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 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The efficacy, safety, administration, and advantages and disadvantages of respiratory syncytial virus (RSV) immune globulin and palivizumab for preventing RSV infection are discussed. Prevention of RSV infection has attracted considerable attention because of its dinical and economic impact. Studies have shown respiratory syncytial virus immune globulin intravenous (RSV-IGIV) and palivizumab to be effective in decreasing the number of hospitalizations and hospital days attributable to RSV. The number of intensive-care-unit admissions and the severity of RSV infection in high-risk children decreased with the use of these agents. Both agents have been well tolerated, with few adverse effects; however, their high cost necessitates strict guidelines on use. The patient populations at greatest risk are those with bronchopulmonary dysplasia, those with congenital heart disease, those with a history of apnea or respiratory arrest, immunocompromised patients, those with pulmonary consolidation on chest radiography, and those born prematurely. American Academy of Pediatrics guidelines do not preferentially recommend use of either agent; each has advantages and disadvantages. Prophylactic therapy with RSV-IGIV or palivizumab may reduce the likelihood of RSV infection in high-risk patients.
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PMID:Respiratory syncytial virus (RSV) immune globulin and palivizumab for prevention of RSV infection. 1067 78

Respiratory syncytial virus (RSV) is a common cause of respiratory illness in young children, almost all will have been infected by the age of two years old. Very young infants, and those with underlying disease, are at risk of severe RSV disease, but even those who were previously healthy can suffer recurrent respiratory symptoms 9 to 10 years after their initial infection. The management of RSV infection is essentially supportive, thus prophylaxis offers the best hope of reducing the morbidity and mortality of RSV infection. There is no safe and effective RSV vaccine to use in those infants who are at highest risk from the infection. Immunoprophylaxis, however, has been shown to have benefits in randomised controlled trials. Standard immunoglobulin, however, is ineffective as its administration does not achieve an adequate titre of neutralising antibodies. RSV immunoglobulin (RSV-IGIV, RespiGam, Massachusetts Public Health Laboratories, Boston, MA), in contrast, contains high levels of RSV neutralising antibody and has been shown to significantly reduce hospitalisation in preterm infants with or without bronchopulmonary dysplasia (BPD). Its use is not recommended in infants with cyanotic congenital heart disease (CHD), as it was associated with an excess of adverse events. A humanised RSV monoclonal antibody (Palivizumab, MEDI-493, Synagis, MedImmune Inc, Gaithersburg, MD) also significantly reduces hospitalisation for RSV infection in high risk infants, but without serious side effects. The American Academy of Paediatrics has recommended that immunoprophylaxis should be considered for young children at high risk of severe RSV infection and that palivizumab is the preferred agent. Studies have suggested it is essential to carefully select patients for immunoprophylaxis, if its use is to be cost-effective.
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PMID:Respiratory syncytial virus prevention: past and present strategies. 1124 87

Respiratory syncytial virus (RSV) infection, which primarily manifests as bronchiolitis or pneumonia, is the leading cause of lower respiratory tract infection in infants and young children. It is associated with more than 100,000 pediatric hospitalizations each year in the United States. Infants who were premature; have chronic lung disease, congenital heart disease, or immunodeficiency disorders; or have underlying metabolic or neuromuscular disorders are at increased risk for especially severe RSV disease. Treatment of children hospitalized with RSV disease is primarily supportive, with administration of supplemental oxygen and fluid replacement therapy. Bronchodilators may benefit at least a subset of such patients. Antiviral therapy with aerosolized ribavirin is available for high-risk, severely ill patients. Handwashing, cleaning of environmental surfaces, and cohorting in hospital settings may decrease RSV transmission. In children born premature and younger than 1 year of age, and in patients with bronchopulmonary dysplasia younger than 2 years of age, passive protection against severe RSV disease may be achieved through monthly injections of anti-RSV antibody (palivizumab) during winter months. No vaccine is available to provide active immunity against RSV, but live attenuated and subunit cloned surface protein vaccines are in development.
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PMID:Respiratory Syncytial Virus: Update on Infection, Treatment, and Prevention. 1138 54

(1) Approximately 80% of cases of bronchiolitis appear to be due to respiratory syncytial virus (RSV). (2) Overall, about 1% of cases of bronchiolitis lead to hospitalisation. This rises to about 25% in children with a history of severe prematurity, bronchopulmonary dysplasia or congenital heart disease.
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PMID:RSV infection and bronchiolitis: who qualifies for prevention? 1147 95

We report on a female preterm infant with hepatic failure and neonatal tissue siderosis of hemochromatotic type diagnosed by using both histochemistry and atomic absorption spectroscopy. The infant presented with meconium ileus, signs of rapidly progressive hepatic failure, and hyperferritinemia (7132 ng/ml). Despite surgery and intensive care the infant died 32 days after birth. Postmortem examination showed a wrinkled liver with extensive collapse of the hepatic architecture and regenerating nodules as well as hepatic and extrahepatic iron accumulation of hemochromatotic type, sparing the reticuloendothelial system. Atomic absorption spectroscopy confirmed an increase in the iron content of various organs: liver, heart, pancreas, oral salivary gland, kidney, and adrenal gland. The increase in the iron content of various organs was determined by comparing the analysis of the propositus with those of 5 gestationally age-related preterm infants who had died in the intensive care unit: 2 died of meconium aspiration syndrome, the other 3 of hyaline membrane disease, bronchopulmonary dysplasia, and immaturity, respectively. We also compared the analysis of 15 fetuses having a a condition predisposing to iron accumulation (trisomy 21, trisomy 18, cytomegalovirus, amnion infection syndrome, Rhesus- and ABO-incompatibility, congenital hemolysis, anti-phospholipid syndrome, congenital heart disease). Delta F508, the most frequent mutation seen in cystic fibrosis patients, was excluded by gene sequencing. Different noxae causing iron accumulation in the neonatal period have led to the statement that neonatal hemochromatosis may collect different etiologies, such as metabolic disorders, infections, chromosomal aberrations, and immunological disorders. In this study, we report the singular evidence of neonatal iron accumulation of hemochromatotic type in an infant presenting with meconium ileus and propose a classification of the neonatal disorders associated with iron accumulation.
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PMID:Hepatic failure with neonatal tissue siderosis of hemochromatotic type in an infant presenting with meconium ileus. Case report and differential diagnosis of the perinatal iron storage disorders. 1170 Aug 92

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory disease in young children in both developing and developed countries. By age 2, nearly all children have been infected by RSV.The clinical manifestations range from mild upper respiratory symptoms to bronchiolitis and pneumonia. First infections are nearly always symptomatic and frequently cause lower respiratory tract disease, whereas subsequent infections are generally milder. Although children with underlying conditions such as prematurity, chronic lung disease, congenital heart disease, and immuno-suppression are at high risk for severe disease, many children without underlying conditions require hospitalization. Treatment is supportive. Immunoprophylaxis with palivizumab or RSV immune globulin may benefit children born prematurely, especially those with bronchopulmonary dysplasia. To date, the development of an effective vaccine has been unsuccessful.
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PMID:Respiratory syncytial virus infections in children. 1189 15

Respiratory syncytial virus remains a significant cause of severe lower respiratory tract disease in children. The risk of serious RSV illness is highest among children with prematurity, chronic lung disease and congenital heart disease. No effective vaccine and anti-viral agents have been obtained even now. Therefore, conservative therapy including respiratory aid has been a principal therapy for serious RSV disease. Recently, monthly intramuscular administration of humanized anti-RSV monoclonal antibody(palivizumab) was introduced in clinical fields in USA and Europe. Palivizumab prophylaxis has appeared to be safe and effective for prevention of serious RSV illness in premature children and those with bronchopulmonary dysplasia.
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PMID:[Humanized respiratory syncytial virus monoclonal antibody]. 1190 63

Severe respiratory syncytial virus (RSV) disease is associated with unacceptable morbidity and mortality in children, especially in young children. Underlying conditions including prematurity with or without bronchopulmonary dysplasia, congenital heart disease, immunosuppression or another underlying respiratory condition, such as cystic fibrosis, increase the risk of contracting and developing severe RSV disease. Environmental factors such as crowding, day-care attendance, and exposure to passive smoke can increase the risk of severe RSV disease. Children with severe RSV disease often require intensified medical care, including hospitalization, which places a burden on the child, the family, and the health care system. There are currently no effective curative treatments for severe RSV disease. Preventive measures, such as infection control and prophylaxis, appear to be the best options in the management of RSV disease in these high-risk patients.
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PMID:Risk factors for severe respiratory syncytial virus infection in infants. 1199 3

Identification of variables that predict duration of RSV-associated hospitalization may be useful in the identification of preventive and therapeutic strategies. A recently published prediction model (Michigan model) for the duration of hospitalization in RSV infection demonstrated good discrimination between children with and without an increased likelihood of a hospital stay >or= 7 days, based on variables such as log weight, congenital heart disease, failure to thrive, premature birth, bronchopulmonary dysplasia, other pulmonary diseases, miscellaneous conditions, early mechanical ventilation, and early ribavirin treatment (receiver operating characteristic (ROC) area, 0.89). Validation of this model is of particular interest for Europe, since the mean duration of hospitalization in The Netherlands is approximately twice that in the USA. The objective of the current study was 1) to validate the Michigan model for RSV hospitalized patients in a large university hospital in The Netherlands, and 2) to develop our own prediction model for a prolonged hospital stay. Data from 177 children younger than 12 months of age admitted with confirmed RSV infection to the Sophia Children's Hospital Rotterdam between 1992-1995, were used for valiation of the Michigan model and derivation of the Rotterdam model. Mean duration of hospitalization for the Rotterdam database was 10.3 (+/-6.3) days, with a median of 9 days; 138 (78%) patients had a hospital stay >or= 7 days. The Michigan model performed poorly when applied to the Rotterdam database, with an ROC area of 0.65 (95% CI, 0.57-0.73). The Rotterdam prediction model (hospital stay >or= 9 days, the median in our database) considered weight and need for oxygen supplementation. The ROC area was 0.65 (95% CI, 0.57-0.73). When using data from patients for the 1995-1996 season, the ROC area was 0.52 (95% CI, 0.34-0.72). The Michigan and the Rotterdam models failed to identify a considerable number of patients who had a prolonged hospital stay, with a low false-positive rate. We conclude that neither the Michigan, nor the Rotterdam model reliably predicted the duration of hospitalization based on demographic and clinical variables.
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PMID:Prediction of duration of hospitalization in respiratory syncytial virus infection. 1200 Dec 79

Respiratory syncytial virus (RSV) is the most common pathogen of the lower respiratory tract in infants. Groups at risk for severe disease include preterm infants, infants with pulmonary disease such as bronchopulmonary dysplasia, infants with congenital heart disease, and infants suffering from immunodeficiency. However, most infants getting severely ill from RSV are otherwise healthy and born at term. The incidence of hospitalisation caused by RSV is increasing, and there is an association between diagnosed RSV infection and subsequent development of wheeze and asthma. No vaccine or causal therapy is available. However, prophylaxis with a humanized monoclonal antibody of murine origin, palivizumab, reduces the risk of hospitalisation in high-risk infants, but the treatment is expensive. The most important prophylaxis methods at the present time are therefore hygienic measures with the purpose of preventing nosocomial infection in hospitals.
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PMID:[Respiratory syncytial virus]. 1252 6


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