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Acute respiratory infections in hospitalised infants with congenital heart disease

Published online by Cambridge University Press:  14 December 2020

Namrata Ahuja Open the ORCID record for Namrata Ahuja [Opens in a new window] ,
Wendy J Mack ,
Susan Wu ,
John C Wood  and
Christopher J Russell
Namrata Ahuja*
Affiliation:
Division of Hospital Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
Wendy J Mack
Affiliation:
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
Susan Wu
Affiliation:
Division of Hospital Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
John C Wood
Affiliation:
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Division of Cardiology, Children’s Hospital Los Angeles, Los Angeles, CA, USA
Christopher J Russell
Affiliation:
Division of Hospital Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
*
Address for correspondence: Namrata Ahuja, MD, Division of Hospital Medicine, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS #94, Los Angeles, CA90027. Tel: 323-361-6277. E-mail: nahuja@chla.usc.edu
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Abstract

Objectives:

To assess the overall burden and outcomes of acute respiratory infections in paediatric inpatients with congenital heart disease (CHD).

Methods:

This is a retrospective cross-sectional study of non-neonates <1 year with CHD in the Kid’s Inpatient Database from 2012. We compared demographics, clinical characteristics, cost, length of stay, and mortality rate for those with and without respiratory infections. We also compared those with respiratory infections who had critical CHD versus non-critical CHD. Multi-variable regression analyses were done to look for associations between respiratory infections and mortality, length of stay, and cost.

Results:

Of the 28,696 infants with CHD in our sample, 26% had respiratory infections. Respiratory infection-associated hospitalisations accounted for $440 million in costs (32%) for all CHD patients. After adjusting for confounders including severity, mortality was higher for those with respiratory infections (OR 1.5, p = 0.003), estimated mean length of stay was longer (14.7 versus 12.2 days, p < 0.001), and estimated mean costs were higher ($53,760 versus $46,526, p < 0.001). Compared to infants with respiratory infections and non-critical CHD, infants with respiratory infections and critical CHD had higher mortality (4.5 versus 2.3%, p < 0.001), longer mean length of stay (20.1 versus 15.5 days, p < 0.001), and higher mean costs ($94,284 versus $52,585, p < 0.001).

Conclusion:

Acute respiratory infections are a significant burden on infant inpatients with CHD and are associated with higher mortality, costs, and longer length of stay; particularly in those with critical CHD. Future interventions should focus on reducing the burden of respiratory infections in this population.

Keywords

Respiratory infectionbronchiolitiscongenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 4 , April 2021 , pp. 547 - 555
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Doucette, A, Jiang, X, Fryzek, J, Coalson, J, McLaurin, K, Ambrose, CS. Trends in respiratory syncytial virus and bronchiolitis hospitalization rates in high-risk infants in a United States nationally representative database, 1997–2012. PLoS One 2016; 11: e0152208. doi: 10.1371/journal.pone.0152208.CrossRefGoogle Scholar
Welliver, RC, Checchia, PA, Bauman, JH, Fernandes, AW, Mahadevia, PJ, Hall, CB. Fatality rates in published reports of RSV hospitalizations among high-risk and otherwise healthy children. Curr Med Res Opin 2010; 26: 2175–2181. doi: 10.1185/03007995.2010.505126.CrossRefGoogle ScholarPubMed
Pongiglione, G, Possidoni, A, di Luzio Paparatti, U, et al. Incidence of respiratory disease during the first two years of life in children with hemodynamically significant congenital heart disease in Italy: a retrospective study. Pediatr Cardiol 2016; 37: 1581–1589. doi: 10.1007/s00246-016-1473-9.CrossRefGoogle ScholarPubMed
Granbom, E, Fernlund, E, Sunnegårdh, J, Lundell, B, Naumburg, E. Respiratory tract infection and risk of hospitalization in children with congenital heart defects during season and off-season: a Swedish national study. Pediatr Cardiol 2016; 37: 1098–1105. doi: 10.1007/s00246-016-1397-4.CrossRefGoogle ScholarPubMed
HCUP Kids’ Inpatient Database (KID). Healthcare Cost and Utilization Project (HCUP). 2012.Google Scholar
Oster, ME, Lee, KA, Honein, MA, Riehle-Colarusso, T, Shin, M, Correa, A. Temporal trends in survival among infants with critical congenital heart defects. Pediatrics 2013; 131: e1502–e1508. doi: 10.1542/peds.2012-3435.CrossRefGoogle ScholarPubMed
HCUP Clinical Classifications Software (CCS) for ICD-9-CM. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp Accessed September 22, 2018.Google Scholar
Feudtner, C, Feinstein, JA, Zhong, W, Hall, M, Dai, D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014; 14: 199. doi: 10.1186/1471-2431-14-199.CrossRefGoogle ScholarPubMed
Richardson, T, Rodean, J, Harris, M, Berry, J, Gay, JC, Hall, M. Development of hospitalization resource intensity scores for kids (H-RISK) and comparison across pediatric populations. J Hosp Med 2018; 13: 602–608. doi: 10.12788/jhm.2948.Google ScholarPubMed
HCUP Cost-to-Charge Ratio Files (CCR). Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD, 2012.Google Scholar
Simonato, M, Baritussio, A, Carnielli, VP, et al. Influence of the type of congenital heart defects on epithelial lining fluid composition in infants undergoing cardiac surgery with cardiopulmonary bypass. Pediatr Res 2018; 83: 791–797. doi: 10.1038/pr.2017.326.CrossRefGoogle ScholarPubMed
Lee, J-T, Chang, L-Y, Wang, L-C, et al. Epidemiology of respiratory syncytial virus infection in northern Taiwan, 2001–2005 – seasonality, clinical characteristics, and disease burden. J Microbiol Immunol Infect 2007; 40: 293–301. http://www.ncbi.nlm.nih.gov/pubmed/17712463. Accessed June 27, 2019.Google ScholarPubMed
Chu, PY, Hornik, CP, Li, JS, et al. Respiratory syncytial virus hospitalisation trends in children with haemodynamically significant heart disease, 1997–2012. Cardiol Young 2016; 360: 1–10. doi: 10.1017/S1047951116000470.Google Scholar
Geskey, JM, Cyran, SE. Managing the morbidity associated with respiratory viral infections in children with congenital heart disease. Int J Pediatr 2012; 2012: 646780. doi: 10.1155/2012/646780.CrossRefGoogle ScholarPubMed
Yount, LE, Mahle, WT. Economic analysis of palivizumab in infants with congenital heart disease. Pediatrics 2004; 114: 1606–1611. doi: 10.1542/peds.2004-0224.CrossRefGoogle ScholarPubMed
Mansbach, J, Kunz, S, Acholonu, U, Clark, S, Camargo, CA Jr Evaluation of compliance with palivizumab recommendations in a multicenter study of young children presenting to the emergency department with bronchiolitis. https://insights.ovid.com/pubmed?pmid=17572518. Accessed June 29, 2018.Google Scholar
Moynihan, JA, Kim, TY, Young, T, Checchia, PA. Rate of palivizumab administration in accordance with current recommendations among hospitalized children. J Pediatr Health Care 2004; 18: 224–227. doi: 10.1016/j.pedhc.2004.02.006.CrossRefGoogle ScholarPubMed
Hampp, C, Kauf, TL, Saidi, AS, Winterstein, AG. Cost-effectiveness of respiratory syncytial virus prophylaxis in various indications. Arch Pediatr Adolesc Med 2011; 165: 498–505. doi: 10.1001/archpediatrics.2010.298.CrossRefGoogle ScholarPubMed
Stewart, DL, Ryan, KJ, Seare, JG, Pinsky, B, Becker, L, Frogel, M. Association of RSV-related hospitalization and non-compliance with Palivizumab among commercially insured infants: a retrospective claims analysis. BMC Infect Dis 2013; 13: 334. doi: 10.1186/1471-2334-13-334.CrossRefGoogle ScholarPubMed
Afghani, B, Ngo, T, Leu, S-Y, et al. The effect of an interventional program on adherence to the American academy of pediatrics guidelines for palivizumab prophylaxis. Pediatr Infect Dis J 2006; 25: 1019–1024. doi: 10.1097/01.inf.0000243164.47048.4b.CrossRefGoogle Scholar
Chow, JW, Chicella, MF, Christensen, AM, Moneymaker, CS, Harrington, J, Dice, JE. Improving palivizumab compliance rough a pharmacist-managed RSV prevention clinic. J Pediatr Pharmacol Ther 2017; 22: 338–343. doi: 10.5863/1551-6776-22.5.338.Google ScholarPubMed
Frogel, M, Nerwen, C, Cohen, A, VanVeldhuisen, P, Harrington, M, Boron, M. Prevention of hospitalization due to respiratory syncytial virus: results from the palivizumab outcomes registry. J Perinatol 2008; 28: 511–517. doi: 10.1038/jp.2008.28.CrossRefGoogle ScholarPubMed
Golombek, SG, Berning, F, Lagamma, EF. Compliance with prophylaxis for respiratory syncytial virus infection in a home setting. Pediatr Infect Dis J 2004; 23: 318–322. http://www.ncbi.nlm.nih.gov/pubmed/15071285. Accessed June 29, 2018.CrossRefGoogle Scholar
Flannery, B, Reynolds, SB, Blanton, L, et al. Influenza vaccine effectiveness against pediatric deaths: 2010–2014. Pediatrics 2017; 139. doi: 10.1542/peds.2016-4244.CrossRefGoogle ScholarPubMed
Santibanez, TA, Lu, P-J, O’Halloran, A, Meghani, A, Grabowsky, M, Singleton, JA. Trends in childhood influenza vaccination coverage--U.S., 2004–2012. Public Health Rep 2014; 129: 417–427. doi: 10.1177/003335491412900505.CrossRefGoogle ScholarPubMed
French, CE, McKenzie, BC, Coope, C, et al. Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review. Influenza Other Respi Viruses 2016; 10: 268–290. doi: 10.1111/irv.12379.CrossRefGoogle ScholarPubMed
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