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Impact of palivizumab on RSV hospitalizations for children with hemodynamically significant congenital heart disease.

Chang RK, Chen AY - Pediatr Cardiol (2009)

Bottom Line: That represents a 19% reduction in RSV hospitalizations among HS-CHD patients after 2003.The 19% decrease in RSV hospitalizations equates to seven fewer hospitalizations (76 hospital days) per year among HS-CHD patients.We conclude that, since the recommendation of palivizumab for children with HS-CHD in 2003, the impact on RSV hospitalizations in California among HS-CHD patients has been limited.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 491, Torrance, CA 90509, USA. rkchang@ucla.edu

ABSTRACT
The objective of this study was to evaluate the impact of palivizumab prophylaxis on respiratory syncytial virus (RSV) hospitalizations among children with hemodynamically significant congenital heart disease (CHD). In 2003, the American Academy of Pediatrics (AAP) revised the bronchiolitis policy statement and recommended the use of palivizumab in children <24 months old with hemodynamically significant CHD (HS-CHD). California statewide hospital discharge data from years 2000-2002 (pre-AAP policy revision) were compared to those from years 2004-2006 (post-AAP policy revision). Hospitalizations due to RSV bronchiolitis for children <2 years of age were identified by IDC-9 CM codes 4661.1, 480.1, and 079.6 as the Principal Diagnosis. Children with CHD and children with HS-CHD were identified by the codiagnoses. The overall RSV hospitalization rate was 71 per 10,000 children <2 years of age. Of all RSV hospitalizations, 3.0% were among children with CHD, and 0.50% among children with HS-CHD. HS-CHD patients accounted for 0.56% of RSV hospitalizations in 2000-2002, compared to 0.46% RSV hospitalizations in 2004-2006. That represents a 19% reduction in RSV hospitalizations among HS-CHD patients after 2003. The 19% decrease in RSV hospitalizations equates to seven fewer hospitalizations (76 hospital days) per year among HS-CHD patients. We conclude that, since the recommendation of palivizumab for children with HS-CHD in 2003, the impact on RSV hospitalizations in California among HS-CHD patients has been limited. Considering the high cost of palivizumab administration, the cost-benefit of RSV prophylaxis with palivizumab warrants further investigation.

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Average length of stay (days) for all patients <2 years of age (filled circles), patients with congenital heart disease (CHD; filled squares), and patients with cyanotic CHD or heart failure (HS-CHD; open circles), 2000–2006
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Fig2: Average length of stay (days) for all patients <2 years of age (filled circles), patients with congenital heart disease (CHD; filled squares), and patients with cyanotic CHD or heart failure (HS-CHD; open circles), 2000–2006

Mentions: Table 1 summarizes the RSV hospitalizations among all patients <2 years, patients with CHD, and patients with HS-CHD. The length of stay was significantly longer for HS-CHD patients. No trend of changes was noted in the mean or median length of stay over time (Fig. 2). Among the RSV hospitalizations, 2.5% required intubation or use of a ventilator. The percentage of HS-CHD hospitalizations requiring intubation/ventilator was not significantly different in 2000–2002 (17.9%) versus 2004–2006 (18.0%; p = 0.87).Table 1


Impact of palivizumab on RSV hospitalizations for children with hemodynamically significant congenital heart disease.

Chang RK, Chen AY - Pediatr Cardiol (2009)

Average length of stay (days) for all patients <2 years of age (filled circles), patients with congenital heart disease (CHD; filled squares), and patients with cyanotic CHD or heart failure (HS-CHD; open circles), 2000–2006
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2807022&req=5

Fig2: Average length of stay (days) for all patients <2 years of age (filled circles), patients with congenital heart disease (CHD; filled squares), and patients with cyanotic CHD or heart failure (HS-CHD; open circles), 2000–2006
Mentions: Table 1 summarizes the RSV hospitalizations among all patients <2 years, patients with CHD, and patients with HS-CHD. The length of stay was significantly longer for HS-CHD patients. No trend of changes was noted in the mean or median length of stay over time (Fig. 2). Among the RSV hospitalizations, 2.5% required intubation or use of a ventilator. The percentage of HS-CHD hospitalizations requiring intubation/ventilator was not significantly different in 2000–2002 (17.9%) versus 2004–2006 (18.0%; p = 0.87).Table 1

Bottom Line: That represents a 19% reduction in RSV hospitalizations among HS-CHD patients after 2003.The 19% decrease in RSV hospitalizations equates to seven fewer hospitalizations (76 hospital days) per year among HS-CHD patients.We conclude that, since the recommendation of palivizumab for children with HS-CHD in 2003, the impact on RSV hospitalizations in California among HS-CHD patients has been limited.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Pediatrics, Harbor-UCLA Medical Center, 1000 West Carson Street, Box 491, Torrance, CA 90509, USA. rkchang@ucla.edu

ABSTRACT
The objective of this study was to evaluate the impact of palivizumab prophylaxis on respiratory syncytial virus (RSV) hospitalizations among children with hemodynamically significant congenital heart disease (CHD). In 2003, the American Academy of Pediatrics (AAP) revised the bronchiolitis policy statement and recommended the use of palivizumab in children <24 months old with hemodynamically significant CHD (HS-CHD). California statewide hospital discharge data from years 2000-2002 (pre-AAP policy revision) were compared to those from years 2004-2006 (post-AAP policy revision). Hospitalizations due to RSV bronchiolitis for children <2 years of age were identified by IDC-9 CM codes 4661.1, 480.1, and 079.6 as the Principal Diagnosis. Children with CHD and children with HS-CHD were identified by the codiagnoses. The overall RSV hospitalization rate was 71 per 10,000 children <2 years of age. Of all RSV hospitalizations, 3.0% were among children with CHD, and 0.50% among children with HS-CHD. HS-CHD patients accounted for 0.56% of RSV hospitalizations in 2000-2002, compared to 0.46% RSV hospitalizations in 2004-2006. That represents a 19% reduction in RSV hospitalizations among HS-CHD patients after 2003. The 19% decrease in RSV hospitalizations equates to seven fewer hospitalizations (76 hospital days) per year among HS-CHD patients. We conclude that, since the recommendation of palivizumab for children with HS-CHD in 2003, the impact on RSV hospitalizations in California among HS-CHD patients has been limited. Considering the high cost of palivizumab administration, the cost-benefit of RSV prophylaxis with palivizumab warrants further investigation.

Show MeSH
Related in: MedlinePlus