Respiratory Syncytial Virus-Associated Acute Lower Respiratory Infections in Children With Bronchopulmonary Dysplasia: Systematic Review and Meta-Analysis
Authors: Chaw Pa Saidou , Hua Lei , Cunningham Steve , Campbell Harry , Mikolajczyk Rafael , Nair Harish ,   RESCEU Investigators, Nair Harish , Campbell Harry , Shi Ting , Zhang Shanshan , Li You , Hua Lei , Openshaw Peter , Wedzicha Jadwicha , Falsey Ann , Miller Mark , 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 , Cai Bing , Knirsch Charles , Leach Amanda , Stoszek Sonia , Cheret Arnaud , Gavart Sandra , Aerssens Jeroen , Fuentes Robert , Rosen Brian , Nair Harish , Campbell Harry , Shi Ting , Zhang Shanshan , Li You , Hua Lei , Openshaw Peter , Wedzicha Jadwicha , Falsey Ann , Miller Mark , 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 , Cai Bing , Knirsch Charles , Leach Amanda , Stoszek Sonia , Cheret Arnaud , Gavart Sandra , Aerssens Jeroen , Fuentes Robert , Rosen Brian 
Published: October 2019

Abstract

Background
Respiratory syncytial virus (RSV) is among the most important causes of acute lower respiratory tract infection (ALRI) in young children. We assessed the severity of RSV-ALRI in children less than 5 years old with bronchopulmonary dysplasia (BPD).

Methods
We searched for studies using EMBASE, Global Health, and MEDLINE. We assessed hospitalization risk, intensive care unit (ICU) admission, need for oxygen supplementation and mechanical ventilation, and in-hospital case fatality (hCFR) among children with BPD compared with those without (non-BPD). We compared the (1) length of hospital stay (LOS) and (2) duration of oxygen supplementation and mechanical ventilation between the groups.

Results
Twenty-nine studies fulfilled our inclusion criteria. The case definition for BPD varied substantially in the included studies. Risks were higher among children with BPD compared with non-BPD: RSV hospitalization (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7–4.2; P &lt; .001), ICU admission (OR, 2.9; 95% CI, 2.3–3.5; P &lt; .001), need for oxygen supplementation (OR, 4.2; 95% CI, .5–33.7; P = .175) and mechanical ventilation (OR, 8.2; 95% CI, 7.6–8.9; P &lt; .001), and hCFR (OR, 12.8; 95% CI, 9.4–17.3; P &lt; .001). Median LOS (range) was 7.2 days (4–23) (BPD) compared with 2.5 days (1–30) (non-BPD). Median duration of oxygen supplementation (range) was 5.5 days (0–21) (BPD) compared with 2.0 days (0–26) (non-BPD). The duration of mechanical ventilation was more often longer (&gt;6 days) in those with BPD compared with non-BPD (OR, 11.9; 95% CI, 1.4–100; P = .02).

Conclusions
The risk of severe RSV disease is considerably higher among children with BPD. There is an urgent need to establish standardized BPD case definitions, review the RSV prophylaxis guidelines, and encourage more specific studies on RSV infection in BPD patients, including vaccine development and RSV-specific treatment.