COVID-19 restrictions and hygiene measures reduce the rates of respiratory infections and wheezing among preterm infants
Keywords:
preterm birth, COVID-19, bronchopulmonary dysplasia, respiratory infections, wheezingAbstract
Background and aim: During the 2020 and 2021 Italian COVID-19 pandemic social restrictions and strict hygiene measures were recommended to limit the spread of SARS-CoV-2. We aimed to assess whether rates of respiratory infections and wheezing in preterm infants have changed during the pandemic.
Methods: Single center, retrospective study. Preterm infants in the first 6 months of life discharged home prior to (Period 1, January 2017 - December 2019) or during the pandemic (Period 2, January 2020 - March 2021) were compared. Rates of respiratory infection and wheezing in preterm infants with or without bronchopulmonary dysplasia (BDP) were assessed.
Results: During period 2 premature infants had lower rates of respiratory infections (36 out of 55 in Period 1 vs 11 out of 28 in Period 2, P=0.023) and wheezing (20 out of 55 in Period 1 vs 1 out of 28 in Period 2, P=0.001). This difference remained significant when infants with BPD (all grades) were analyzed separately (respiratory infections 26 out of 40 in Period 1 vs 7 out of 24 in Period 2, P=0.005; wheezing 16 out of 40 in Period 1 vs 1 out of 24 in Period 2, P=0.001). In contrast, respiratory infections and wheezing in preterm infants without BPD did not change after pandemic.
Conclusions: Episodes of respiratory infections and wheezing among preterm infants were reduced during pandemic. We highlight the importance of proper family education for preventing respiratory tract infections in preterm infants with BPD, beyond the extraordinary conditions of the COVID-19 pandemic.
References
Vittucci AC, Piccioni L, Coltella L, et al. The Disappearance of Respiratory Viruses in Children during the COVID-19 Pandemic. Int J Environ Res Public Health. 2021;18:9550. doi: 10.3390/ijerph18189550.
Binns E, Koenraads M, Hristeva L, et al. Influenza and respiratory syncytial virus during the COVID-19 pandemic: Time for a new paradigm? Pediatr Pulmonol. 2022;57:38-42. doi: 10.1002/ppul.25719.
Allen J, Zwerdling R, Ehrenkranz R, et al.; American Thoracic Society. Statement on the care of the child with chronic lung disease of infancy and childhood. Am J Respir Crit Care Med. 2003;168:356-96. doi: 10.1164/rccm.168.3.356.
Lemons JA, Bauer CR, Oh W, et al. Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network. Pediatrics. 2001;107:E1. doi: 10.1542/peds.107.1.e1.
Lamarche-Vadel A, Blondel B, Truffer P, et al. Re-hospitalization in infants younger than 29 weeks' gestation in the EPIPAGE cohort. Acta Paediatr. 2004;93:1340-5. doi: 10.1080/08035250410032926.
Ralser E, Mueller W, Haberland C, et al. Rehospitalization in the first 2 years of life in children born preterm. Acta Paediatr. 2012;101:e1-5. doi: 10.1111/j.1651-2227.2011.02404.x.
Praprotnik M, Stucin Gantar I, Lučovnik M, Avčin T, Krivec U. Respiratory morbidity, lung function and fitness assessment after bronchopulmonary dysplasia. J Perinatol. 2015;35:1037-42. doi: 10.1038/jp.2015.124.
Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723-9. doi: 10.1164/ajrccm.163.7.2011060.
Charkaluk ML, Rousseau J, Dehouck-Vallois M, et al. Occurrence and severity of acute respiratory infections during the first year among very preterm infants: an Epipage-2 cohort analysis. Eur J Pediatr. 2021;180:1833-1840. doi: 10.1007/s00431-021-03956-w.
Natarajan G, Pappas A, Shankaran S, et al. Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia: impact of the physiologic definition. Early Hum Dev. 2012;88:509-15. doi: 10.1016/j.earlhumdev.2011.12.013.
Keller RL, Feng R, DeMauro SB,et al. Prematurity and Respiratory Outcomes Program. Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study. J Pediatr. 2017;187:89-97.e3. doi: 10.1016/j.jpeds.2017.04.026.
Cheong JLY, Doyle LW. An update on pulmonary and neurodevelopmental outcomes of bronchopulmonary dysplasia. Semin Perinatol. 2018;42:478-484. doi: 10.1053/j.semperi.2018.09.013.
Allen J, Zwerdling R, Ehrenkranz R, et al; American Thoracic Society. Statement on the care of the child with chronic lung disease of infancy and childhood. Am J Respir Crit Care Med. 2003;168(3):356-96. doi: 10.1164/rccm.168.3.356.
Berry M, Gamieldien J, Fielding BC. Identification of new respiratory viruses in the new millennium. Viruses. 2015;7:996-1019. doi: 10.3390/v7030996.
Fahey T, Stocks N, Thomas T. Systematic review of the treatment of upper respiratory tract infection. Arch Dis Child. 1998;79:225-30. doi: 10.1136/adc.79.3.225.
Mansbach JM, Piedra PA, Teach SJ, et al. Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Arch Pediatr Adolesc Med. 2012;166(8):700-6. doi: 10.1001/archpediatrics.2011.1669.
National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. CDC COVID-19 Science Briefs [Internet]. Atlanta (GA): Centers for Disease Control and Prevention (US); 2020-. Scientific Brief: SARS-CoV-2 Transmission. [Updated 2021 May 7]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570442/
McGrath-Morrow SA, Lee G, Stewart BH, et al. Day care increases the risk of respiratory morbidity in chronic lung disease of prematurity. Pediatrics. 2010;126:632-7. doi: 10.1542/peds.2010-0844.
Collaco JM, Aherrera AD, Breysse PN, Winickoff JP, Klein JD, McGrath-Morrow SA. Hair nicotine levels in children with bronchopulmonary dysplasia. Pediatrics. 2015;135:e678-86. doi: 10.1542/peds.2014-2501.
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Davide Scarponi, Luca Bedetti, Tommaso Zini, Marianna Di Martino, Greta Miriam Cingolani, Eugenio Spaggiari, Katia Rossi, Francesca Miselli, Licia Lugli, Barbara Maria Bergamini, Lorenzo Iughetti, Alberto Berardi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.