Background Respiratory syncitial virus is a common childhood pathogen, affecting nearly all children at least once in the first 2 years of life. The consequences can be serious, requiring hospital admission in many children in the winter months. It causes cardiac surgical programmes to be disrupted and intensive care units are full with peak admission rate on Christmas day. The current application form for funding for palivizumab administration requires statement of co-morbidities for cardiac patients.
Methods We have determined the co-morbidities associated with congenital heart disease to determine which children would be at highest risk of morbidity and mortality over the winter months to determine and who would be best suited to immuno-prophylaxis. This was discussed and agreed by a multi-disciplinary meeting in October 2015, with multiple sites across the UK. The evidence was presented to determine who was at increased risk of complication following RSV infection.
Results A total of 68 paediatricians met and agreed that those with haemodynamically significant congenital heart disease at higher risk were those with cyanosis (oxygen saturation <85%), those with medication to control heart failure and those with pulmonary hypertension. Those who were preterm, who had Down’s syndrome, those who were immune deficient (Di George Syndrome) and those on the transplant list, were all more likely to suffer from the consequences of RSV infection. However, those who had minor disease, those with repaired congenital heart disease and those with 22q11.2 micro-deletion without immune deficiency were less likely to suffer from complication and would not benefit from immuno-prophylaxis. The risk was increased if there was nosocomial infection, there were multiple siblings at nursery and if there were smokers in the household.
Conclusions RSV infection causes major morbidity and some mortality for children with congenital heart disease. In order to minimise cost for the NHS and to maximise benefit for the patient, a list of co-morbidities which helps to identify children at risk will help to protect vulnerable children, clarify the indications and aid the paediatrician in decision making.
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