Neonatal Med.  2018 Nov;25(4):144-152. 10.5385/nm.2018.25.4.144.

Clinical Features of Respiratory Syncytial Virus Infection in Neonates: A Single Center Study

• Chang SH
• Jang GC
• Yoon SW

• KMID: 2436132
• DOI: http://doi.org/10.5385/nm.2018.25.4.144

Abstract

PURPOSE
The aim of this study was to investigate the clinical characteristics of Respiratory syncytial virus (RSV) infection during the neonatal period to provide information that is useful in clinical practice and suggest extension of the palivizumab administration.
METHODS
Neonates admitted to the National Health Insurance Service Ilsan Hospital neonatal intensive care unit due to respiratory symptoms and for whom multiplex reverse transcription-polymerase chain reaction and multiplex real time-polymerase chain reaction tests were performed between October 2011 and May 2016 were included in this study. Medical records were retrospectively reviewed, and data was collected for 156 neonates.
RESULTS
Among the 156 neonates, RSV was detected in 114 (73.1%), non-RSV in 25 (16%), and no virus in 17 (10.9%). The majority were full term infants (92.4%) and peak incidence of RSV infection was in January. Post-natal care center infection was more common in the RSV group (46.6%) than that in the other virus groups (24%, P=0.0243). Clinical symptoms were severe in the RSV group in contrast to that in the non-RSV or others groups. The RSV group frequently needed oxygen therapy (P=0.0001) and the duration of hospital stays were longer (P=0.0001).
CONCLUSION
RSV is a significant cause of respiratory infection in neonates and the severity is higher in contrast to that with other viral causes of infection. Infants in post-natal care centers have a high-risk of developing RSV infections; therefore, palivizumab administration may be considered in this group to prevent hospitalization and reduce the duration of hospital stay.

Keyword

Respiratory syncytial viruses; Newborn; Palivizumab; Post-natal care center

MeSH Terms

Hospitalization
Humans
Incidence
Infant
Infant, Newborn*
Intensive Care, Neonatal
Length of Stay
Medical Records
National Health Programs
Oxygen
Palivizumab
Respiratory Syncytial Viruses*
Retrospective Studies
Oxygen
Palivizumab

Figure

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  Figure 1. Seasonal and monthly distribution of respiratory syncytial virus (RSV) A, RSV B, and non-RSV viruses for a 5-year period from 2011 to 2016. Season 1: September 2011 to August 2012; Season 2: September 2012 to August 2013; Season 3: September 2013 to August 2014; Season 4: September 2014 to August 2015; and Season 5: September 2015 to May 2016.

Reference

1. Shay DK, Holman RC, Newman RD, Liu LL, Stout JW, Anderson LJ. Bronchiolitis-associated hospitalizations among US children, 1980-1996. JAMA. 1999; 282:1440–6.

2. Choi EH, Lee HJ, Kim SJ, Eun BW, Kim NH, Lee JA, et al. The association of newly identified respiratory viruses with lower respiratory tract infections in Korean children, 2000-2005. Clin Infect Dis. 2006; 43:585–92.

3. Meert K, Heidemann S, Abella B, Sarnaik A. Does prematurity alter the course of respiratory syncytial virus infection? Crit Care Med. 1990; 18:1357–9.

4. Resch B, Gusenleitner W, Muller W. The impact of respiratory syncytial virus infection: a prospective study in hospitalized infants younger than 2 years. Infection. 2002; 30:193–7.

5. Pedersen O, Herskind AM, Kamper J, Nielsen JP, Kristensen K. Rehospitalization for respiratory syncytial virus infection in infants with extremely low gestational age or birthweight in Denmark. Acta Paediatr. 2003; 92:240–2.

6. Cardenas S, Auais A, Piedimonte G. Palivizumab in the prophylaxis of respiratory syncytial virus infection. Expert Rev Anti Infect Ther. 2005; 3:719–26.

7. Alan S, Erdeve O, Cakir U, Akduman H, Zenciroglu A, Akcakus M, et al. Outcome of the respiratory syncytial virus related acute lower respiratory tract infection among hospitalized newborns: a prospective multicenter study. J Matern Fetal Neonatal Med. 2016; 29:2186–93.

8. Hall CB, Weinberg GA, Blumkin AK, Edwards KM, Staat MA, Schultz AF, et al. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013; 132:e341–8.

9. Song WS, Song BJ, Kim WD. Clinical characteristics of acute respiratory tract infections in full-term newborns without risk factors. Neonatal Med. 2015; 22:27–33.

10. Yoon GH, Kim YH. The clinical characteristics in infantile bronchiolitis and pneumonia according to respiratory syncytial virus subgroups: experience of single tertiary medical center from 2010 to 2012. Allergy Asthma Respir Dis. 2013; 1:84–9.

11. Seo JJ, Kim MJ, Kim SH, Kee HY, Chung JK, Kim ES, et al. Characterization of respiratory viral infection in children in Gwangju. Infect Chemother. 2008; 40:218–29.

12. Kim HY, Kim KM, Kim SH, Son SK, Park HJ. Clinical manifestations of respiratory viruses in hospitalized children with acute viral lower respiratory tract infections from 2010 to 2011 in Busan and Gyeongsangnam-do, Korea. Pediatr Allergy Respir Dis. 2012; 22:265–72.

13. Park KH, Shin JH, Lee EH, Seo WH, Kim YK, Song DJ, et al. Seasonal variations of respiratory syncytial virus infection among the children under 60 months of age with lower respiratory tract infections in the capital area, the Republic of Korea, 2008-2011. J Korean Soc Neonatol. 2012; 19:195–203.

14. Jung HD, Cheong HM. Prevalence of respiratory viruses in patients causing acute respiratory infections, 2013. Public Health Wkly Rep. 2014; 7:805–12.

15. Hwang SJ, Park DJ, Gu PT, Koo HS, Lee MO. Characteristics of respiratory syncytial virus isolated from acute respiratory infectious disease in Busan. J Bacteriol Virol. 2016; 46:173–80.

16. Jung HD, Cheong HM, Kim SS. Prevalence of respiratory viruses in patients with acute respiratory infections, 2014. Public Health Wkly Rep. 2016; 9:26–36.

17. Yoon GH, Kim YH. The clinical characteristics in infantile bronchiolitis and pneumonia according to respiratory syncytial virus subgroups: experience of single tertiary medical center from 2010 to 2012. Allergy Asthma Respir Dis. 2013; 1:84–9.

18. Kang SY, Hong CR, Kang HM, Cho EY, Lee HJ, Choi EH, et al. Clinical and epidemiological characteristics of human metapneumovirus infections, in comparison with respiratory syncytial virus A and B. Korean J Pediatr Infect Dis. 2013; 20:168–77.

19. McConnochie KM, Hall CB, Walsh EE, Roghmann KJ. Variation in severity of respiratory syncytial virus infections with subtype. J Pediatr. 1990; 117(1 Pt 1):52–62.

20. Martinello RA, Chen MD, Weibel C, Kahn JS. Correlation between respiratory syncytial virus genotype and severity of illness. J Infect Dis. 2002; 186:839–42.

21. Gilca R, De Serres G, Tremblay M, Vachon ML, Leblanc E, Bergeron MG, et al. Distribution and clinical impact of human respiratory syncytial virus genotypes in hospitalized children over 2 winter seasons. J Infect Dis. 2006; 193:54–8.

22. Hendry RM, Burns JC, Walsh EE, Graham BS, Wright PF, Hemming VG, et al. Strain-specific serum antibody responses in infants undergoing primary infection with respiratory syncytial virus. J Infect Dis. 1988; 157:640–7.

23. Taylor CE, Morrow S, Scott M, Young B, Toms GL. Comparative virulence of respiratory syncytial virus subgroups A and B. Lancet. 1989; 1:777–8.

24. Hall CB, Walsh EE, Schnabel KC, Long CE, McConnochie KM, Hildreth SW, et al. Occurrence of groups A and B of respiratory syncytial virus over 15 years: associated epidemiologic and clinical characteristics in hospitalized and ambulatory children. J Infect Dis. 1990; 162:1283–90.

25. Devincenzo JP. Natural infection of infants with respiratory syncytial virus subgroups A and B: a study of frequency, disease severity, and viral load. Pediatr Res. 2004; 56:914–7.

26. Shin SH, Kim JR, Lee JA, Choi CW, Kim EK, Choi EH, et al. Clinical characteristics of severe respiratory syncytial virus infection requiring mechanical ventilation in neonatal period and early infancy. Korean J Pediatr. 2008; 51:372–6.

27. Fodha I, Vabret A, Ghedira L, Seboui H, Chouchane S, Dewar J, et al. Respiratory syncytial virus infections in hospitalized infants: association between viral load, virus subgroup, and disease severity. J Med Virol. 2007; 79:1951–8.

28. Park SH, Cho HJ, Shim SY, Son DW, Eun BW, Sun YH, et al. Acute respiratory infections in the neonatal intensive care unit: isolation of viruses and the characteristics of respiratory syncytial virus infection. J Korean Soc Neonatol. 2009; 16:182–9.

29. Jung YJ, Kwon HJ, Huh HJ, Ki CS, Lee NY, Kim JW. Comparison of the AdvanSure real-time RT-PCR and Seeplex RV12 ACE assay for the detection of respiratory viruses. J Virol Methods. 2015; 224:42–6.

30. Olabarrieta I, Gonzalez-Carrasco E, Calvo C, Pozo F, Casas I, Garcia-Garcia ML. Hospital admission due to respiratory viral infections in moderate preterm, late preterm and term infants during their first year of life. Allergol Immunopathol (Madr). 2015; 43:469–73.

31. Min SJ, Song JS, Choi JH, Seon HS, Kang EK, Kim DH, et al. Analysis of palivizumab prophylaxis in patients with acute lower respiratory tract infection caused by respiratory syncytial virus. Korean J Pediatr Infect Dis. 2011; 18:154–62.

32. Hall CB. Nosocomial respiratory syncytial virus infections: the "Cold War" has not ended. Clin Infect Dis. 2000; 31:590–6.

33. Garcia CG, Bhore R, Soriano-Fallas A, Trost M, Chason R, Ramilo O, et al. Risk factors in children hospitalized with RSV bronchiolitis versus non-RSV bronchiolitis. Pediatrics. 2010; 126:e1453–60.

34. Hall CB, Douglas RG Jr, Geiman JM. Respiratory syncytial virus infections in infants: quantitation and duration of shedding. J Pediatr. 1976; 89:11–5.

35. Ministry of Health and Welfare. Status of postpartum care centers nationwide [Internet]. Sejong: Ministry of Health and Welfare;2016. [cited 2018 Oct 8]. Available from: http://www.mohw.go.kr/react/gm/sgm0601vw.jsp?PAR_MENU_ID=13&MENU_ID=1304020701&page=3&CONT_SEQ=338140.

36. Lee SS, Park JS, Lee SY, Oh MA, Choi HJ, Song MY. The 2015 national survey on fertility and family health and welfare. Sejong: Korea Institute for Health and Social Affairs;2015.

37. Hong SJ, Kim DK, Lee DS, Cho SM, Choi SM. RSV outbreak at a single postpartum care center in Gyeongsangbukdo. Korean J Perinatol. 2016; 27:60–6.