Korean Circ J.  2016 Sep;46(5):719-726. 10.4070/kcj.2016.46.5.719.

Retrospective Multicenter Study of Respiratory Syncytial Virus Prophylaxis in Korean Children with Congenital Heart Diseases

• Kim AY
• Jung SY
• Choi JY
• Kim GB
• Kim YH
• Shim WS
• Kang IS
• Jung JW

• KMID: 2389631
• DOI: http://doi.org/10.4070/kcj.2016.46.5.719

Abstract

BACKGROUND AND OBJECTIVES
We conducted a review of current data on respiratory syncytial virus (RSV) prophylaxis with palivizumab, in Korean children with congenital heart diseases (CHD). In 2009, the Korean guideline for RSV prophylaxis had established up to five shots monthly per RSV season, only for children <1 year of age with hemodynamic significance CHD (HS-CHD).
SUBJECTS AND METHODS
During the RSV seasons in 2009-2015, we performed a retrospective review of data for 466 infants with CHD, examined at six centers in Korea.
RESULTS
Infants received an average of 3.7±1.9 (range, 1-10) injections during the RSV season. Fifty-seven HS-CHD patients (12.2%) were hospitalized with breakthrough RSV bronchiolitis, with a recurrence in three patients, one year after the initial check-up. Among patients with simple CHD, only five (1.1%) patients received one additional dose postoperatively, as per the limitations set by the Korean guideline. Among the 30 deaths (6.4%), five (1.1%) were attributed to RSV infection; three to simple CHD, one to Tetralogy of Fallot, and one to hypertrophic cardiomyopathy (HCM). Of the three HCM patients that exceeded guidelines for RSV prophylaxis, two (66.6%) were hospitalized, and one died of RSV infection (33.3%).
CONCLUSION
In accordance to the Korean guideline, minimal injections of palivizumab were administered to patients having HS-CHD

Keyword

Respiratory syncytial virus; Congenital heart disease; Pediatrics; Palivizumab; Prophylaxis

MeSH Terms

Bronchiolitis
Cardiomyopathies
Cardiomyopathy, Hypertrophic
Child*
Heart Defects, Congenital
Heart Diseases*
Heart*
Hemodynamics
Humans
Infant
Korea
Palivizumab
Pediatrics
Recurrence
Respiratory Syncytial Viruses*
Retrospective Studies*
Seasons
Tetralogy of Fallot
Palivizumab

Figure

• 

  Fig. 1 The number of patients according to palivizumab injections (N=466). The mean number who received injections was 3.7±1.9 per patient (range, 1-10). Only 146 patients (31%) received more than five injections because of prematurity, whereas the majority (n=320; 69%) received less than four injections, including 166 patients (36%) who received only one injection.

• 

  Fig. 2 The number of patients starting treatment during the recommended time of the year, in accordance with the national guideline. There were 182 patients (39%) who did not start the first injection of palivizumab at the right time according to the guideline, with an average delay of 2.7±2.6 months (range, 1-4 months).

• 

  Fig. 3 The serial infection rate of RSV according to each calendar month. Fifty-seven patients (12.2%) were hospitalized with breakthrough RSV bronchiolitis after prophylaxis. The mean age of these patients was 7.9±5.7 months (range, 1.6-23.8), and most (86%) experienced frequent RSV infections between October and the following January. RSV: respiratory syncytial virus.

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