Respiratory Syncytial Virus Immunoprophylaxis in a Paediatric Cardiac Tertiary Referral Centre

Respiratory Syncytial Virus Immunoprophylaxis in a Paediatric Cardiac Tertiary Referral Centre

S252 Heart, Lung and Circulation 2010;19S:S1–S268 Abstracts ABSTRACTS respectively, since 1996. Increasing case complexity has led to the use of p...

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S252

Heart, Lung and Circulation 2010;19S:S1–S268

Abstracts

ABSTRACTS

respectively, since 1996. Increasing case complexity has led to the use of pre- and post-transplant circulatory support, management of pulmonary hypertension, T- and B-cell, and ABO mismatches. Survival did not vary according to pre-transplant diagnosis (CM or CHD) or use of pre-transplant circulatory support. Conclusions: The results of paediatric heart transplantation in Australia are comparable with internationally accepted standards. Increasing case complexity has not impacted on post-transplant survival. doi:10.1016/j.hlc.2010.06.614 600 Primary Hypoplasia of the Aortic Arch—An Unrecognized Cause of Hypertension in the Young Adult T. Goh ∗ Monash Medical Centre, Australia Investigations for hypertension (hbp) in the young centre on excluding coarctation of the aorta (coa) and renal causes (rarely endocrine causes). Little attention has been paid on the role of the primary hypoplastic aortic arch (phaa). Ohm’s law and Poiseuille’s law state: effective resistance in a tube is inversely proportional to the fourth power of the radius; supporting hbp with phaa. Aim: To investigate the incidence of phaa in pts with hbp. Method: 60 pts most of whom had previous coa were screened serially for hbp. CT/MRI of the aortic arch (aa) with special emphasis on segmental measurements indexed to BSA as follows: Normalised Arch = 14.56BSA0543 (C. Whight)

(1)

Z(S.D) = 11.49(ln(arch(mm) − 0.543 ln(BSA) − 2.678 (2) where Z < −2 = phaa and Z > −2 = normal arch. Bp > 130 systolic = hbp. Results: 4 pts with phaa were identified. Pt.1m. aged 18 had a double aortic arch with division of rt. arch in infancy. Childhood growth and bp were normal till puberty wherein hbp (140/80) was noted with no femoral delay. Z(S.D) of phaa −2.5 after stenting Z −0.5, hbp settled (120/80). Pt.2f. aged 14 had rt.ao arch with asymptomatic vascular ring and noted phaa early in childhood, observed and developed hbp (174/71) at puberty. Z(S.D) phaa −4.3.no femoral delay awaiting treatment. Pt.3f. aged 14 with Turners diagnosed in infancy with no coa. Observed and recent hbp 140/80 Z(S.D.) −3.4.no femoral delay awaiting treatment. Pt.4m. aged 18 with pda intervention in childhood, noted hpb(160/80).Z(S.D.) −3.2. no femoral delay. awaiting treatment. Conclusion: phaa (indexed) has been recognized in 4 young adult pts with hpb. Hbp settled in 1 post stenting of phaa. 3pts await treatment.

Indexed measurements of the aa should be undertaken in pts. Being investigated for hbp to ascertain incidence of phaa. doi:10.1016/j.hlc.2010.06.615 601 Respiratory Syncytial Virus Immunoprophylaxis in a Paediatric Cardiac Tertiary Referral Centre P. Alexander 1,∗ , L. Eastaugh 1 , J. Royle 2 , A. Daley 3 , L. Shekerdemian 4 , D. Penny 1 1 Cardiology Department, The Royal Children’s Hospital, Melbourne, Australia 2 Immunisation Service, Department of General Medicine, The Royal Children’s Hospital, Melbourne, Australia 3 Microbiology Department, The Royal Children’s Hospital, Melbourne, Australia 4 Paediatric Intensive Care Unit, The Royal Children’s Hospital, Melbourne, Australia

Background: Passive immunisation with palivizumab is recommended in many countries for children with haemodynamically significant CHD. Our centre trialled RSV immunoprophylaxis in such children up to 12 months old during 2008 and 2009. Methods: Institutional databases were used to identify all RSV admissions between 2005 and 2009. A separate, prospective database was developed for all CHD who received palivizumab in 2008–2009. Patients receiving palivizumab were cohorted so that multiple doses could be administered from single vials. Results: 117 infants (45 in 2008 and 72 in 2009) received a median of 4 palivizumab doses. Children with symptomatic CHD represented 6.3% of RSV bronchiolitis hospital admissions in 2005–2007 reducing to 2.3% in 2008–2009 (p = 0.06); and 64% of ICU RSV admissions in 2005–2007, reducing to 40% in 2008–2009 (p < 0.05). Infants with CHD had longer hospital admissions (median 9 days) than those without (median 4 days, p < 0.05). There were no adverse events, and in the 2-year trial period only two palivizumab patients were diagnosed with RSV. Other CHD patients requiring ICU admission for RSV bronchiolitis had their cardiac diagnosis made in other centres, or developed RSV prior to receiving palivizumab. Conclusions: Infants with CHD are at increased risk of prolonged hospital admission with RSV bronchiolitis. Coordinated palivizumab administration in infants with symptomatic CHD reduced the number of hospitalisations, and ICU admissions due to RSV. Cohorting patients for maximal palivizumab use reduced overall cost. To significantly impact on admission in our tertiary referral centre, immunoprophylaxis should be considered at a state or national level. doi:10.1016/j.hlc.2010.06.616