Human Rhinoviruses in Severe Respiratory Disease in Very Low Birth Weight Infant
E. Kathryn Miller, MD, MPHa, Jimena Bugna, MDb, Romina Libster, MDa,b, Bryan E. Shepherd, PhDc, Paula M. Scalzo, PhDb, Patricio L. Acosta, PhDb, Diego Hijano, MDa,b, Natalia Reynosob, Juan P. Batalle, PhDb, Silvina Coviello, PhDb, M. Ines Klein, MDb,d,e, Gabriela Bauer, MDd, Alicia Benitez, MDe, Steven R. Kleeberger, MDf, and Fernando P. Polack, MDa,b
Objectives: To assess incidence, burden of illness, and risk factors for human rhinoviruses (HRVs) in a cohort of very low birth weight (VLBW) infants.
Methods: A 2-year prospective cohort study was conducted among VLBW premature infants in Buenos Aires, Argentina. Infants were enrolled in the NICU from June 1, 2003, to May 31, 2005, and managed monthly and with every acute respiratory illness (ARI) during the first year of life. Nasal wash samples were obtained during every respiratory episode and tested for HRV, respiratory syncytial virus (RSV), human parainfluenza viruses, influenza viruses, and human metapneumovirus using reverse transcriptase-polymerase chain reaction.
Results: Of 119 patients, 66 (55%) had HRV-associated ARIs. The incidence of HRV-associated ARI was 123 events per 100 child-years of follow-up. Of those infants experiencing an episode of bronchiolitis, 40% had HRV versus 7% with RSV. The incidence of HRV-associated bronchiolitis was 75 per 100 infant-years of follow-up. HRV was associated with 12 of 36 hospitalizations (33%), and RSV was associated with 9 of 36 hospitalizations (25%). The incidence of HRV-associated hospitalization was 12 per 100 infant-years of follow-up. The risk of HRV-associated hospitalization was higher for infants with bronchopulmonary dysplasia and those who were not breastfed.
Conclusions: HRV is an important and frequent pathogen associated with severe respiratory infections in VLBW infants. Bronchopulmonary dysplasia and the absence of breastfeeding are risk factors for hospitalization. The results of our study reveal that HRV is the predominant pathogen of respiratory infections in premature infants.