Respiratory failure and death in vulnerable premature children with lower respiratory tract illness

BACKGROUND: Efforts to better understand the risk factors associated with respiratory failure (RF) and fatal LRTI in premature children in developing countries are necessary to elaborate evidenced-based preventive interventions. We aim to characterize the burden of RSV and hMPV LRTI in premature children and determine risk factors for RF and fatal illness in a vulnerable population. METHODS: A prospective, population-based, cross-sectional study. Subjects with severe LRTI were enrolled during respiratory season. Risk factors for RF and death in premature infants were investigated. RESULTS: 664 premature children participated. Infant's hospitalization rate due to LRTI was 82.6/1,000 (95% confidence interval (CI), 68.6-96.7/1,000). Infant's RSV and hMPV rates were 40.9/1,000 (36.3-45.6 /1,000) and 6.6/1,000 (3.9-9.2 /1,000), respectively. The RF rate was 8.2/1,000 (4.9-11.5 /1,000). LRTI mortality was 2.2/1,000 (0.7-3.7 /1,000); for RSV was 0.8/1,000 (0-1.7 /1,000) with a case fatality ratio of 1.8%. Never breastfeeding, malnutrition, younger than 6 months, congenital heart disease and lower hematocrit were risk factors for RF. Experiencing pneumonia, pneumothorax, sepsis or apnea were clinical determinants of poor outcomes. CONCLUSIONS: Premature children under 2 years old in vulnerable environments experience RF and death more often than term counterparts. Modifiable risk factors associated with poor outcomes should prompt evidence-based interventions.