Respiratory Viral Detection and Invasive Bacterial Infections in Infants ≤90 Days
Erin G Nicholson1,2, Tess Stopczynski3, Leila C Sahni1,2
1From the Baylor College of Medicine, Houston, TX.
Insights
Febrile infants 0 to 90 days old with specific respiratory viruses, like RSV, show a lower risk of invasive bacterial infections (IBIs). This finding aids in interpreting viral testing for infants with acute respiratory illness.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Neonatal Care
Background:
- Invasive bacterial infections (IBIs) are a concern in young infants.
- Accurate diagnosis requires understanding respiratory viral infections in infants 0-90 days old.
- Data are needed to guide molecular respiratory viral testing for IBI evaluation.
Purpose of the Study:
- To determine the frequency and severity of respiratory viral infections in infants 0-90 days old.
- To quantify the occurrence of IBI in febrile and nonfebrile infants with acute respiratory illness.
- To assess the relationship between respiratory viruses and IBI in this age group.
Main Methods:
- Cross-sectional analysis of infants 0-90 days old with emergency department visits or hospitalizations.
- Surveillance conducted at 7 US pediatric medical institutions.
- Respiratory viral detection and IBI assessment in relation to clinical severity.
Main Results:
- 3,780 infants were analyzed (December 2016-March 2020).
- Respiratory syncytial virus was the most common virus.
- IBIs were less frequent in infants with respiratory viruses (1.3%) compared to those without (4.9%).
- No IBIs detected with RSV, parainfluenza, metapneumovirus, influenza, or adenovirus alone.
Conclusions:
- Febrile infants 0-90 days old with certain respiratory viruses have a reduced risk of IBI.
- Findings support the interpretation of respiratory viral testing in this population.
- Further research can refine diagnostic and treatment strategies.
Background:
Comprehensive data are needed to guide the use and interpretation of molecular respiratory viral testing in evaluating infants 0 to ≤90 days old for invasive bacterial infections (IBIs). We aimed to describe the frequency and severity of respiratory viral infections in febrile and nonfebrile infants 0 to ≤90 days of age with emergency department visits or hospitalizations for acute respiratory illness and to quantify the occurrence of IBI (bacteremia and bacterial meningitis) in these groups.
Methods:
The New Vaccine Surveillance Network conducts acute respiratory illness surveillance at 7 US pediatric medical institutions in the United States. We conducted a cross-sectional analysis of febrile and nonfebrile infants 0 to ≤90 days of age enrolled in the emergency department or inpatient hospital settings. Respiratory viral detection from research respiratory samples in the context of clinical severity and IBI was examined.
Results:
Three thousand seven hundred and eighty febrile and nonfebrile infants 0 to ≤90 days of age enrolled from December 1, 2016, to March 31, 2020. Respiratory syncytial virus was the most common virus detected regardless of febrile status. IBIs were significantly more frequent in febrile infants without a respiratory virus compared with those with a respiratory virus detected (4.9% vs. 1.3%; P < 0.001). IBIs were not detected in infants with respiratory syncytial virus (n = 259), parainfluenza virus (n = 66), human metapneumovirus (n = 13), influenza virus (n = 67), or adenovirus (n = 11) alone. IBI and respiratory viral coinfections were found in infants with endemic coronaviruses (5.8%, 3/52), rhinovirus/enterovirus (2.2%, 7/324) and viral coinfections (2.0%, 2/99).
Conclusions:
These data suggest that febrile infants 0 to ≤90 days old with certain respiratory viruses are at lower risk of IBI.
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