Assessing Clinical Improvement of Infants Hospitalized For Respiratory Syncytial Virus-Related Critical Illness.

Details

• Alternative Title:
  The Journal of Infectious Diseases, 2025, v. 232, no. 6: Assessing Clinical Improvement of Infants Hospitalized For Respiratory Syncytial Virus-Related Critical Illness.
• Journal Article:
  The Journal of Infectious Diseases
• Personal Author:
  Leland, Shannon B. ; Zambrano, Laura D. ; Staffa, Steven J. ; McNamara, Elizabeth R. ; Newhams, Margaret M. ; Halasa, Natasha ; Amarin, Justin Z. ; Stewart, Laura S. ; Shein, Steven L. ; Carroll, Christopher L. ; Fitzgerald, Julie C. ; Michaels, Marian G. ; Bline, Katherine ; Cullimore, Melissa L. ; Loftis, Laura ; Montgomery, Vicki L. ; Jeyapalan, Asumthia S. ; Pannaraj, Pia S. ; Schwarz, Adam J. ; Cvijanovich, Natalie Z. ; Zinter, Matt S. ; Maddux, Aline B. ; Bembea, Melania M. ; Irby, Katherine ; Zerr, Danielle M. ; Kuebler, Joseph D. ; Babbitt, Christopher J. ; Gaspers, Mary G. ; Nofziger, Ryan ; Kong, Michele ; Coates, Bria M. ; Schuster, Jennifer E. ; Gertz, Shira J. ; Mack, Elizabeth H. ; White, Benjamin R. ; Harvey, Helen ; Hobbs, Charlotte V. ; Dapul, Heda ; Butler, Andrew D. ; Bradford, Tamara T. ; Rowan, Courtney M. ; Wellnitz, Kari ; Staat, Mary Allen ; Aguiar, Cassyanne L. ; Hymes, Saul R. ; Campbell, Angela P. ; Randolph, Adrienne G.
• Description:
  Pediatric respiratory syncytial virus (RSV)-related acute lower respiratory tract infection (LRTI) commonly requires hospitalization. The Clinical Progression Scale-Pediatrics (CPS-Ped) measures level of respiratory support and degree of hypoxia across a range of disease severity, but it has not been applied in infants hospitalized with severe RSV-LRTI.
  
  We analyzed data from a prospective surveillance registry of infants hospitalized for RSV-related complications across 39 pediatric intensive care units in the United States from October through December 2022. We assigned CPS-Ped (0 = discharged home at respiratory baseline to 8 = death) at admission and days 2-7, 10, and 14. We identified predictors of clinical improvement (CPS-Ped ≤2 or 3-point decrease) by day 7 using multivariable log-binomial regression models and estimated the sample size (80% power) to detect 15% between-group clinical improvement with CPS-Ped versus hospital length of stay (LOS).
  
  Of 585 hospitalized infants, 138 (23.6%) received invasive mechanical ventilation (IMV) and 1 died. Failure to clinically improve by day 7 occurred in 205 (35%) infants and was associated with age <3 months, prematurity, underlying respiratory condition, and IMV in the first 24 hours in the multivariable analysis. The estimated sample size per arm required for detecting a 15% clinical improvement in a potential study was 584 using CPS-Ped clinical improvement versus 2031 for hospital LOS.
  
  CPS-Ped can be used to capture a range of disease severity and track clinical improvement in infants who develop RSV-related critical illness and could be useful for evaluating therapeutic interventions for RSV.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Respiratory Syncytial Virus Infections
  • Infant
  • Male
  • Female
  • Hospitalization
  • Prospective Studies
  • Critical Illness
  • Intensive Care Units, Pediatric
  • Length of Stay
  More +
• Keywords:
  • acute hypoxic respiratory failure
  • acute respiratory distress syndrome
  • pediatric
  • intensive care unit
  • outcome
• Source:
  The Journal of Infectious Diseases, 2025, v. 232, no. 6
• DOI:
  https://doi.org/10.1093/infdis/jiaf018
• ISSN:
  0022-1899 ; 1537-6613
• Pubmed ID:
  39812486
• Pubmed Central ID:
  PMC12265475
• Document Type:
  Text
• Funding:
  K23 DK119463/DK/NIDDK NIH HHSUnited States/ ; R01 AI154470/AI/NIAID NIH HHSUnited States/ ; T32 HL155020/HL/NHLBI NIH HHSUnited States/ ; CC/CDC HHSUnited States/ ; HL/NHLBI NIH HHSUnited States/ ; T32HL155020/NH/NIH HHSUnited States/
• Genre:
  Journal Article
• Place as Subject:
  United States
• Pages in Document:
  1283-1291 (18 pdf pages)
• Volume:
  232
• Issue:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:ac4131f3455b67abc6ed570b1bd7c0e8bf1c039702a5d1db7e34f90f5a621c601101a575710ec41938611853f4fd71c4cc4e482ecf230501b4d50e5edd415553