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PEDIATRICS Vol. 104 No. 4 October 1999, pp. 894-899

Rehospitalization for Respiratory Syncytial Virus Among Premature Infants

Received Dec 3, 1998; accepted Mar 25, 1999.

Steven Joffe*, Gabriel J. Escobar*, Dagger , Steven B. Black*, §, Mary Anne Armstrong*, and Tracy A. Lieu*

From the * Division of Research, Kaiser Permanente Medical Care Program (Northern California Region), Oakland, California; the Dagger  Department of Pediatrics, Kaiser Permanente Medical Care Program, Walnut Creek, California; and the § Department of Quality and Utilization, Kaiser Permanente Medical Care Program (Northern California Region), Oakland, California.

Objectives.  New interventions to prevent respiratory syncytial virus (RSV) have recently become available. Clinical decisions about the use of these interventions require a better understanding of the incidence of and risk factors for RSV. We sought to characterize the epidemiology of severe RSV disease among premature infants and to identify high-risk subgroups.

Design.  Retrospective cohort.

Setting.  Kaiser Permanente Northern California, July 1992 to April 1996.

Participants.  One thousand seven hundred twenty-one premature infants born at 23 to 36 weeks who were discharged from a neonatal intensive care nursery (NICU) within 12 months before the December to March RSV season. A secondary analysis included 769 infants discharged during the RSV season.

Outcome Measures.  Hospitalization for RSV.

Results.  Of 1721 infants already home from the NICU at the start of the season, 3.2% were rehospitalized for RSV. In a multivariate model, risk factors for RSV hospitalization included gestation <= 32 weeks (odds ratio [OR], 2.6), >= 28 days of perinatal oxygen (OR, 3.7), and NICU discharge during September to November (OR, 2.7). Predicted risk of hospitalization varied by subgroup, ranging from 1.2% to 24.6%. Among 769 infants discharged from the NICU during the RSV season, 3.5% were rehospitalized for RSV during the same season; gestation and perinatal oxygen were not associated with admission.

Conclusions.  Most premature infants in this population were at less risk of severe RSV disease than previous studies in other populations have suggested. Preterm infants with a lower gestational age, a prolonged perinatal oxygen requirement, and NICU discharge within 3 months of the RSV season were most likely to require hospitalization for RSV disease. Cost-effectiveness analyses are needed to help define the role of available prophylactic interventions.  Key words:  respiratory syncytial virus infections, bronchiolitis, epidemiology, neonatal infections, prematurity, infections, respiratory, intensive care, neonatal, bronchopulmonary dysplasia, chronic lung disease, seasonal variation, prophylaxis, passive immunization.




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