Advertisement

Respiratory Viruses in the Neonatal Intensive Care Unit

  • Phillip S. Wozniak
Chapter

Abstract

Respiratory viral infections (RVIs) pose a unique challenge for clinicians in the neonatal intensive care unit (NICU) due to preterm infants’ increased susceptibility to infections (Maitre NL and Williams JV, Res Rep Neonatol. 6:41–49, 2016). RVIs often present with nonspecific symptoms and currently lack effective treatments (Baraldi et al., Ital J Pediatr. 40:65, 2014). Death due to viral bronchiolitis is a major cause of morbidity and mortality in developing nations and industrialized nations alike, and patients with bronchiolitis frequently require intensive care and use of mechanical ventilation (Thompson et al., JAMA 289:179–186, 2003). Infants who acquire RVI during their birth hospitalizations have significantly longer length of stay and are more likely to develop chronic respiratory disease, particularly bronchopulmonary dysplasia (Bennett et al., J Pediatr 161:814–818, 2012). Furthermore, infants with RVIs are often placed on empiric antibiotic therapy, which can frustrate antimicrobial stewardship efforts (Bennett et al., J Pediatr 161:814–818, 2012; Cantey et al., Lancet Infect Dis 2016;16:1178–1184). RVIs are also associated with increased costs to both health systems and families due to increased care and lost productivity. In 2016, Zinna et al. (Pediatrics 138:e20161675, 2016) showed that infants with hospital-acquired RVI in the United Kingdom had hospital charges more than double those of uninfected infants. Similarly, the Sentinel-1 Study (Anderson et al., Am J Perinatol 34:51–61, 2017) in the United States demonstrated that each hospitalization for respiratory syncytial virus (RSV), the most common etiological agent of viral bronchiolitis in children age <1 year, costs more than $55,000, even excluding the additional outpatient visits before and after hospitalization. The goal of this chapter is to address the epidemiology, pathogenesis, diagnosis, treatment, and prevention of respiratory viruses in the highly vulnerable patient population in the NICU.

Keywords

Influenza Polymerase chain reaction Respiratory syncytial virus Rhinovirus Upper respiratory tract infection 

References

  1. 1.
    Baraldi E, Lanari M, Manzoni P, et al. Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Ital J Pediatr. 2014;40:65.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ronchi A, Michelow IC, Chapin KC, et al. Viral respiratory tract infections in the neonatal intensive care unit: the VIRIoN-I study. J Pediatr. 2014;165:690–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Bennett NJ, Tabarani CM, Bartholoma NM, et al. Unrecognized viral respiratory tract infections in premature infants during their birth hospitalization: a prospective surveillance study in two neonatal intensive care units. J Pediatr. 2012;161:814–8.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kidszun A, Hansmann A, Winter J, et al. Detection of respiratory viral infections in neonates treated for suspicion of nosocomial bacterial sepsis: a feasibility study. Pediatr Infect Dis J. 2014;33:102–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Bennett NJ, Tabarani CM, Bartholoma NM, et al. Unrecognized viral respiratory tract infections in premature infants during their birth hospitalization: a prospective surveillance study in two neonatal care units. J Pediatr. 2012;161:814–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Maitre NL, Williams JV. Human metapneumovirus in the preterm neonate: current perspectives. Res Rep Neonatol. 2016;6:41–9.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Drysdale SB, Lo J, Prendergast M, et al. Lung function of preterm infants before and after viral infections. Eur J Pediatr. 2014;173:1497–504.CrossRefPubMedGoogle Scholar
  8. 8.
    Weisman L. Populations at risk for developing respiratory syncytial virus and risk factors for respiratory syncytial virus severity: infants with predisposing conditions. Pediatr Infect Dis J. 2003;22:S33–9.PubMedGoogle Scholar
  9. 9.
    Willson DF, Landrigan CP, Horn SD, Smout RJ. Complications in infants hospitalized for bronchiolitis or respiratory syncytial virus pneumonia. J Pediatr. 2003;143:S142–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Feltes TF, Cabalka AK, Meissner HC, et al. Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr. 2003;143:532–40.CrossRefPubMedGoogle Scholar
  11. 11.
    Anderson EJ, Carosone-Link P, Yogev R, Yi J, Simoes EAF. Effectiveness of palivizumab in high-risk infants and children: a propensity score weighted regression analysis. Pediatr Infect Dis J. 2017;36:699–704.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Wilkesmann A, Ammann RA, Schildgen O, et al. Hospitalized children with respiratory syncytial virus infection and neuromuscular impairment face an increased risk of a complicated course. Pediatr Infect Dis J. 2007;26:485–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Manzoni P, Paes B, Resch B, Carbonell-Estrany X, Bont L. High risk for RSV bronchiolitis in late preterms and selected infants affected by rare disorders: a dilemma of specific prevention. Early Hum Dev. 2012;88:S34–41.CrossRefPubMedGoogle Scholar
  14. 14.
    Giebels K, Marcotte JE, Podoba J, et al. Prophylaxis against respiratory syncytial virus in young children with cystic fibrosis. Pediatr Pulmonol. 2008;43:169–74.CrossRefPubMedGoogle Scholar
  15. 15.
    Hall CB, Powell KR, MacDonald NE, et al. Respiratory syncytial viral infection in children with compromised immune function. N Engl J Med. 1986;315:77–81.CrossRefPubMedGoogle Scholar
  16. 16.
    El Saleeby CM, Somes GW, DeVincenzo JP, Gaur AH. Risk factors for severe respiratory syncytial virus disease in children with cancer: the importance of lymphopenia and young age. Pediatrics. 2008;121:235–43.CrossRefPubMedGoogle Scholar
  17. 17.
    Sung L, Alonzo TA, Gerbing RB, et al. Respiratory syncytial virus infections in children with acute myeloid leukemia: a report from the Children’s Oncology Group. Pediatr Blood Cancer. 2008;51(6):784.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Edwards KM, Zhu Y, Griffin MR, et al. Burden of human metapneumovirus infection in young children. N Engl J Med. 2013;368:633–43.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bosis S, Esposito S, Niesters HG, Crovari P, Osterhaus AD, Principi N. Impact of human metapneumovirus in childhood: comparison with respiratory syncytial virus and influenza viruses. J Med Virol. 2005;75:101–4.CrossRefPubMedGoogle Scholar
  20. 20.
    van den Hoogen BG, van Doornum GJ, Fockens JC, et al. Prevalence and clinical symptoms of human metapneumovirus infection in hospitalized patients. J Infect Dis. 2003;188:1571–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Anderson EJ, Simoes EA, Buttery JP, et al. Prevalence and characteristics of human metapneumovirus infection among hospitalized children at high risk for severe lower respiratory tract infection. J Pediatric Infect Dis Soc. 2012;1(3):212–22.CrossRefPubMedGoogle Scholar
  22. 22.
    Ronchi A, Doern C, Brock E, Pugni L, Sanchez PJ. Neonatal adenoviral infection: a seventeen year experience and review of the literature. J Pediatr. 2014;164:529–35.CrossRefPubMedGoogle Scholar
  23. 23.
    Friedman JN, Rieder MJ, Walton JM. Bronchiolitis: recommendations for diagnosis, monitoring and management of children one to 24 months of age. Paediatr Child Health. 2014;19:485–98.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Rogers BB, Shankar P, Jerris RC, et al. Impact of a rapid respiratory panel test on patient outcomes. Arch Pathol Lab Med. 2015;139:636–41.CrossRefPubMedGoogle Scholar
  25. 25.
    Centers for Disease Control and Prevention. Recommended dosage and duration of influenza antiviral medications for treatment or chemoprophylaxis. Available at https://www.cdc.gov/flu/pdf/professionals/antivirals/antiviral-dosage-duration.pdf. Accessed 17 Jan 2018.
  26. 26.
    Sattar SA, Springthorpe VS, Tetro J, Vashon R, Keswick B. Hygienic hand antiseptics: should they not have activity and label claims against viruses? Am J Infect Control. 2002;30:355–72.CrossRefPubMedGoogle Scholar
  27. 27.
    Groothuis J, Bauman J, Malinoski F, Eggleston M. Strategies for prevention of RSV nosocomial infection. J Perinatol. 2008;28:319–23.CrossRefPubMedGoogle Scholar
  28. 28.
    Bont L. Nosocomial RSV infection control and outbreak management. Paediatr Respir Rev. 2009;10:S16–7.CrossRefGoogle Scholar
  29. 29.
    Karanfil LV, Conlon M, Lykens K, et al. Reducing the rate of nosocomially transmitted respiratory syncytial virus. Am J Infect Control. 1999;27:91–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Macartney KK, Gorelick MH, Manning ML, Hodinka RL, Bell LM. Nosocomial respiratory syncytial virus infections: the cost-effectiveness and cost-benefit of infection control. Pediatrics. 2000;106:520–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Subramanian KN, Weisman LE, Rhodes T, et al. Safety, tolerance and pharmacokinetics of a humanized monoclonal antibody to respiratory syncytial virus in premature infants and infants with bronchopulmonary dysplasia. MEDI-493 Study Group. Pediatr Infect Dis J. 1998;17:110–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Peluso AM, Harnish BA, Miller NS, Cooper ER, Fujii AM. Effect of young sibling visitation on respiratory syncytial virus activity in a NICU. J Perinatol. 2015;35:627–30.CrossRefPubMedGoogle Scholar
  33. 33.
    Caserta MT, Yang H, Gill SR, Holden-Wiltse J, Pryhuber G. Viral respiratory infections in preterm infants during and after hospitalization. J Pediatr. 2017;182:53–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Pediatric Infectious Diseases, Department of PediatricsThe Ohio State University College of MedicineColumbusUSA

Personalised recommendations