Background: This study aimed to determine the prevalence of respiratory pathogens among newborns admitted to a neonatal medium care unit (NMcU) and to identify clinical predictors. Methods: a 1-y observational study was performed of neonates admitted to an NMcU in amsterdam, The Netherlands. Nasopharyngeal samples were collected for the detection of respiratory viruses and bacteria by real-time PcR (RT-PcR). cycle threshold (ct) values were provided to estimate viral load. Predictors for the presence of study pathogens were identified. results: From October 2010 through september 2011, 334 neonates (median age 1.3 d, 53.6% male) were included. Overall, 37 respiratory pathogens were detected in 34 children (10.2%): parainfluenza-1 (n = 9), human rhinovirus (n = 7), parainfluenza-3 (n = 6), respiratory syncytial virus (RsV, n = 6), Streptococcus pneumoniae (n = 3), adenovirus (n = 2), human coronavirus (n = 2), influenza a (n = 1), and bocavirus (n = 1). Neonates with higher viral loads (ct <35; n = 11) were more often clinically ill than those with lower viral loads (ct ≥35; n = 23). Two variables significantly contributed to the detection of study pathogens: age (odds ratio (OR) 1.21 for each day older; 95% confidence interval 1.12-1.30) and rhinorrhea (OR 6.71; 95% confidence interval 1.54-29.21). conclusion: Respiratory pathogens seem to play a role in neonates admitted to an NMcU. The influence of respiratory pathogen detection on clinical management remains to be determined.i nfections in neonates (newborn children aged until 28 d postpartum) have been known to cause significant mortality and long-term morbidity (1). One of the most important infectious disease syndromes in newborns is neonatal sepsis, with an estimated incidence of 1.5% during the first 72 h of life (2). Most infants with sepsis present with nonspecific signs and symptoms. The most common of these vague signs are temperature instability, lethargy, apnea, and poor feeding (3,4). Neonates with respiratory tract infection can present with a clinical picture that is consistent with sepsis, in addition to more classical symptoms such as tachypnea and hypoxemia (5).The outcome of neonatal infections may be improved if illness is recognized early and appropriate antimicrobial agents are administered promptly (6). If sepsis cannot be reasonably excluded on clinical grounds, blood cultures should be obtained and empiric antibiotics should be administered. Unfortunately, laboratory investigations are not always helpful, and cultures of blood or other tissues are often negative or not possible to perform. The early detection of a (viral) respiratory tract infection could be useful because it might reduce the use of antibiotics (7).Common pathogens causing respiratory illness in newborns are respiratory syncytial virus (RSV), influenza virus, adenovirus, rhinovirus, and parainfluenza viruses (2,3). Less common pathogens, including the more recently identified bocavirus, have also been detected in infants with acute respiratory infection (7,8). However,...

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