M. Pilkington1,2, A. G. Kim1, N. S. Rubalcava1, G. A. Norwitz1, S. K. Gadepalli1, E. E. Perrone1 1University Of Michigan,Pediatric Surgery Section,Ann Arbor, MI, USA 2University Of Calgary,Pediatric General Surgery,Calgary, AB, Canada
Introduction: The burden of symptomatic respiratory viral illnesses in children with repaired congenital diaphragmatic hernia (CDH) within one year of their index hospitalization discharge is unknown.
Methods: Retrospectively reviewed electronic health records for all pediatric patients discharged alive with CDH from 4/2009-4/2019. Variables included initial hospitalization details, emergency department (ED) visits, and readmissions within a year of discharge. Swab-positive (SP) viral infections had a positive respiratory panel with ≥1 identified virus; presumed (P) viral infections were clinically designated (no respiratory panel sent or no virus identified). Descriptive statistics are presented as median [interquartile range] or proportions.
Results: Eighty-nine patients (49% female, EGA 39 [37+4to 39+3] weeks) diagnosed with CDH survived to discharge during the study period. The expected probability of survival was 83% [69-88%] based on the CDHSG formula. Thirty-two (36%) patients visited the ED in 65 separate encounters, 14 (44%) patients had 18 unique swab-positive or presumed (SP/P) viral infections (Figure 1). Twenty-eight (31%) patients had 58 unanticipated readmissions, 8 (29%) patients had 11 unique readmissions for SP/P viral infections. Other reasons for hospital encounters included feeding or feeding tube-related complications and post-operative issues. Identified causative viruses were human rhino-enterovirus (HRV/EV) (n=7), respiratory syncytial virus (RSV) (n=3), coronavirus (n=1), and adenovirus (n=1); 11 cases were presumed viral or virus not identified. Among patients with SP/P infections, five (29%) were born at <37 weeks’ gestation, five (29%) had required ECMO, eight (44%) were on home oxygen, and 11 (61%) were discharged on medication(s) for persistent respiratory disease on index discharge. There was no significant difference between those that did (n=17) or did not (n=72) present with a SP/P infection with regards to index hospital length of stay, ECMO use, or duration of mechanical ventilation, but significantly more patients on home oxygenation presented with a SP/P infection (47% vs 18%, p=0.01) The median length of stay for admitted patients was five days [4.5-8]. Four required intensive care management. All survived to discharge.
Conclusion: Respiratory viral infections account for one in four ED encounters and one in five unanticipated readmissions in children with CDH in the first year following discharge. The most common causative agents were HRV/EV and RSV. Data supports the importance of specific anticipatory guidance regarding the importance of exposure and hand hygiene in this vulnerable population.
