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Atypical extrapulmonary presentations of severe respiratory syncytial virus infection requiring intensive care
1Department of Pediatrics, Rainbow Babies and Childrens Hospital, Cleveland, Ohio 44106.
Insights
Severe respiratory syncytial virus (RSV) infections disproportionately affected premature infants, leading to intensive care. Hypothermia and pneumonia presented at significantly different ages in infants with RSV.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Respiratory Syncytial Virus (RSV) is a common cause of severe respiratory illness in infants.
- Premature infants and those with underlying conditions are at higher risk for severe RSV disease.
- Understanding epidemic patterns and clinical presentations is crucial for effective management.
Purpose of the Study:
- To analyze the patterns and nature of a four-month epidemic of severe RSV-associated disease.
- To identify demographic, clinical, and therapeutic characteristics of infants requiring pediatric intensive care unit (PICU) admission.
- To compare clinical outcomes and treatment responses in different patient subgroups.
Main Methods:
- Retrospective analysis of presenting, demographic, clinical, and therapeutic data for 218 infants with RSV infection.
- Documentation of RSV infection using fluorescent antibody and/or enzyme-linked immunosorbent assay.
- Evaluation of PICU patients for airway stabilization, intubation, sepsis workup, and bacterial cultures.
Main Results:
- Of 218 infants, 49 (22.4%) were admitted to the PICU, predominantly premature infants.
- Common clinical patterns included hypothermia, septic shock appearance, apnea, pneumonia, and wheezing due to bronchiolitis.
- Statistically significant age differences were observed between patients presenting with hypothermia and pneumonia. Ribavirin was administered to 18% of PICU patients, with no significant difference in outcomes for infants with bronchopulmonary dysplasia.
Conclusions:
- Severe RSV infections pose a significant threat to vulnerable infant populations, particularly those born prematurely.
- Clinical presentations of RSV disease vary significantly with age, necessitating tailored management strategies.
- Further research is needed to optimize therapeutic interventions, including ribavirin, for severe RSV cases.
Abstract:
The patterns and nature of a four-month epidemic of severe respiratory syncytial virus (RSV)-associated disease were analyzed using presenting, demographic, clinical, and therapeutic data. Of 218 infants with RSV infection admitted to Rainbow Babies and Childrens Hospital, 49 (22.4%), most born prematurely, entered the pediatric intensive care unit (PICU). Fluorescent antibody and/or enzyme-linked immunosorbent assay documented RSV infection. PICU patients underwent airway stabilization; 53.5% were intubated and evaluated for sepsis. Patients with positive bacterial cultures received antibiotics; 18% were given ribavirin. Patterns of infection included hypothermia, septic shock appearance, apnea, pneumonia, and wheezing due to bronchiolitis. The average age difference between patients with hypothermia (23.3 days) and those with pneumonia (11.2 months) was statistically significant. There were no significant differences in average age, gestational age at birth, number intubated, worst pH and PCO2, duration of intensive care, or treatment modalities between infants with bronchopulmonary dysplasia who received ribavirin and those who did not.