Table 3. Summary of evidence for wheeze associated with RSV infection among within-study population comparisons.
| Outcome | Comparator 1 | Comparator 2 | FU | Study design (no. of studies); Sample size |
Absolute difference (95% CI) | Relative risk (95% CI) |
Certainty of evidence | Conclusion | |
|---|---|---|---|---|---|---|---|---|---|
| Comparator 2 risk | Absolute risk differencea | ||||||||
| Simple wheeze; parent and/or physician-reported | |||||||||
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H <12 months of age |
Prematurity: 32–35 wGA, No RSV-H <12 months of age |
During 6th y | PC32 (n=1); 434 |
14 per 100 | NS | RR 1.16 (0.70, 1.93) |
Lowb,c |
Little to no difference For parent/physician-reported simple wheeze (episodes <3 within 12 months) during the 6th year among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H <12 months of age |
Prematurity: 32–35 wGA, No RSV-H <12 months of age |
Across 2–6 y | PC32 (n=1); 474 |
49 per 100 | 18 more per 100 (7–30 more) |
RR 1.36 (1.15, 1.60) |
Lowb,c |
Small increase For parent/physician-reported simple wheeze (episodes <3 within 12 months) from 2–6 years among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
| At-risk with RSV-H vs. not-at-risk with RSV-H | Prematurity: <33 wGA & RSV-H | Term: 39–41 wGA & RSV-H | 1 y | RFUPC37 (n=1); 17 |
67 per 100 | NS | RR 0.54 (0.18, 1.55) |
Very lowb,c,d |
Very uncertain For parent and physician-reported simple wheeze (episodes <3 in 12 months) within one year among premature (<33 wGA) vs. term infants with hospitalization in their first RSV season |
| Recurrent wheeze; parent and/or physician-reported | |||||||||
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H <12 months of age |
Prematurity: 32–35 wGA, No RSV-H <12 months of age |
During 6th y | PC32 (n=1); 434 |
10 per 100 | NS | RR 1.28 (0.71, 2.32) |
Lowb,c |
Little to no difference For parent/physician-reported recurrent wheeze (≥3 episodes within 12 months) during the 6th year among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H <12 months of age |
Prematurity: 32–35 wGA, No RSV-H <12 months of age |
Across 2–6 y | PC32 (n=1); 422 |
27 per 100 | 19 more per 100 (7–35 more) |
RR 1.70 (1.27, 2.29) |
Lowb,c |
Small increase For parent/physician-reported recurrent wheeze (≥3 episodes within 12 months) from 2–6 years among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
| At-risk with RSV-H vs. not-at-risk with RSV-H | Prematurity: <33 wGA & RSV-H | Term: 39–41 wGA & RSV-H | 1 y | RFUPC37 (n=1); 17 |
0 per 100 | NS | RR 0.80 (0.04, 16.14) |
Very lowb,c,d |
Very uncertain For parent and physician-reported recurrent wheeze ≥3 episodes in 12 months) within one year among premature (<33 wGA) vs. term infants with hospitalization in their first RSV season |
| Any/all wheeze; parent and/or physician-reported | |||||||||
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H <12 months of age |
Prematurity: 32–35 wGA, No RSV-H <12 months of age |
During 6th y | PC32 (n=1); 434 |
21 per 100 | NS | RR 1.12 (0.75, 1.67) |
Lowb,c |
Little to no difference For parent/physician-reported any/all wheeze (any within 12 months) during the 6th year among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H <12 months of age |
Prematurity: 32–35 wGA, No RSV-H <12 months of age |
Across 2–6 y | PC32 (n=1); 412 |
54 per 100 | 17 more per 100 (5–31 more) |
RR 1.31 (1.10, 1.57) |
Lowb,c |
Small increase For parent/physician-reported any/all wheeze (any within 12 months) from 2–6 years among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
| At-risk with RSV-H vs. not-at-risk with RSV-H | Prematurity: <33 wGA & RSV-H | Term: 39–41 wGA & RSV-H | 1 y | RFUPC37 (n=1); 17 |
67 per 100 | NS | RR 0.64 (0.24, 1.75) |
Very lowb,c,d |
Very uncertain For parent and physician-reported any/all wheeze within one year among premature (<33 wGA) vs. term infants with hospitalization in their first RSV season |
| Severe wheeze; parent or physician-reported | |||||||||
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H <12 months of age |
Prematurity: 32–35 wGA, No RSV-H <12 months of age |
During 6th y | PC34 (n=1); 434 |
9 per 100 | NS | RR 0.91 (0.44, 1.88) |
Lowb,c |
Little to no difference For parent/physician-reported severe wheeze (≥1 hospitalization or ≥3 medical attendances or medication for three consecutive months or five cumulative months) during the 6th year among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
| At-risk with RSV-H vs. at-risk without RSV-H | Prematurity: 32–35 wGA, RSV-H <12 months of age |
Prematurity: 32–35 wGA, No RSV-H <12 months of age |
Across 2–6 y | PC34 (n=1); 427 |
24 per 100 | 14 more per 100 (3–29 more) |
RR 1.59 (1.13, 2.24) |
Lowb,c |
Small increase For parent/physician-reported severe wheeze (≥1 hospitalization or ≥3 medical attendances or medication for three consecutive months or five cumulative months) from 2–6 years among infants born premature (32–35 wGA) with vs. without hospitalization for RSV at <12 months |
| At-risk with RSV-H vs. not-at-risk with RSV-H | Prematurity: <33 wGA & RSV-H | Term: 39–41 wGA & RSV-H | 1 y | RFUPC37 (n=1); 17 |
0 per 100 | NS | RD 0.00 (-0.34, 0.34) |
Very lowb,c,d |
Very uncertain For physician-reported severe wheeze (hospitalization for wheeze in 12 months) within one year among premature (<33 wGA) vs. term infants with hospitalization in their first RSV season |
| Wheeze duration (days per month post-RSV); parent-reported | |||||||||
| Not-at-risk population | RSV-positive, hospitalized | RSV-positive, non-hospitalized | 1 y | PC52 (n=1); 90 |
MD 0.70 (-0.94, 2.34) |
N/A | Very lowb,c,d |
Very uncertain For parent-reported days with wheeze at one year among hospitalized vs. non-hospitalized healthy term infants positive for RSV at <12 months |
|
Abbreviations: CI, confidence interval; FU, follow-up; MD, mean difference; N/A, not applicable; no., number; NS, not significant; PC, prospective cohort; RD, risk difference; RFUPC, retrospective follow-up of prospective cohort; RR, risk ratio; RSV, respiratory syncytial virus; RSV-H, respiratory syncytial virus hospitalization; vs., versus; wGA: weeks’ gestational age; y, year(s)
a Absolute risk reductions were calculated when findings were statistically significant; NS denotes when findings were not statistically significant
Certainty of evidence was assessed for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Starting at high for observational studies (for prognosis evidence) each outcome is rated as high, moderate, low or very low based on downgrading (if any) for one or more of the following domains:
b Inconsistency
c Imprecision
d Two decrements (-2) due to very serious concerns for this domain