Medical Professional Publications

Viral Respiratory Tract Infections in the NICU

(From the January 2015 Issue of PediatricsOnline)

Researchers from multiple institutions collaborated on a study published in the Journal of Pediatrics that provides novel insight into the frequency and significance of respiratory viral infections in the neonatal intensive care unit (NICU). According to the research, led by Pablo J. Sánchez, MD, principal investigator in the Center for Perinatal Research in the Research Institute at Nationwide Children’s Hospital, nearly one in every 12 NICU infants evaluated for possible bacterial sepsis actually acquired a respiratory virus infection during their hospital stays.

According to Dr. Sánchez, many neonatologists and pediatric infectious diseases specialists do not consider respiratory viral infections when evaluating a sick neonate. Many infants in the NICU are evaluated for possible sepsis, a potentially life-threatening severe infection, yet their bacterial cultures are sterile, indicating that a bacterial infection may not be contributing to the infant’s illness.

“The occurrence and impact of respiratory viral infections in the NICU represents a huge knowledge gap in neonatal infectious diseases,” says Dr. Sánchez, lead author on the study and a board-certified neonatologist and pediatric infectious diseases specialist at Nationwide Children’s. “With the advent of molecular technologies such as PCR, detection of respiratory viruses in the NICU is now readily available and easily performed.”

According to Dr. Sánchez, it was unknown how frequently a respiratory virus could be contributing to or causing the clinical deterioration that prompted an evaluation for sepsis. To study that scenario, the team enrolled NICU infants who had never gone home and who had been prescribed antibiotics for possible bacterial infection. They tested nasopharyngeal specimens by PCR for respiratory viruses.

Dr. Sánchez and his collaborators found that 8 percent of infants who had never been discharged home and who were evaluated for possible bacterial sepsis had actually acquired a respiratory virus infection while in the NICU.

The findings support additional respiratory viral testing of infants with suspected sepsis using optimal molecular assays, Dr. Sánchez says, so as to establish more accurate diagnoses, prevent transmission and inform antibiotic treatments. The researchers hope that this knowledge may decrease antibiotic use in the NICU, as testing would allow for detection of a respiratory virus, rather than bacteria, as the cause of infection for infants with suspected sepsis. Studies similar to this one had never been conducted before in the United States.

Andrea Ronchi, MD, visiting researcher in the Department of Pediatrics at the University of Texas Southwestern Medical Center and pediatric resident at the Children’s Hospital of Milan, Italy, and Ian Michelow, MD, pediatric infectious diseases specialist at Women and Infants Hospital of Brown University in Rhode Island, collaborated on the research with the help of Kimberle Chapin-Robertson, MD, the director of Microbiology and Infectious Disease Molecular Diagnostics at Lifespan’s Rhode Island Hospital.

The team has proposed a larger, multi-center study to the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network that has been approved and is awaiting funding.

“We plan to enroll newborn infants less than 29 weeks of gestation who have never been home and test them for a respiratory virus when antibiotics are started for late-onset bacterial infection,” says Dr. Sánchez of this future study, which will be a collaboration with M. Asuncion Mejias, MD, PhD, principal investigator in the Center for Vaccines and Immunity.

Ronchi A, Michelow IC, Chapin KC, Bliss JM, Pugni L, Mosca F, Sánchez PJ. Viral respiratory tract infections in the neonatal intensive care unit: The VIRIoN-I Study. Journal of Pediatrics. 2014 Oct, 165(4):690-6.

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