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Predicting deterioration in previously healthy infants hospitalized with respiratory syncytial virus infection
A M Brooks1, J T McBride, K M McConnochie
1Department of Pediatrics, Children's Hospital at Strong, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. jazbrooks@msn.com
Insights
Clinical deterioration is uncommon in previously healthy infants hospitalized with respiratory syncytial virus (RSV) infection. While extreme tachypnea and hypoxemia predict deterioration, their low sensitivity limits clinical usefulness for early identification.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Respiratory Syncytial Virus (RSV) is a common cause of hospitalization in infants.
- Clinical deterioration requiring Pediatric Intensive Care Unit (PICU) transfer can occur in previously healthy infants with RSV infection.
- Identifying infants at risk for deterioration is crucial for timely intervention.
Purpose of the Study:
- To estimate the incidence of clinical deterioration leading to PICU transfer in previously healthy infants with RSV infection.
- To assess if initial clinical findings (history, physical exam, oximetry, chest X-ray) can predict such deterioration.
Main Methods:
- Retrospective analysis of infants aged <=1 year hospitalized with RSV infection (1985-1994).
- Index patients were previously healthy infants transferred to the PICU; matched with controls not requiring PICU transfer.
- Comparison of respiratory rate, O2 saturation, wheezing, and chest X-ray findings at presentation.
Main Results:
- 1.8% of previously healthy infants with RSV infection required PICU transfer.
- Infants transferred to PICU had modestly abnormal respiratory rates and O2 saturation at presentation.
- High respiratory rate (>80) and low O2 saturation (<85%) showed high specificity but low sensitivity for predicting deterioration.
Conclusions:
- PICU admission due to clinical deterioration is infrequent in previously healthy infants with RSV infection on general pediatric units.
- Extreme tachypnea and hypoxemia are associated with deterioration but have limited predictive value due to low sensitivity.
- Current clinical parameters have limited usefulness in accurately identifying all infants who will deteriorate.
Objective:
To estimate the incidence of clinical deterioration leading to intensive care unit transfer in previously healthy infants with respiratory syncytial virus (RSV) infection hospitalized on a general pediatric unit and, to assess the hypothesis that history, physical examination, oximetry, and chest radiographic findings at time of presentation can accurately identify these infants.
Study Design:
A virology database was used to identify and determine the disposition of all children
Results:
During the study years, 542 previously healthy, full-term infants were admitted to the general pediatric unit at CHaS with proven RSV infection. Ten (1.8%; 95% confidence interval, 0.9%, 3.4%) were transferred subsequently to the PICU, primarily for close monitoring of progressive respiratory distress. Data for these patients and 7 patients transferred from Rochester General Hospital to the PICU at the CHaS were compared with those for control patients. The mean RR in the ED (63 vs 50), and O(2) saturation in the ED (88% vs 93%) were modestly abnormal in cases compared with controls. Wheezing on examination at time of presentation and chest radiographic findings did not differ between the two groups. A RR >80 and an O(2) saturation <85% at time of presentation each had a specificity >97% for predicting subsequent deterioration. Each parameter, however, had a sensitivity
Conclusion:
Clinical deterioration requiring PICU admission is an uncommon occurrence in previously healthy infants admitted to a general pediatric inpatient unit with RSV infection. Extreme tachypnea and hypoxemia were both associated with subsequent deterioration; however, only a small proportion of patients who clinically deteriorated presented in this way. The clinical usefulness of these parameters, therefore, is limited. respiratory syncytial virus, deterioration, healthy infants, prediction.