Elsevier

The Journal of Pediatrics

Volume 166, Issue 3, March 2015, Pages 703-709.e2
The Journal of Pediatrics

Original Article
Children with Down Syndrome Are High-Risk for Severe Respiratory Syncytial Virus Disease

Portions of the study were presented at the Pediatric Academic Societies' meeting, May 4-7, 2013, Washington, DC.
https://doi.org/10.1016/j.jpeds.2014.11.058Get rights and content

Objective

To assess Down syndrome as an independent risk factor for respiratory syncytial virus (RSV) hospitalization in children younger than 3 years of age and to evaluate illness severity.

Study design

A retrospective cohort study of children enrolled in the military health system database was conducted. The effect of Down syndrome on RSV hospitalization was assessed by Cox proportional hazards model, while we controlled for risk factors. Disease severity was assessed by length of hospital stay, need for respiratory support, and age at hospitalization.

Results

The study included 633 200 children and 3 209 378 person-years. Children with Down syndrome had a hospitalization rate of 9.6% vs 2.8% in children without Down syndrome. Down syndrome had a greater adjusted hazard ratio (HR) for RSV hospitalization than most risk factors, 3.46 (95% CI 2.75-4.37). A sensitivity analysis demonstrated HR 3.21 (95% CI 2.51-4.10) for patients with Down syndrome ages 0-23 months and HR 5.07 (95% CI 2.21-11.59) ages 24-36 months. The median (IQR) length of stay of children with and without Down syndrome was 4 days (2-7) and 2 days (1-4) (P < .001). Patients with Down syndrome had a greater risk of requiring respiratory support (relative risk 5.5; 95% CI, 2.5-12.3). The median (IQR) ages at admission for children with and without Down syndrome were 9.8 months (5.5-17.7) and 3.5 months (1.7-8.7) (P < .001).

Conclusions

Down syndrome is independently associated with an increased risk for RSV hospitalization. Children with Down syndrome are older at time of RSV hospitalization and have more severe RSV illness than children without Down syndrome. This increased risk for hospitalization continues beyond 24 months.

Section snippets

Methods

We conducted a retrospective cohort database study of children born between October 1, 2005 and April 30, 2011 within TRICARE, and with minimum continued enrollment beyond 90 days of life (Figure 1; available at www.jpeds.com). The study was approved by our Institutional Review Board and the Human Research Protection Office for the Office of the Assistant Secretary of Defense for Health Affairs/Defense Health Agency. All patient data were deidentified.

TRICARE is the Department of Defense's

Results

A total of 633 200 children younger than 3 years of age and 3 209 378 person-years were studied. With the exception of male sex, the percentages of the individual known risk factors, ie, CLD, HSHD, etc., for RSV hospitalization were different between the cohort of patients with Down syndrome and the cohort of patients without Down syndrome (Table II). In addition, children with Down syndrome were more likely to have one or more concomitant risk factors than the patients without Down syndrome (P

Discussion

Our study demonstrates that children with Down syndrome have a significantly greater absolute and adjusted rate of RSV hospitalization than those without Down syndrome (Table IV). In addition, the overall incidence density rate ratio of children with Down syndrome vs those without Down syndrome was 6.93 (95% CI, 5.57-8.62). Down syndrome was associated more strongly with RSV hospitalization than any other risk factor except immunodeficiency (Table V). Previous studies have shown that nearly

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  • Cited by (0)

    The views expressed in this article are those of the authors and do not reflect the official policy or position of the United States Army, United States Air Force, the Department of Defense, or the U.S. Government. The authors declare no conflicts of interest.

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