ABSTRACT
BACKGROUND: Respiratory syncytial virus (RSV) is the leading cause of severe acute respiratory infections (ARI) in preterm infants. The incidence of RSV-associated hospitalizations has not been defined in Mexico. OBJECTIVES: To determine the incidence of ARI- and RSV-associated hospitalizations in preterm infants during the first year of life. METHODS: Prospective cohort study of 294 preterm infants followed up through monthly telephone calls and routine outpatient visits. Hospitalized children were identified through daily visits to pediatric wards of participating hospitals and through telephone calls. Respiratory samples were tested for RSV by RT-PCR. RESULTS: Mean gestational age of participating infants was 33 weeks. Ninety-six infants were diagnosed with bronchopulmonary dysplasia (BPD) and 17 with congenital heart disease (CHD); 11 had both conditions. There were 71 hospitalization episodes in 53 infants. Respiratory samples for RSV detection were available in 44 hospitalization episodes, and the result was positive in 16 (36.3%). At least one hospitalization for ARI was recorded in 33 of 96 participants with BPD, in seven of 17 with CHD, and 18 of 192 infants without these diagnoses. Five (71.4%) of CHD infants who required admission also had BPD. RSV-confirmed hospitalization rates were 9.4%, 5.9%, and 2.6% for infants with BPD, CHD, and otherwise healthy preterm infants, respectively. Attributable RSV admission frequencies were estimated to be 13.6%, 16.5%, and 4.1%, respectively. CONCLUSIONS: Mexican preterm infants, particularly those with BPD, have high rates of ARI- and RSVassociated hospitalizations. Specific interventions to reduce the incidence of severe infections in this highrisk group are required.
Subject(s)
Infant, Premature , Respiratory Syncytial Virus Infections/epidemiology , Respiratory Syncytial Virus, Human , Antiviral Agents/therapeutic use , Cohort Studies , Female , Hospitalization , Humans , Incidence , Infant , Infant, Newborn , Male , Mexico/epidemiology , Palivizumab/therapeutic use , Prospective Studies , Respiratory Syncytial Virus Infections/drug therapy , Respiratory Syncytial Virus, Human/drug effects , Respiratory Syncytial Virus, Human/isolation & purification , Respiratory Syncytial Virus, Human/pathogenicity , Respiratory Tract Infections/diet therapy , Respiratory Tract Infections/epidemiologyABSTRACT
La disminución en la ingesta alimentaria durante la fase aguda de una infección respiratoria baja puede afectar el curso de la enfermedad. Estudiamos 42 lactantes (2 a 12 meses) con infección respiratoria baja identificada por los hallazgos clínicos y radiográficos, a los que se les administró antibióticos y nebulizaciones con salbutamol. A su ingreso fueron asignados aleatoriamente al grupo A, alimentados por sonda nasogástrica en bolo intermitente; grupo B, alimentados por sonda nasogástrica a goteo continuo, y grupo C, alimentados por boca ad libitum, todos con una fórmula a base de leche de vaca en polvo reconstituida al 7,5%, con sacarosa 5%y maltodextrina 5%(77 kcal/dl). La ingesta energética en el grupo A aumentó de 69 a 110 kcal*kg*día; en el grupo B, de 68 a 114 y en el C de 55 a 109 (p 0,005 para los primeros tres días). Los lactantes de los grupos A y B tuvieron estadas hospitalarias más corta que los de C (8,7 y 8,4 vs 9,8 días; p < 0,002) y recuperación más rápida de los índices de insuficiencia respiratoria (4,1 y 3,8 vs 5,5 días; p < 0,001). Los grupos A y B también mostraron mayor descenso de la frecuencia cardíaca media (170 a 134 pulsaciones minuto) que el grupo C (169 a 142; p < 0,01). No hubo diferencias en la frecuencia respiratoria, peso/talla, albuminemia, proteína C-reactiva, VHS y glicemia. El apoyo nutricional temprano vía sonda nasogástrica parece favorecer la recuperacion clínica en lactantes con infecciones agudas del tracto respiratorio bajo