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Respiratory syncytial virus infections in children admitted to the intensive care unit
H A Van Steensel-Moll1, E Van der Voort, A P Bos
1Department of Pediatrics, Sophia Children's Hospital, Erasmus University Rotterdam, The Netherlands.
Insights
Respiratory syncytial virus (RSV) in infants often requires intensive care, especially for those with pre-existing conditions. Early detection and management are crucial for reducing severe outcomes and mortality in pediatric RSV cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Respiratory syncytial virus (RSV) is a common cause of pediatric respiratory infections.
- Infants, particularly those with underlying health issues, are at higher risk for severe RSV illness.
Purpose of the Study:
- To analyze the clinical characteristics and outcomes of hospitalized children with RSV infection.
- To identify risk factors associated with severe RSV disease requiring intensive care.
Main Methods:
- Retrospective analysis of 64 children hospitalized with RSV infection during the 1986-1987 winter season.
- Diagnosis confirmed via direct immunofluorescent antibody technique.
- Data collection on intensive care unit (ICU) admission, ventilation, pre-existing conditions, complications, and mortality.
Main Results:
- 36% of children required intensive care; 52% of these had pre-existing conditions (e.g., prematurity, bronchopulmonary dysplasia, congenital heart disease).
- 50% of ICU patients were intubated and ventilated due to apnea, clinical deterioration, or hypercarbia.
- Pulmonary complications (65%) and inappropriate antidiuretic hormone secretion (39%) were common in ICU patients; 5% overall mortality, with 2 deaths in the high-risk group.
Conclusions:
- RSV infection poses a significant threat to infants, especially those with pre-existing conditions, often necessitating intensive care and mechanical ventilation.
- Pre-existing conditions are key risk factors for severe RSV outcomes.
- Pulmonary complications and hormonal imbalances are frequent in critically ill infants with RSV, highlighting the need for vigilant monitoring and management.
Abstract:
During the winter of 1986-1987, 64 children with respiratory syncytial virus (RSV) infection were admitted to our hospital. The diagnosis was made by direct immunofluorescent antibody technique. Twenty-three children (36%) needed intensive care treatment. Nearly 11 (52%) had a preexisting disease state, identified as a risk factor i.e., prematurity (n = 8), bronchopulmonary dysplasia (n = 2), congenital heart disease (n = 1). Twelve patients (50%) were intubated and ventilated. Conditions for intubation and ventilation were repetitive apnea with or without bradycardia (n = 4), clinical deterioration (n = 3) or hypercarbia (n = 5). Seventy-five percent of the patients who needed intensive care management were under three months of age compared to 34% of the children who were admitted to the clinical ward. The mean age for ventilated patients was 7.9 weeks. The mean duration of ventilation was 5.5 days. Volume controlled ventilation was initially applied to all patients. Pulmonary complications (atelectasis, pneumonia, pneumothorax or adult respiratory distress syndrome) were present in 15 (65%) IC patients. Nine (39%) of them also had symptoms of inappropriate antidiuretic hormone secretion (IADHS). Only two patients had symptoms of IADHS and two others had convulsions. Three children (5%) died as a result of respiratory insufficiency. Two of these infants belonged to the risk group.