Original Article
Down Syndrome and Hospitalizations due to Respiratory Syncytial Virus: A Population-Based Study

https://doi.org/10.1016/j.jpeds.2011.11.004Get rights and content

Objective

To assess the risk estimates for respiratory syncytial virus (RSV) hospitalization in children with Down syndrome (DS) and the clinical features and severity of RSV lower respiratory tract infection (LRTI) in hospitalized children.

Study design

Statewide hospitalization data for children with DS for 1995 through 2006 from the Colorado Health and Hospital Association database were combined with birth data from the Colorado Department of Public Health and Environment to obtain population-based estimates of RSV LRTI hospitalization for children with DS in the first 2 years of life. RSV hospitalization data for children with DS at the Children’s Hospital Colorado for 2000 through 2006 were used to compare the course and severity of hospitalization of DS LRTI admissions with those of matched control subjects.

Results

There were 85 RSV LRTI hospitalizations in 630 children born with DS in Colorado, with 50 having no concurrent underlying conditions identified. Children with DS had a significantly higher risk than did those without DS for being hospitalized with RSV LRTI (OR, 5.99; 95% CI, 6.68-5.38), even in the absence of other underlying conditions (OR 3.5; 95% CI, 3.10-4.12). In the case-control study, children with DS hospitalized for RSV presented more frequently with fever (P = .005), had consolidation reported more often on chest radiography (P = .003), and were given bronchodilator therapy more often during the hospital stay (P = .002).

Conclusions

Children with DS have a higher risk of being hospitalized with RSV LRTI even in the absence of coexisting risk factors. They present more often with fever and more often have radiographic consolidation detected on chest radiography.

Section snippets

Methods

Two separate study designs were used. The first used statewide data to calculate population-based rates of RSV hospitalization in Colorado and to describe the clinical features and outcomes of RSV hospitalizations in Colorado children with and without DS. The second, a case-control study, used data from a single major children’s hospital, The Children’s Hospital, Colorado, to define differences in outcomes of children hospitalized with RSV with and without DS. The Colorado Multiple

Population-Based Rates for RSV LRTI Hospitalizations

There were 630 children with DS born in Colorado between 1997 and 2004, an average rate of 12.3 per 10 000 live births/year (95% CI, 11.35-13.25). Among these, there were 85 RSV LRTI hospitalizations within the first 2 years of life with 50 having no concurrent risk factors identified (CHD, PH, CLD, prematurity). The rate for RSV LRTI hospitalization in DS was 67 per 1000 child-years compared with 12 per 1000 child-years in the cohort without DS (OR, 5.99; 95% CI, 5.38-6.68). Comparing

Discussion

Our study shows that children with DS have a 6-fold higher risk of being hospitalized with RSV LRTI in the first 2 years of life than those without DS and an increased severity of disease when hospitalized. This has been reported previously,9, 16 but this study goes further, deriving population-based risk estimates for RSV LRTI in DS and demonstrating increased risk and severity in the absence of other risk factors including CHD. It also demonstrates a gradient in the risk and severity of RSV

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    Supported by a research grant from MedImmune. The study sponsor was not involved in any of the following: (1) study design; (2) the collection analysis, or interpretation of data; (3) the writing of the report; or (4) the decision to submit the manuscript for publication. E.S. has received research support and honoraria for talks from MedImmune and Abbott Inc. The other authors declare no conflicts of interest.

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