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Ý nghĩa lâm sàng của việc phòng ngừa nhiễm trùng đường hô hấp dưới do virus sincitial hô hấp ở trẻ sơ sinh sinh non từ 33 đến 35 tuần thai
Tóm tắt
Trẻ sơ sinh sinh non dễ bị nhiễm trùng đường hô hấp dưới (LRTI) do virus sincitial hô hấp (RSV) nghiêm trọng, dẫn đến nhập viện và có khả năng mắc bệnh hô hấp lâu dài. Mặc dù mức độ nghiêm trọng và hậu quả của LRTI do RSV thường được công nhận ở trẻ sinh ra ≤32 tuần tuổi thai (GA), nhưng vẫn ít người hiểu về những hậu quả tiềm tàng ở trẻ sinh ra từ 33–35 tuần GA. Tuy nhiên, có bằng chứng ngày càng tăng cho thấy trẻ sinh ra trong khoảng từ 33 đến 35 tuần GA có thể có nguy cơ mắc LRTI do RSV tương đương như trẻ sinh ra <32 tuần GA. Sự phát triển phổi bị gián đoạn và hệ miễn dịch chưa trưởng thành đã được liên kết với sự dễ bị tổn thương gia tăng với LRTI do RSV, cùng với các yếu tố nguy cơ môi trường, xã hội và sinh lý khác. Hiện tại, phương pháp hiệu quả duy nhất để phòng ngừa LRTI do RSV là sử dụng palivizumab. Trong bối cảnh tài nguyên y tế hạn chế, việc xác định các trẻ sơ sinh có nguy cơ cao nhất mắc LRTI do RSV, những người có thể được hưởng lợi nhiều nhất từ việc phòng ngừa, là điều rất mong muốn, đặc biệt trong nhóm tuổi thai 33–35 tuần. Mục đích của bài báo này là xem xét nguyên nhân và hậu quả của LRTI do RSV ở trẻ sơ sinh sinh non từ 33–35 tuần GA, và tìm hiểu khả năng sử dụng các yếu tố nguy cơ để xác định trẻ có nguy cơ cao, từ đó tối ưu hóa việc phòng ngừa. Các nguyên nhân và hậu quả của LRTI do RSV ở trẻ sơ sinh sinh non từ 33–35 tuần GA đã được xác định thông qua việc xem xét tài liệu. Một số yếu tố nguy cơ tiềm ẩn làm tăng đáng kể nguy cơ mắc LRTI do RSV nặng và nhập viện sau đó ở nhóm trẻ này đã được xác định, đặc biệt là từ các nghiên cứu FLIP và PICNIC. Một mô hình dự đoán châu Âu dựa trên các yếu tố nguy cơ trong nghiên cứu FLIP đã được phát triển và xác thực gần đây, điều này sẽ hỗ trợ xác định các trẻ sơ sinh sinh ra trong khoảng từ 33 đến 35 tuần GA có nguy cơ cao nhất nhập viện do RSV. Việc thực hiện mô hình này và dự phòng cho các trẻ sơ sinh sinh ra trong khoảng từ 33 đến 35 tuần GA nên là một quyết định quốc gia hoặc khu vực, được đưa ra dựa trên các nhu cầu sức khỏe cộng đồng khác.
Từ khóa
#trẻ sơ sinh sinh non #virus sincitial hô hấp #nhiễm trùng đường hô hấp dưới #phòng ngừa #yếu tố nguy cơ #palivizumab #sức khỏe cộng đồngTài liệu tham khảo
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