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Pulmonary hypertension during respiratory syncytial virus bronchiolitis: a risk factor for severity of illness

Published online by Cambridge University Press:  20 May 2019

Dai Kimura Open the ORCID record for Dai Kimura [Opens in a new window] ,
Isabella F. McNamara ,
Jiajing Wang ,
Jay H. Fowke ,
Alina N. West  and
Ranjit Philip
Dai Kimura*
Affiliation:
Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, TN, USA
Isabella F. McNamara
Affiliation:
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
Jiajing Wang
Affiliation:
Division of Epidemiology, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
Jay H. Fowke
Affiliation:
Division of Epidemiology, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
Alina N. West
Affiliation:
Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, TN, USA
Ranjit Philip
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Tennessee Health Science Center/Le Bonheur Children’s Hospital, Memphis, TN, USA
*
Author for correspondence: Professor Dai Kimura, MD, FAAP, Division of Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children’s Hospital, Children’s Foundation Research Center, 50 N. Dunlap St 3rd Floor, Memphis TN 38103, USA. Tel: 901-287-6303; Fax: 901-287-6336; E-mail: dkimura@uthsc.edu
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Abstract

Background:

Respiratory syncytial virus infection is the most frequent cause of acute lower respiratory tract disease in infants. A few reports have suggested that pulmonary hypertension is associated with increased severity of respiratory syncytial virus infection. We sought to determine the association between the pulmonary hypertension detected by echocardiography during respiratory syncytial virus bronchiolitis and clinical outcomes.

Methods:

We retrospectively reviewed 154 children admitted with respiratory syncytial virus bronchiolitis who had an echocardiography performed during the admission. The association between pulmonary hypertension and clinical outcomes including mortality, intensive care unit (ICU) admission, prolonged ICU stay (>10 days), tracheal intubation, and need of high frequency oscillator ventilation was evaluated.

Results:

Echocardiography detected pulmonary hypertension in 29 patients (18.7%). Pulmonary hypertension was observed more frequently in patients with congenital heart disease (CHD) (n = 11/33, 33%), chronic lung disease of infancy (n = 12/25, 48%), prematurity (<37 weeks gestational age, n = 17/59, 29%), and Down syndrome (n = 4/10, 40%). The presence of pulmonary hypertension was associated with morbidity (p < 0.001) and mortality (p = 0.02). However, in patients without these risk factors (n = 68), pulmonary hypertension was detected in five patients who presented with shock or poor perfusion. Chronic lung disease was associated with pulmonary hypertension (OR = 5.9, 95% CI 2.2–16.3, p = 0.0005). Multivariate logistic analysis demonstrated that pulmonary hypertension is associated with ICU admission (OR = 6.4, 95% CI 2.2–18.8, p = 0.0007), intubation (OR = 4.7, 95% CI 1.8–12.3, p = 0.002), high frequency oscillator ventilation (OR = 8.4, 95% CI 2.95–23.98, p < 0.0001), and prolonged ICU stay (OR = 4.9, 95% CI 2.0–11.7, p = 0.0004).

Conclusions:

Pulmonary hypertension detected by echocardiography during respiratory syncytial virus infection was associated with increased morbidity and mortality. Chronic lung disease was associated with pulmonary hypertension detected during respiratory syncytial virus bronchiolitis. Routine echocardiography is not warranted for previously healthy, haemodynamically stable patients with respiratory syncytial virus bronchiolitis.

Keywords

Pulmonary hypertensionrespiratory syncytial viruscongenital heart diseasechronic lung disease of infancyechocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 5 , May 2019 , pp. 615 - 619
Copyright
© Cambridge University Press 2019 

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