Thang Nguyen, MD
Pediatric Intensivist
Medical Intensive Care Unit, Vietnam National Children's Hospital, United States
Disclosure information not submitted.
Canh Hoang, MD
Pediatric Resident
Vietnam National Children's Hospital, United States
Disclosure information not submitted.
Hanh Tran, MD
Pediatric Resident
Vietnam National Children's Hospital, United States
Disclosure information not submitted.
Bin Huey Quek, MD
Neonatologist
Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, United States
Disclosure information not submitted.
Lee Jan Hau, MBBS, MRCPCH, MCI (he/him/his)
KK Women's and Children's Hospital, Singapore
Singapore, Slovenia
Disclosure information not submitted.
Title: The Epidemiology of Critical Respiratory Diseases in Ex-premature Infants in Vietnam
Introduction: The burden of ex-premature infants admitted to pediatric intensive care unit (PICU) and its impact on health care system in low and middle-income countries are not well described. This study aimed to describe epidemiology, resource utilization, and outcomes of ex-premature infants (EPI) with critical respiratory illness in Vietnam and to test hypothesis that EPI require more PICU resources and have worse outcomes compared to term infants.
Methods: This prospective observational study was conducted from November 2019 to April 2021 at the medical PICU, Vietnam National Children’s Hospital. Infants < 2 years admitted to the PICU for acute respiratory illnesses were enrolled. Demographic and clinical details of the study population were recorded. We compared outcomes and major resources used between term and ex-preterm infants. Continuous and categorical variables were described in medians (interquartile range) and numbers (percentages), respectively.
Results: A total of 1183 patients < 2 years were admitted to the PICU for critical respiratory illness. 202 (17.1%) infants (gestation age (GA) and birth weight of 29.5 weeks [27; 33]1,200 g [600; 1,800], respectively) were premature. Respiratory viruses were detected in 53.5% and 38.2% among EPI and term infants, respectively. Respiratory syncytial virus was the most common virus etiology in both groups. Compared to term infants, a higher proportion of EPI required mechanical ventilation (MV) (66.5 vs. 85.6%, p< 0.005) and vasopressor (10.7 vs. 37.6%, p< 0.005) support. EPIs had a longer duration of PICU (11.0 [7; 22] vs 6.0 days [3; 11], p=0.09) and hospital stay (21.5[13; 40] vs 10.0[5; 18] days, p< 0.005) compared to term infants. EPI also had a higher case fatality rate compared to term infants (31.3 vs 22.6%, p =0.008).
Case fatality was 46.2% in extremely preterm group (GA < 28 weeks), which was significantly higher than that in very preterm (GA 28-32 weeks) (29.4%) and moderate to late preterm group (GA > 32 weeks) (21.9%) (p=0.017)
Conclusion: EPI with critical respiratory illness is a significant patient population in the PICU. Compared to term infants, EPI required more PICU support and had worse clinical outcomes. Future studies should examine interventions that potentially can reduce PICU admission in these vulnerable infants.