The Burden of Respiratory Syncytial Virus Disease in Pre-Term Infants

Abstract

This mini-review summarises the risk factors for acquiring Respiratory Syncitial Virus (RSV) infection, and describes the harmful effects of the infection in pre-term infants. Moreover, theoretical considerations are discussed for the prevention of RSV infection in high-risk infant categories, such as pre-term infants. Background: Neonates positive for RSV are more prone to severe infection than neonates infected with other common respiratory viruses. Despite RSV infection being more common in late neonates than in early ones, pre-term infants ≤ 35 wk gestational age (GA) are at high risk for developing severe RSV disease. Efforts to prevent infection include case management, vaccination and the identification of risk factors. The morbidity and mortality risks of RSV disease are highest in pre-term newborns with other underlying disease, such as bronchopulmonary dysplasia (BPD) or hemodynamically significant congenital heart disease (hsCHD). Associations between RSV-positive neonates and climate factors are also discussed. Nosocomial-acquired respiratory syncytial virus infections in pre-term infants in Neonatal Intensive Care Units (NICUs) are reported. The development of an RSV vaccine has been challenging, and vaccine in pre-term infants is currently unavailable. Palivizumab, a monoclonal antibody licensed for the prevention of RSV, lowers respiratory tract disease in pre-term infants. The home healthcare nurse can play an important role. By developing patient and caregiver trust, the nurse can implement an RSV prevention plan, leading to a decrease in the hospitalization of premature infants with RSV. Conclusions: Commercially-insured late pre-term infants with RSV infection are at high risk of recurrent wheezing and infantile asthma for 1 year after the initial episode, and pose a significant economic burden on the healthcare system. Education is critical for the continuing development of clinical NICU nursing practice.