Family history of atopy and clinical course of RSV infection in ambulatory and hospitalized infants.
ABSTRACT Respiratory syncytial virus (RSV) infection can be severe in pediatric patients. Risk factors for severe disease include age less than 6 months, prematurity, preexisting heart or lung disease or malformations, gastroesophageal reflux, and immunodeficiency. The aim of the present study was to investigate the influence of family history of allergy on the clinical course of RSV infection in ambulatory and hospitalized infants. In a retrospective study, 172 patients younger than 12 months of age (99 inpatients and 73 outpatients) were enrolled. Information was obtained from hospital charts and from questionnaires sent to pediatricians. Inpatients had a significantly higher rate of atopy in their family history than outpatients, 62% and 29%, respectively (P < 0.001). Bronchiolitis was diagnosed more frequently in patients with an atopic burden than those without, 89% versus 74%, respectively (P < 0.02). Inpatients with an atopic family history had a significantly longer hospital stay than those without such a history, 7.4 +/- 3.7 days and 6.1 +/- 2.3 days, respectively (P < 0.04). Factors other than age that are considered a risk for severe infection with RSV (prematurity, preexisting heart or lung disease or malformation, and gastroesophageal reflux) were not confirmed in the present study. We conclude that infants with a family history of atopy are at increased risk for severe RSV infection as indicated by higher rates of hospitalization, longer hospital stay, and more frequent occurrence of bronchiolitis.
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ABSTRACT: Acute viral respiratory illness during infancy has been implicated as a precursor for subsequent lower respiratory morbidity in childhood. A prospective, longitudinal study of respiratory function, airway responsiveness, and lower respiratory illness during early childhood was performed in a cohort of 253 healthy infants to characterise those who experienced bronchiolitis. Seventeen infants (7% of the cohort), were given a diagnosis of bronchiolitis during the first two years of life with two (1%) requiring hospital admission. Seventy one per cent of those infants with bronchiolitis had a family history of atopy, 53% of asthma, and 29% had a mother who smoked cigarettes. These family history characteristics in this group with bronchiolitis were not different from the rest of the cohort. There were also no differences in the number of older siblings, the number breast fed, the duration of breast feeding, or socioeconomic status of the families between those that did and did not get bronchiolitis. Respiratory function was assessed at 1, 6, and 12 months of age. Maximum flow at functional residual capacity (VmaxFRC) was measured using the rapid thoracic compression technique. Resistance (Rrs) and size corrected compliance (Crs/kg) were obtained from a single brief occlusion at end inspiration. Airway responsiveness was assessed by histamine inhalation challenge and the provocation concentration of histamine resulting in a 40% fall on VmaxFRC from baseline (PC40) was determined. Respiratory measurements were ranked into terciles to assess the distribution of infants who developed bronchiolitis through the cohort. Cough and wheeze were noted to be frequent before the episode of bronchiolitis. This study has demonstrated that infants who develop bronchiolitis have evidence of pre-existing reduced respiratory function and lower respiratory symptoms. It is proposed that bronchiolitis, although potentially contributory, is not usually causative of subsequent lower respiratory morbidity.Archives of Disease in Childhood 02/1995; 72(1):16-24. · 3.05 Impact Factor
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ABSTRACT: Sixty-two children who had bronchiolitis in infancy associated with isolation of respiratory syncytial virus were reviewed at ages ranging from 2 to 7 years. Thrity-five (56 per cent) had had further wheezing, and 27 (43 per cent) had wheezed on more than 5 occasions. There was a significantly higher incidence of asthma in first degree relatives of those infants who developed recurrent wheezing in comparison with those of infants who did not.Journal of Pediatrics 12/1971; 79(5):744-7. · 4.04 Impact Factor
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ABSTRACT: Bronchodilator responsiveness was assessed by measuring specific respiratory conductance before and after inhalation of aerosolized bronchodilator in 50 infants who had acute bronchiolitis due to respiratory syncytial virus infection. Thirty per cent of the infants showed an improvement in specific conductance. Responders could not be differentiated from nonresponders by family histories of atopy, eosinophil counts, or immunoglobulin levels in blood and nasal secretions. Eighty-three per cent of the families and 54% of the mothers of the infants were smokers. Babies of smoking mothers had lower specific conductances than did those of nonsmoking mothers but showed no differences in bronchodilator response. The clinical significance of this bronchodilator-responsive sub-group has yet to be defined.Pediatric Pulmonology 01/1985; 1(2):85-90. · 2.38 Impact Factor