There were, however, no significant differences between the premature group and the special population group in terms of proportions of hospitalized infants tested for RSV (79% vs. at enrolment (10.2??9.2 vs. 3.5??3.1?months, valuerepresent the overall percentages of each disorder subgroup Of the 5,832 included patients, 291 patients (5.0%) were withdrawn. There was no significant difference between groups in the proportion of patients withdrawn (5.0% vs. 4.9%, value /th /thead Mean length of stay (daysSD)7.3??6.97.3??5.80.995Admitted to ICU (%)15 (29.4)8 (40.0)0.411Mean length of stay in ICU (daysSD)1.7??3.73.3??5.40.241Given respiratory support (%)10 (19.6)12 (60.0)0.002Mean length of respiratory support (daysSD)1.0??3.13.6??5.00.044Intubated (%)4 (7.8)5 (25.0)0.105Mean length of intubation (daysSD)0.7??2.91.6??3.60.299 Open in a separate window Mean lengths of stay are calculated only for those that experienced the event A greater proportion of group 2 infants (2.35%, 95%CI 1.56C3.52) had an RSV-positive hospitalization compared with group 1 infants (1.32%, 95%CI 1.04C1.68; em p /em ?=?0.003). There was no significant difference Glycolic acid oxidase inhibitor 1 between the two groups in terms of number of days to their first RSV-positive hospitalization (43.2??38.0 vs. 32.5??40.6, em p /em ?=?0.307). In a Cox proportional hazards model, group 2 had a similar risk of RSV-positive hospitalization compared with group 1 (HR?=?1.6, 95%CI 0.96C2.86, em B /em ?=?0.468, em df /em ?=?1, em p /em ?=?0.106; Fig.?2b) and neither compliance ( em p /em ?=?0.702) nor the interaction of the two ( em p /em ?=?0.130) significantly affected RSV-positive hospitalization risk. Standard indications A subanalysis was conducted comparing infants in group 2 with infants prophylaxed for all other indications (prematurity, as well as BPD/CLD and CHD) ( em n /em ?=?6,387). The results were similar to the original analysis. There was a significant difference between infants prophylaxed for all standard indications (prematurity, BPD/CLD, and CHD) and the special population in terms of proportion with an RI hospitalization (5.7% vs. 9.0%, em p /em ? ?0.0005). Similarly, being in the special population group was associated with an increased HR for RI hospitalization (HR?=?1.5, 95%CI 1.2C1.9, em B /em ?=?0.388, em df /em ?=?1, em p /em ?=?0.001). A trend was found where a greater proportion of infants in the special population group had RSV hospitalizations compared to those with standard indications (2.35% vs. 1.40%, em p /em ?=?0.062) (unadjusted), but HRs for RSV-positive hospitalization were again similar (HR?=?1.536, 95%CI 0.889C2.654, em B /em ?=?0.429, em df /em ?=?1, em p /em ?=?0.124). Discussion There has been a fourfold rise over the past 4?years from 5.6% to 19.1% in infants receiving palivizumab prophylaxis for non-approved underlying medical conditions. This was primarily driven by increases in the Down syndrome category and also by those that were immunized for other reasons. Examples in the latter group include having a twin that qualified for prophylaxis, severe failure to thrive in association with short bowel syndromes and cholestasis, tracheostomy, severe obstructive sleep apnea, and complex metabolic disorders. The results suggest that physicians and healthcare providers are increasingly prescribing palivizumab prophylaxis for indications not currently recommended by position statements and provincial guidelines [2]. Differences in demographic information between the two groups showed that a greater proportion of group 2 infants were in daycare than group 1. However, this is not unexpected, as group 2 infants were, on average, older at the age of enrolment. While no significant differences were found between groups relative to expected doses received, a significantly lower percentage of group 2 infants received all their injections within the recommended time intervals. Group 2 infants were twice as likely to be hospitalized for both an RI event and RSV infection. This could be due Glycolic acid oxidase inhibitor 1 to lower efficacy of RSV prophylaxis in this population, but this group also comprises a range of medical disorders and disease severity and our sample Glycolic acid oxidase inhibitor 1 sizes are too small to individually elucidate the effect of immunization on RSV hospitalization in each condition. It is more likely that the severity of the preexisting medical disorder in these patients makes them generally more susceptible to RIs and perhaps RSV prophylaxis may modulate the degree of illness, but this has yet to be determined. While compliance has previously been shown to be associated with lower RSV-positive hospitalization rates [18], this was Glycolic acid oxidase inhibitor 1 not found in the current data. However, our results concur with the Palivizumab Outcomes Registry, which also found no association between compliance and RSV-positive hospitalization [17]. Higher RSV-positive hospitalization rates have been documented in infants with other medical conditions. A retrospective cohort study of Glycolic acid oxidase inhibitor 1 children prophylaxed in Tennessee reported that, of 3,378 hospitalizations over Rabbit Polyclonal to MRPS24 4?years, 22.8% occurred in children with other medical conditions, such as Down syndrome and neuromuscular disease, while only 12.2% were attributed to prematurity [8]. Similarly, in a nationwide Japanese survey conducted from 2006 to 2008, 1,115 children aged 4?years who were.
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