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Respiratory infection in congenital cardiac disease. Hospitalizations in young children in Spain during 2004 and 2005: the CIVIC Epidemiologic Study

Published online by Cambridge University Press:  11 June 2007

Constancio Medrano ,
Luis Garcia-Guereta ,
Josefina Grueso ,
Beatriz Insa ,
Fernando Ballesteros ,
Jaume Casaldaliga ,
Victorio Cuenca ,
Fuensanta Escudero ,
Lola Garcia de la Calzada  and
Maite Luis
...Show all authors
Constancio Medrano*
Affiliation:
Hospital Juan Canalejo, A Coruña, Spain
Luis Garcia-Guereta
Affiliation:
Hospital La Paz, Madrid, Spain
Josefina Grueso
Affiliation:
Hospital Virgen del Rocio, Sevilla, Spain
Beatriz Insa
Affiliation:
Hospital La Fe, Valencia, Spain
Fernando Ballesteros
Affiliation:
Hospital Gregorio Marañon, Madrid, Spain
Jaume Casaldaliga
Affiliation:
Hospital Vall d’Hebron, Barcelona, Spain
Victorio Cuenca
Affiliation:
Hospital Carlos Haya, Malaga, Spain
Fuensanta Escudero
Affiliation:
Hospital Virgen de la Arrixaca, Murcia, Spain
Lola Garcia de la Calzada
Affiliation:
Hospital Miguel Server, Zaragoza, Spain
Maite Luis
Affiliation:
Hospital de Cruces, Baracaldo, Spain
Manuel Luque
Affiliation:
Hospital Reina Sofia, Cordoba, Spain
Alberto Mendoza
Affiliation:
Hospital 12 de Octubre, Madrid, Spain
Fredy Prada
Affiliation:
Hospital Sant Joan de Deu, Barcelona, Spain
Maria del Mar Rodríguez
Affiliation:
Hospital Virgen de las Nieves, Granada, Spain
Pedro Suarez
Affiliation:
Hospital Materno Infantil, Las Palmas de Gran Canaria, Spain
Concepción Quero
Affiliation:
Hospital Ramon y Cajal, Madrid, Spain
Magda Guilera
Affiliation:
Health Outcomes Research Europe, Barcelona, Spain
*
Correspondence to: Constancio Medrano, Paediatric Cardiology, Children’s Heart Area, Hospital Universitario ‘Juan Canalejo’, As Xubias s/n, 15006 A Coruna, Spain. Tel: +34 981 178000, Ext.: 292038; Fax: +34 981 178196; E-mail: [email protected]
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Abstract

Objectives

To evaluate the rate of hospitalization for acute respiratory tract infection in children less than 24 months with haemodynamically significant congenital cardiac disease, and to describe associated risk factors, preventive measures, aetiology, and clinical course.

Materials and methods

We followed 760 subjects from October 2004 through April 2005 in an epidemiological, multicentric, observational, follow-up, prospective study involving 53 Spanish hospitals.

Results

Of our cohort, 79 patients (10.4%, 95% CI: 8.2%–12.6%) required a total of 105 admissions to hospital related to respiratory infections. The incidence rate was 21.4 new admissions per 1000 patients-months. Significant associated risk factors for hospitalization included, with odds ratios and 95% confidence intervals shown in parentheses: 22q11 deletion (8.2, 2.5–26.3), weight below the 10th centile (5.2, 1.6–17.4), previous respiratory disease (4.5, 2.3–8.6), incomplete immunoprophylaxis against respiratory syncytial virus (2.2, 1.2–3.9), trisomy 21 (2.1, 1.1–4.2), cardiopulmonary bypass (2.0, 1.1–3.4), and siblings aged less than 11 years old (1.7, 1.1–2.9). Bronchiolitis (51.4%), upper respiratory tract infections (25.7%), and pneumonia (20%) were the main diagnoses. An infectious agent was found in 37 cases (35.2%): respiratory syncytial virus in 25, Streptococcus pneumoniae in 5, and Haemophilus influenzae in 4. The odds ratio for hospitalization due to infection by the respiratory syncytial virus increases by 3.05 (95% CI: 2.14 to 4.35) in patients with incomplete prophylaxis. The median length of hospitalization was 7 days. In 18 patients (17.1%), the clinical course of respiratory infection was complicated and 2 died.

Conclusions

Hospital admissions for respiratory infection in young children with haemodynamically significant congenital cardiac disease are mainly associated with non-cardiac conditions, which may be genetic, malnutrition, or respiratory, and to cardiopulmonary bypass. Respiratory syncytial virus was the most commonly identified infectious agent. Incomplete immunoprophylaxis against the virus increased the risk of hospitalization.

Keywords

Infantcongenitally malformed heartshaemodynamically significantrespiratory syncytial virusTrisomy 21
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 4 , August 2007 , pp. 360 - 371
Copyright
Copyright © Cambridge University Press 2007

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