS registry (2005-2017).
Kim D1, Saleem M1, Paes B2, Mitchell I3, Lanctôt KL1.
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Infants with congenital diaphragmatic hernia (CDH) are at increased risk of respiratory morbidity from recurrent respiratory tract infections including those from respiratory syncytial virus (RSV). Data from prospective studies on RSV prophylaxis in CDH infants are limited. The objective was to determine the risk of respiratory illness- and RSV-related hospitalizations (RIH and RSVH, respectively) among infants prophylaxed for CDH, standard indications (SI), and those without increased risk (NR).

The prospective Canadian RSV Evaluation Study of Palivizumab (CARESS) registry was searched for infants who received palivizumab during 12 RSV seasons (2005-2017) in Canada. Demographic comparisons between CDH, NR, and SI groups were performed using ANOVA and chi-square tests. Cox proportional hazards analyses were conducted to compare RIH and RSVH risks across the groups adjusted for potential confounders.

In total, 21,107 infants (201 CDH, 389 NR, and 20,517 SI) were included. RIH incidences were 10.0% (CDH), 2.1% (NR), and 6.2% (SI). CDH patients had a significantly higher RIH hazard compared to NR (HR=3.6, 95%CI 1.5-8.8, p=0.005) but not SI (HR=1.2, 95%CI 0.8-2.0, p=0.379). RSVH incidences were 0.6%, 0.3%, and 1.5% for CDH, NR, and SI, respectively. RSVH risk was similar across groups (SI: HR=0.0, p=0.922; NR: HR=0.0, p= 0.934).

CDH infants had a 3-fold increased risk of RIH compared to NR but not SI infants. RSVH risk was similar with low RSVH incidences across all groups, implying that CDH infants may benefit from palivizumab during the RSV season, similar to other high-risk groups.

PMID: 30517603 DOI: 10.1093/cid/ciy1010