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Infants born prematurely at increased risk for respiratory disease
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Infants who were born prematurely were at increased risk for having respiratory distress syndrome and were more prone to chronic respiratory problems later on, according to study data published online.
Adrian R. Levy, PhD, of Oxford Outcomes in Vancouver, and colleagues reported on data from a study in Quebec, where the researchers analyzed 7,488 premature babies born in 1996 and 1997.
The researchers said 6.1% of late preterm babies had respiratory distress syndrome symptoms and 7% had lower respiratory tract infections in infancy.
The researchers noted other risk factors associated with respiratory distress syndrome, including “male sex, or diagnosis of other respiratory conditions, diaphragm anomalies, bacteremia, intraventricular hemorrhage, congenital heart disease or respiratory system anomalies,” according to the study findings.
Levy and colleagues reported that late preterm infants “may benefit from interventions decreasing the risk of contracting respiratory viruses causing acute [lower respiratory tract infections].”
The researchers urged study into strategies that would decrease the risk and burden of severe lower respiratory tract infections in infancy among late preterm infants, particularly those with a history of respiratory distress syndrome. They noted some study limitations, specifically that they could measure oxygen use in the babies, and that there was the potential for misclassification of respiratory distress syndrome.
Disclosure: The study was supported by Abbott. Levy reports no relevant financial disclosures.
Perspective
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Ellen R. Wald, MD
It is well recognized that very premature infants are at high risk for chronic lung disease and are at particular risk of increased severity of bronchiolitis or lower respiratory tract infections (LRTI) due to respiratory syncytial virus (RSV); hence, the use of palivizumab (Synagis, MedImmune) for infants aged younger than 32 weeks of gestational age.
The study showed that late preterm infants with a history of respiratory distress syndrome (RDS) had significantly increased risk of hospitalization for severe LRTI within the RSV season in their first year of life. This risk was not documented specifically for RSV but rather for respiratory disease occurring during RSV season. RSV was not proven (as testing for this virus is erratic), and knowing that RSV is cause of infection does not alter management (and has been discouraged recently as possibly unnecessary testing). High rates of chronic respiratory morbidity continue throughout childhood for these preterm infants with a diagnosis of RDS who subsequently experience LRTI during RSV season.
My interpretation of this is study is: 1) There is clearly a desire to establish areas for preventive therapy for RSV (ie, palivizumab); 2) authors assume severe LRTI during RSV season is a proxy for RSV; 3) probably need to prove it is due to RSV before considering preventive treatment; and 4) I would like to see in another database.
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