Atypical Extrapulmonary Presentations Of Severe Respiratory Syncytial Virus Infection Requiring Intensive Care

Abstract

The patterns and nature of a four-month epidemic of severe respiratory syncytial virus (RSV)-associated disease were analyzed using presenting, demographic, clinical, and therapeutic data. Of 218 infants with RSV infection admitted to Rainbow Babies and Childrens Hospital, 49 (22.4%), most born prematurely, entered the pediatric intensive care unit (PICU). Fluorescent antibody and/or enzyme-linked immunosorbent assay documented RSV infection. PICU patients underwent airway stabilization; 53.5% were intubated and evaluated for sepsis. Patients with positive bacterial cultures received antibiotics; 18% were given ribavirin. Patterns of infection included hypothermia, septic shock appearance, apnea, pneumonia, and wheezing due to bronchiolitis. The average age difference between patients with hypothermia (23.3 days) and those with pneumonia (11.2 months) was statistically significant. There were no significant differences in average age, gestational age at birth, number intubated, worst pH and PCO2, duration of intensive care, or treatment modalities between infants with bronchopulmonary dysplasia who received ribavirin and those who did not.

Changes in cardiac output and stroke volume as measured by non-invasive CO monitoring in infants with RSV bronchiolitis

“…Of these, 5 infants were recruited from the MICU, 6 were recruited from the ICP, and 4 from the Inpatient Units. There were 10 males and 5 females with a median age of 2.0 (0.4-18) months, median weight of 5.8 (3)(4)(5)(6)(7)(8)(9)(10)(11) kg and median height of 60 (50-84) cm. Median time to acute stabilization was 4 (1-6) days, time between initial and final CO recording was 2.5 (0.8-7.2) days and length of hospitalization was 3.6 (1.6-8.9) days.…”

“…In most cases these infants are admitted to the hospital for respiratory distress and hypoxia; however, RSV has been reported to produce myocarditis [2] or is associated with myocardial injury [3], arrhythmias [4,5], and viral-induced sepsis [6]. Infants with respiratory insufficiency from bronchiolitis may have similar clinical features to infants with congestive heart failure [7], presenting with irritability, fever, tachypnea, tachycardia and a mottled appearance.…”

The clinical picture presented by premature neonates infected with the respiratory syncytial virus

“…Thus, RSV infection and the age parameters may influence the clinical course in those patients who have no nosocomial infection. Another study reported hypothermia as the predominant symptom present in 49 babies admitted into an NICU, half of whom had been born prematurely, but the authors did not check for bradycardia [20].…”

Nursing Care of Infants and Children with Bronchiolitis

“…6 They are present with low grade fever, hypothermia in younger infants, running nose, and irritating cough. 7,8 Concomitant otitis media is common. 8 Apnea may occur particularly in low-birth weight and preterm babies.…”