07:00am Wednesday 22 November 2017

Preventing common respiratory infection in preterm babies: NEJM study

RSV (respiratory syncytial virus) is highly contagious and is the most important cause of hospitalization in babies during the ‘RSV season,’ which in Canada is December through April. Respiratory symptoms of RSV are similar to those for cold and flu, and it’s often confused with those viral diseases unless confirmed by testing.

RSV is highly contagious and is second only to influenza for causing lung-relate hospitalizations of babies in ‘RSV season,’ which in Canada is December through April. Respiratory symptoms of RSV are similar to those for cold and flu, and it’s often confused with those viral diseases unless confirmed by testing.

The randomized clinical trial shows that treating all premature babies with the biologic drug palivizumab dramatically reduces wheezing throughout the first year of life. The effects remained after therapy had stopped and beyond the RSV season. Also important, the study confirms that the virus is the cause of the recurrent wheezing seen among premature babies as they grow throughout the first year, says lead author Dr. Maarten Blanken. “Until now we haven’t known whether RSV is actually the cause of long-term wheezing or not. It’s been a chicken-and-egg question,” he says. A visiting Research Fellow at SickKids, Dr. Blanken is based at University Medical Center Utrecht in The Netherlands.

The trial looks at 429 preterm infants across The Netherlands who were randomized to the drug (a monoclonal antibody) or placebo. It shows that as a preventive treatment, the product reduced the number of wheezing days in the first year of life by 61 per cent.

These results lay the groundwork for a follow-up study on the role of RSV in the child’s risk of asthma, Dr. Blanken says. Next steps for his research group include comparing asthma rates in the treatment group to those in the placebo group as the children grow. Dr. Blanken’s team hopes to determine whether the RSV-caused wheezing causes asthma, which is also an important cause of hospitalization in children.

The potential cost of giving virtually all preterm babies palizumab is an important consideration for neonatal intensive care units. With that in mind, Dr. Blanken is working with Dr. Wendy Ungar at SickKids on an economic analysis of the preventive protocol. Dr. Ungar is Director of TASK (Technology Assessment at SickKids) and Senior Scientist in Child Health Evaluative Sciences at SickKids.

Dr. Blanken’s research team in Utrecht includes Dr. Louis Bont, a world expert in RSV infection.

The study is called “Respiratory Syncytial Virus and Recurrent Wheeze in Healthy Preterm Infants.”

The Hospital for Sick Children (SickKids).


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