Respiratory syncytial virus bronchiolitis in ex-preterm infants in the Scottish highlands: review of hospital admissions and an analysis of hospital cost.

Ex-preterm infants are vulnerable to respiratory syncytial virus (RSV) bronchiolitis and their hospital admission is associated with increased morbidity. Palivizumab is currently available as prophylaxis against RSV infection but its use in ex-preterm infants is controversial. A retrospective case review study was, therefore, carried out to determine the rate of readmission with RSV bronchiolitis among ex-preterm infants in the Highland Region of Scotland and to estimate the hospital cost per admission. Between 1995 and 1999, a total of 3,046 children under 2 years of age were admitted to Raigmore Hospital, 1,691 of whom (60.4%) lived outwith Inverness. 507 children had acute bronchiolitis and ex preterm infants with RSV positive bronchiolitis accounted for 3.6% of total admissions with acute bronchiolitis. 72% of these children lived outwith Inverness. The median length of hospital stay for children born at less than 30 weeks and for children who had had bronchopulmonary dysplasia (BPD) was 6 and 10.5 days respectively. The average hospital costs per admission for children of less than 30 weeks and children of more than 30 weeks were 3,376 Pounds and 2,074 Pounds respectively. It was more expensive for children with BPD (4,431 Pounds per admission) when compared with those without BPD (1,959 Pounds per admission). This study has shown that most of the children admitted to hospital lived outwith Inverness, many at some considerable distance, and this, as much as severity of illness, may have contributed to hospital admission. Further studies are required to determine productivity losses associated with RSV infection and justification of use of Palivizumab in ex preterm infants of less than 30 weeks gestation and of BPD living in remote areas of Scottish Highlands.