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Pulmonary hypertension during respiratory syncytial virus bronchiolitis: a risk factor for severity of illness

Published online by Cambridge University Press:  20 May 2019

Dai Kimura Open the ORCID record for Dai Kimura [Opens in a new window] ,
Isabella F. McNamara ,
Jiajing Wang ,
Jay H. Fowke ,
Alina N. West  and
Ranjit Philip
Dai Kimura*
Affiliation:
Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, TN, USA
Isabella F. McNamara
Affiliation:
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
Jiajing Wang
Affiliation:
Division of Epidemiology, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
Jay H. Fowke
Affiliation:
Division of Epidemiology, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
Alina N. West
Affiliation:
Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, TN, USA
Ranjit Philip
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, TN, USA
*
Author for correspondence: Professor Dai Kimura, MD, FAAP, Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Children’s Foundation Research Center, 50 N. Dunlap St 3rd Floor, Memphis TN 38103, USA. Tel: 901-287-6303; Fax: 901-287-6336; E-mail: dkimura@uthsc.edu
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Abstract

Background:

Respiratory syncytial virus infection is the most frequent cause of acute lower respiratory tract disease in infants. A few reports have suggested that pulmonary hypertension is associated with increased severity of respiratory syncytial virus infection. We sought to determine the association between the pulmonary hypertension detected by echocardiography during respiratory syncytial virus bronchiolitis and clinical outcomes.

Methods:

We retrospectively reviewed 154 children admitted with respiratory syncytial virus bronchiolitis who had an echocardiography performed during the admission. The association between pulmonary hypertension and clinical outcomes including mortality, intensive care unit (ICU) admission, prolonged ICU stay (>10 days), tracheal intubation, and need of high frequency oscillator ventilation was evaluated.

Results:

Echocardiography detected pulmonary hypertension in 29 patients (18.7%). Pulmonary hypertension was observed more frequently in patients with congenital heart disease (CHD) (n = 11/33, 33%), chronic lung disease of infancy (n = 12/25, 48%), prematurity (<37 weeks gestational age, n = 17/59, 29%), and Down syndrome (n = 4/10, 40%). The presence of pulmonary hypertension was associated with morbidity (p < 0.001) and mortality (p = 0.02). However, in patients without these risk factors (n = 68), pulmonary hypertension was detected in five patients who presented with shock or poor perfusion. Chronic lung disease was associated with pulmonary hypertension (OR = 5.9, 95% CI 2.2–16.3, p = 0.0005). Multivariate logistic analysis demonstrated that pulmonary hypertension is associated with ICU admission (OR = 6.4, 95% CI 2.2–18.8, p = 0.0007), intubation (OR = 4.7, 95% CI 1.8–12.3, p = 0.002), high frequency oscillator ventilation (OR = 8.4, 95% CI 2.95–23.98, p < 0.0001), and prolonged ICU stay (OR = 4.9, 95% CI 2.0–11.7, p = 0.0004).

Conclusions:

Pulmonary hypertension detected by echocardiography during respiratory syncytial virus infection was associated with increased morbidity and mortality. Chronic lung disease was associated with pulmonary hypertension detected during respiratory syncytial virus bronchiolitis. Routine echocardiography is not warranted for previously healthy, haemodynamically stable patients with respiratory syncytial virus bronchiolitis.

Keywords

Pulmonary hypertensionrespiratory syncytial viruscongenital heart diseasechronic lung disease of infancyechocardiography

Information

Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 5 , May 2019 , pp. 615 - 619
Copyright
© Cambridge University Press 2019 

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References

Shi, T, McAllister, DA, O’Brien, KL., et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet 2017; 390: 946–958.CrossRefGoogle ScholarPubMed
Welliver, RC. Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection. J Pediat 2003; 143: S112–S117.CrossRefGoogle ScholarPubMed
Beckhaus, AA,Castro-Rodriguez, JA. Down syndrome and the risk of severe RSV infection: a meta-analysis. Pediatrics 2018; 142: e20180225.CrossRefGoogle ScholarPubMed
Resch, B, Manzoni, P,Lanari, M. Severe respiratory syncytial virus (RSV) infection in infants with neuromuscular diseases and immune deficiency syndromes. Paediatr Respir Rev 2009; 10: 148–153.CrossRefGoogle ScholarPubMed
Simoes, EA. Environmental and demographic risk factors for respiratory syncytial virus lower respiratory tract disease. J Pediatr 2003; 143: S118–S126.CrossRefGoogle ScholarPubMed
Krishnan, U,Rosenzweig, EB. Pulmonary hypertension in chronic lung disease of infancy. Curr Opin Pediatr 2015; 27: 177–183.CrossRefGoogle ScholarPubMed
Roth, TS,Aboulhosn, JA. Pulmonary hypertension and congenital heart disease. Cardiol Clin 2016; 34: 391–400.CrossRefGoogle ScholarPubMed
Pedraza-Bernal, AM, Rodriguez-Martinez, CE,Acuna-Cordero, R. Predictors of severe disease in a hospitalized population of children with acute viral lower respiratory tract infections. J Med Virol 2015 May; 88: 754–759.CrossRefGoogle Scholar
Jung, JW. Respiratory syncytial virus infection in children with congenital heart disease: global data and interim results of Korean RSV-CHD survey. Korean J Pediatr 2011; 54: 192–196.CrossRefGoogle ScholarPubMed
Navas, L, Wang, E, de Carvalho, V,Robinson, J. Improved outcome of respiratory syncytial virus infection in a high-risk hospitalized population of Canadian children. Pediatric Investigators Collaborative Network on Infections in Canada. J Pediatr 1992; 121: 348–354.CrossRefGoogle Scholar
MacDonald, NE, Hall, CB, Suffin, SC, Alexson, C, Harris, PJ,Manning, JA. Respiratory syncytial viral infection in infants with congenital heart disease. N Eng J Med 1982; 307: 397–400.CrossRefGoogle ScholarPubMed
Castelli, JB, Maeda, WT,Aiello, VD. Respiratory syncytial virus as a trigger of a pulmonary hypertensive crisis after operative correction of aortic coarctation. Cardiol Young 2007; 17: 223–225.CrossRefGoogle ScholarPubMed
Bardi-Peti, L,Ciofu, EP. Pulmonary hypertension during acute respiratory diseases in infants. Maedica (Buchar) 2010; 5: 13–19.Google ScholarPubMed
Sreeram, N, Watson, JG,Hunter, S. Cardiovascular effects of acute bronchiolitis. Acta Paediatr Scand 1991; 80: 133–136.CrossRefGoogle ScholarPubMed
Fitzgerald, D, Davis, GM, Rohlicek, C,Gottesman, R. Quantifying pulmonary hypertension in ventilated infants with bronchiolitis: a pilot study. J Paediatr Child Health 2001; 37: 64–66.CrossRefGoogle ScholarPubMed
West, JB,West, JB. Pulmonary Pathophysiology: The Essentials. Wolters Kluwer/Lippincott Williams & Wilkins Health, Philadelphia, 2012.Google Scholar
Legg, JP, Hussain, IR, Warner, JA, Johnston, SL,Warner, JO. Type 1 and type 2 cytokine imbalance in acute respiratory syncytial virus bronchiolitis. Am J Respir Crit Care Med 2003; 168: 633–639.CrossRefGoogle ScholarPubMed
Donahue, DM, Lee, ME, Suen, HC, Quertermous, T, Wain, JC. Pulmonary hypoxia increases endothelin-1 gene expression in sheep. J Surg Res 1994; 57: 280–283.CrossRefGoogle Scholar
Samransamruajkit, R, Moonviriyakit, K, Vanapongtipagorn, P, Prapphal, N, Deerojanawong, J,Poovorawan, Y. Plasma endothelin-1 in infants and young children with acute bronchiolitis and viral pneumonia. Asian Pac J Allergy Immunol launched Allergy Immunol Soc Thailand 2002; 20: 229–234.Google ScholarPubMed
de Zegher, F, De Boeck, K, Devlieger, H, van der Voort, E,Elzenga, NJ. Respiratory syncytial virus infection in infants with unequal pulmonary perfusion. N Eng J Med 1991; 324: 1066–1067.Google ScholarPubMed
Moler, FW, Khan, AS, Meliones, JN, Custer, JR, Palmisano, J,Shope, TC. Respiratory syncytial virus morbidity and mortality estimates in congenital heart disease patients: a recent experience. Crit Care Med 1992; 20: 1406–1413.CrossRefGoogle ScholarPubMed
Mirza, H, Ziegler, J, Ford, S, Padbury, J, Tucker, R,Laptook, A. Pulmonary hypertension in preterm infants: prevalence and association with bronchopulmonary dysplasia. J Pediatr 2014; 165: 909–914.e901.CrossRefGoogle ScholarPubMed
Mourani, PM, Sontag, MK, Younoszai, A, Ivy, DD,Abman, SH. Clinical utility of echocardiography for the diagnosis and management of pulmonary vascular disease in young children with chronic lung disease. Pediatrics 2008; 121: 317–325.CrossRefGoogle ScholarPubMed
Hosheh, O,Randle, E. G441 Bronchiolitis in picu: who struggles to survive? Arch Dis Childhood 2017; 102: A174–A174.Google Scholar
Ghazaly, M,Nadel, S. Characteristics of children admitted to intensive care with acute bronchiolitis. Eur J Pediatr 2018; 177: 913–920.CrossRefGoogle ScholarPubMed
Altman, CA, Englund, JA, Demmler, G., et al. Respiratory syncytial virus in patients with congenital heart disease: a contemporary look at epidemiology and success of preoperative screening. Pediatr Cardiol 2000; 21: 433–438.CrossRefGoogle Scholar
Mourani, PM,Abman, SH. Pulmonary vascular disease in bronchopulmonary dysplasia: pulmonary hypertension and beyond. Curr Opin Pediatr 2013; 25: 329–337.CrossRefGoogle ScholarPubMed
Thorburn, K. Pre-existing disease is associated with a significantly higher risk of death in severe respiratory syncytial virus infection. Arch Dis Childhood 2009; 94: 99–103.CrossRefGoogle ScholarPubMed