Acute Lower Respiratory Infections Associated With Respiratory Syncytial Virus in Children With Underlying Congenital Heart Disease: Systematic Review and Meta-analysis
Authors: Chaw Pa Saidou , Wong Stephanie Wen Lan , Cunningham Steve , Campbell Harry , Mikolajczyk Rafael , Nair Harish ,   RESCEU Investigators, Nair Harish , Campbell Harry , Shi Ting , Zhang Shanshan , Openshaw Peter , Wedzicha Jadwicha , Falsey Ann , Miller Mark , Beutels Philippe , Bont Louis , Pollard Andrew , Molero Eva , Martinon-Torres Federico , Heikkinen Terho , Meijer Adam , Fischer Thea Kølsen , van den Berge Maarten , Giaquinto Carlo , Mikolajczyk Rafael , Chaw Pa Saidou , Gallichan Scott , Kieffer Alexia , Demont Clarisse , Hackett Judy , Tafesse Eskinder , Cai Bing , Knirsch Charles , Lopez Antonio Gonzalez , Dieussaert Ilse , Dermateau Nadia , Stoszek Sonia , Cheret Arnaud , Gavart Sandra , Aerssens Jeroen , Fuentes Robert , Rosen Brian , Nair Harish , Campbell Harry , Shi Ting , Zhang Shanshan , Openshaw Peter , Wedzicha Jadwicha , Falsey Ann , Miller Mark , Beutels Philippe , Bont Louis , Pollard Andrew , Molero Eva , Martinon-Torres Federico , Heikkinen Terho , Meijer Adam , Fischer Thea Kølsen , van den Berge Maarten , Giaquinto Carlo , Mikolajczyk Rafael , Chaw Pa Saidou , Gallichan Scott , Kieffer Alexia , Demont Clarisse , Hackett Judy , Tafesse Eskinder , Cai Bing , Knirsch Charles , Lopez Antonio Gonzalez , Dieussaert Ilse , Dermateau Nadia , Stoszek Sonia , Cheret Arnaud , Gavart Sandra , Aerssens Jeroen , Fuentes Robert , Rosen Brian 
Published: April 2019

Background

Respiratory syncytial virus (RSV) is the most common viral pathogen associated with acute lower respiratory infections (ALRIs), with significant childhood morbidity and mortality worldwide. Estimates reporting RSV-associated ALRI (RSV-ALRI) severity in children with congenital heart disease (CHD) are lacking, thus warranting the need to summarize the available data. We identified relevant studies to summarize the findings and conducted a meta-analysis of available data on RSV-associated ALRI hospitalizations in children aged &lt;5 years, comparing those with underlying CHD to those without CHD.

Methods

We conducted a systematic search of existing relevant literature and identified studies reporting hospitalization of children aged &lt;5 years with RSV-ALRI with underlying or no CHD. We summarized the data and conducted (where possible) a random-effects meta-analysis to compare the 2 groups.

Results

We included 18 studies that met our strict eligibility criteria. The risk of severe RSV-ALRI (odds ratio, 2.2; 95% confidence interval [CI], 1.6–2.8), the rate of hospitalization (incidence rate ratio, 2.8; 95% CI, 1.9–4.1), and the case-fatality ratio (risk ratio [RR], 16.5; 95% CI, 13.7–19.8) associated with RSV-ALRI was higher among children with underlying CHD as compared to those without no CHD. The risk of admission to the intensive care unit (RR, 3.9; 95% CI, 3.4–4.5), need for supplemental oxygen therapy (RR, 3.4; 95% CI, .5–21.1), and need for mechanical ventilation (RR, 4.1; 95% CI, 2.1–8.0) was also higher among children with underlying CHD.

Conclusion

This is the most detailed review to show more-severe RSV-ALRI among children aged &lt;5 years with underlying CHD, especially hemodynamically significant underlying CHD, as compared those without CHD, supporting a need for improved RSV prophylactics and treatments that also have efficacy in children older than 1 year.