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

Abstract

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.