| Objective:To analyze the related risk factors and summarize the clinical characteristics of children with severe respiratory syncytial virus pneumonia.Methods:A retrospective study was conducted on children with RSV pneumonia in the respiratory department of the Children’ s Hospital affiliated to the Capital Institute of Pediatrics from January 1,2014 to December 31.(1)According to the standard of the severe pneumonia in the 2019 version of Diagnosis and treatment of community acquired pneumonia in children,the children who meet the inclusion criteria are divided into the severe RSV pneumonia group and the general group.The two groups of children were compared and analyzed by their general data,clinical symptoms,laboratory examinations,imaging data,treatment,outcomes,and follow-up information after discharge.(2)Children with known RSV subtypes were divided into the group A and B,and their general data and clinical data were compared to analyze the clinical characteristics of infection with different subtypes.(3)Single factor analysis was performed by χ2-test,Fisher exact test,t-test and u-test,and multiple factor analysis was performed by Logistic regression.Results:1.Among the 248 patients included in the study,194 cases(78.2%)were≤2 years old,and the ratio of male to female was 1.9:1.RSV infection occurred throughout the year,and the incidence rate was highest in winter and autumn(83.4%).2.According to disease severity,111 cases(44.8%)were in the severe group and 137 cases(55.2%)were in the general group.The differences in the gender,feeding method,atopic history of the family,onest seasons between the two group were not obvious(P>0.05),and the differences in the age,fetal age,underlying diseases,atopy,history of maternal diabetes during pregnancy,sibilings,co infection between the two groups were statistically significant(P<0.05).The median and quartile proportions of neutrophils in the severe group were 42.4(30.0-56.0)%,and the platelet count was 364(275-475)×109/L,which were significantly higher than those in the normal group(P<0.001).However,there was no statistically significant difference in the white blood cell count,CRP,ALT,AST and D-dimer levels between the two groups(P>0.05).The multivariate logistic regression determined the factors increasing the risk of severe RSV infection were:less than six months old(OR=2.763,P=0.010),premature delivery(OR=3.577,P=0.008),underlying diseases(OR=25.006,P<0.001),atopy(OR=3.381,P<0.001),history of maternal diabetes during pregnancy(OR=14.174,P=0.031),co infection(OR=2.983,P=0.001),increased proportion of neutrophils in peripheral blood(OR=3.571,P=0.003).3.The symptoms of cough was found in all casese(100%),followed by fever(82.3%)and wheezing(69.8%),and some of them had diarrhea(15.3%).The symptoms of wheezing and dyspnea in the severe infected group were significantly higher than those in the general infected group,and the difference was statistically significant(P<0.05).On chest imaging,lung patchy shadows were the main manifestations in both groups(65.7%vs 56.9%),while in the severe group,large lung consolidation(7.2%vs 0),interlobular septal thickening(3.6%vs 0)and bronchial wall thickening(4.5%vs 0)were observed.4.In severe group,there were 74 cases of respiratory failure(66.7%),3 cases of atelectasis(2.7%),2 cases of pleural effusion(1.8%),1 case of pneumothorax(0.9%);2 cases of secondary metabolic acidosis(1.8%),3 cases of toxic encephalopathy(2.7%),and 1 of them was complicated with sepsis and toxic enteroparalysis(0.9%)5.A total of 108 children in the two groups were infected with other pathogens(43.55%),of which 75 cases(30.24%)were double infection and 33 cases(13.31%)were multiple infection.The detection rate of combined bacteria(81/248,32.66%)was higher than that of combined virus(28/248,11.29%).Among the co infection pathogen,haemophilus influenzae accounted for the highest proportion(36/248,14.52%),followed by streptococcus pneumoniae(26/248,10.40%),EB virus was the most common co infected virus(13/248,5.24%)and mycoplasma(19/248,7.66%)was the most common co-infected atypical pathogen.Compared with single infection,children with co infection were prone to dyspnea,had higher CRP level,higher proportion of oxygen therapy,intravenous glucocorticoid and antibiotics,and longer hospitalization time.6.In the severe group,75 patients(67.6%)needed oxygen therapy,including 65(58.6%)patients with oxygen inhalation through nasal catheter,9(8.0%)patients with non-invasive mechanical ventilation,and 1(0.9%)patients with invasive mechanical ventilation.Intravenous use of gamma globulin,glucocorticoids and antibiotics in the severe group was significantly higher than that in the general group(9.9%vs 0,62.1%vs 21.2%,56.8%vs 38.0%,P<0.01).In terms of antibiotic use,single drug use was dominant in both groups(47.8%vs 46.5%,P>0.05),and the proportion of combined drug use in the severe group was higher than that in the general group(9.0%vs 1.5%,P<0.01).Among the single antibiotic use,the use rate of cephalosporins was higher in the severe group(21.62%vs 9.49%,P=0.008),while the third-generation cephalosporin was most common(12.61%vs 3.65%,P=0.008).The utilization rate of macrolide was higher in the general group(18.25%vs 16.22%,P=0.064),but there was no statistically significant difference between the groups.Among the combined drug use,the use rate of cephalosporins combined with macrolide was the highest(5.41%vs 0.73%,P=0.047).Among 248 cases,229 cases(92.3%)reached the discharge standard,19 cases(7.7%)were discharged automatically without recovery,and no death.The hospitalization time in the severe group was longer(P<0.001).7.Because of the replacement of the electronic medical record system in the hospital,137 children’s telephone numbers were missing,so only 111 children enrolled in the group in 2017-2018 were followed up by telephone.99 of them were followed up successfully,and the result showed that with in one year after discharge the incidence rate of secondary wheezing was 22.20%and recurrent wheezing was 13.13%,and the rate of diagnosed as bronchial asthma by doctors accounted for 4.04%,but there was no significant difference between the two groups(P>0.05).8.Among the 58 patients with known RSV subtypes,50 cases were infected with RSV-A and 8 cases were infected with RSV-B.There was no statistically significant difference in clinical symptoms and disease severity between the two groups(P>0.05).The proportion of having sibilings and the intravenous use of glucocorticoids in RSV-A group were higher than those in B group.The ALT level of RSV-B group was higher than that of A group.Conclusion:1.The factors increasing the risk of sever RSV infection were:Less than six months old,premature delivery,underlying diseases,atopy,history of maternal diabetes during pregnancy and co infections.The increased proportion of neutrophils in peripheral blood was a predictor of severe RSV infection,while white blood cells count and C-reactive protein can not reflect the disease severity well.There was no significant difference in the severity of disease caused by different subtypes of RSV.2.Severe RSV infection are prone to wheezing,dyspnea and respiratory failure,which will lead to more serious disease burden.3.Most of the children with RSV pneumonia have a good prognosis,and a few of them may develop recurrent wheezing and even asthma. |
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