Preterm twins and triplets. A high-risk group for severe respiratory syncytial virus infection
E. A. Simoes, S. J. King, M. V. Lehr and J. R. Groothuis
Department of Pediatrics, University of Colorado School of Medicine, Denver.
OBJECTIVE--To assess the impact of multiple births and crowded homes on the
severity of respiratory syncytial virus illness in preterm infants with
bronchopulmonary dysplasia. RESEARCH DESIGN--Retrospective case-control
chart review from a prospective longitudinal respiratory illness study.
SETTING--Neonatal High-Risk Follow-Up Clinic (outpatient setting) and
tertiary care hospitals (inpatient setting). PARTICIPANTS--Fourteen sets of
twins and two sets of triplets followed up between 1983 and 1989 and
matched with 34 singleton infants for date of birth (within 3 months) and
gestational age (within 1 month). MEASUREMENTS/MAIN RESULTS--The risk of
developing respiratory syncytial virus illness was significantly higher in
multiple-birth infants than in singletons (53% vs 24%; P = .01).
Multiple-birth infants were also at greater risk for developing pneumonia
(24% vs 6%; P = .05) and requiring hospitalization (32% vs 18%; P = .05)
than were singletons. Additional risk factors for developing pneumonia and
bronchiolitis were examined in all 68 children. Multiple birth (P = .05),
gestational age of less than 30 weeks (P = .02), and crowded homes (defined
as more than one person living in 19 m2 of living space [P = .002] or more
than one child living in 22 m2 of living space [P = .004]) were additional
risk factors for developing pneumonia. CONCLUSION--Multiple-birth preterm
infants are at a higher risk of developing pneumonia than are singletons.
Additional risk factors for developing pneumonia in preterm infants with
bronchopulmonary dysplasia include gestational age of less than 30 weeks
and crowded homes. At-risk infants with any of these risk factors should be
targeted for prophylactic and therapeutic interventions against respiratory
syncytial virus.
