The Burden of Respiratory Syncytial Virus Disease in Pre-Term Infants

This mini-review summarises the risk factors for acquiring Respiratory Syncitial Virus (RSV)infection, and describes the harmful effects of the infection in pre-term infants. Moreover,theoretical considerations are discussed for the prevention of RSV infection in high-risk infantcategories, such as pre-term infants.Background: Neonates positive for RSV are more prone to severe infection than neonatesinfected with other common respiratory viruses. Despite RSV infection being more common in lateneonates than in early ones, pre-term infants ≤ 35 wk gestational age (GA) are at high risk fordeveloping severe RSV disease. Efforts to prevent infection include case management,vaccination and the identification of risk factors. The morbidity and mortality risks of RSV diseaseare highest in pre-term newborns with other underlying disease, such as bronchopulmonarydysplasia (BPD) or hemodynamically significant congenital heart disease (hsCHD). Associationsbetween RSV-positive neonates and climate factors are also discussed. Nosocomial-acquiredrespiratory syncytial virus infections in pre-term infants in Neonatal Intensive Care Units (NICUs)are reported. The development of an RSV vaccine has been challenging, and vaccine in pre-term infants is currently unavailable. Palivizumab, a monoclonal antibody licensed for the prevention ofRSV, lowers respiratory tract disease in pre-term infants. The home healthcare nurse can play animportant role. By developing patient and caregiver trust, the nurse can implement an RSVprevention plan, leading to a decrease in the hospitalization of premature infants with RSV.Conclusions: Commercially-insured late pre-term infants with RSV infection are at high risk ofrecurrent wheezing and infantile asthma for 1 year after the initial episode, and pose a significanteconomic burden on the healthcare system. Education is critical for the continuing development ofclinical NICU nursing practice.