Respiratory Syncytial Virus Prophylaxis in Infants with Hemodynamically Significant Congenital Heart Defects: Single Center Study

Introduction: Respiratory syncytial virus (RSV) infection is a leading cause of morbidity and mortality in children with hemodynamically significant congenital heart defects (hsCHD). Direct viral invasion and secondary inflammatory changes by abnormal cardiopulmonary circulation are the cause of the "storm" in RSV bronchiolitis.

Aim: to assess the efficacy of palivizumab immunoprophylaxis by children with hsCHD.

Patients: 111 protocols were issued in two seasons - 67 for left-to-right shunt lesions, 27 – complex CHD and 17 - obstructive lesions: 24 of them for a second season. The results of the immunoprophylaxis were analysed based on medical documentation and telephone interview with the parents.

Results: No phone contact was accomplished in 5 cases. Immunoprophylaxis was not carried out in 14 children due to administrative reasons (5), refusal of families (3) or general practitioner (2) from intramuscular injections or death before the season (4). Ninety-two children with at least one application were included. The treatment was started before surgery in 19, after surgery in 57, and in 16 the operation was performed during immunoprophylaxis. There were no adverse events nor fatal outcomes. A full course of more than 4 applications was accomplished by 75 children. Seventy kids were disease-free during the season. 22 (24%) had acute respiratory diseases, significantly more common by the surgical group (p = 0.035). Twelve children, 5 with bronchiolitis and 2 with pneumonia, with moderate or severe course, were admitted at the community hospital. None of them needed mechanical ventilation. Hospitalized children were younger (p = 0.032) and with an incomplete course of treatment (p = 0.05).

Conclusion: Immunoprophylaxis with palivizumab safely and relatively effectively protects children with hsCHD from severe lower respiratory diseases during the RSV season. Efforts for overcoming the administrative and subjective obstacles of immunoprophylaxis and conducting a full course are needed.