Assessing Clinical Improvement of Infants Hospitalized for Respiratory Syncytial Virus-Related Critical Illness.
Document Type
Article
Publication Date
1-15-2025
Abstract
BACKGROUND: 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.
METHODS: We analyzed data from a prospective surveillance registry of infants hospitalized for RSV-related complications across 39 U.S. PICUs from October through December 2022. We assigned CPS-Ped (0=discharged home at respiratory baseline to 8=death) at admission, 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).
RESULTS: Of 585 hospitalized infants, 138 (23.6%) received invasive mechanical ventilation (IMV). Of the 49 (8.4%) infants whose CPS-Ped score worsened by 2 points after admission, one 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 2,031 for hospital LOS.
CONCLUSIONS: 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.
Publication Title
The Journal of infectious diseases
Recommended Citation
Leland, S., Zambrano, L., Staffa, S., McNamara, E., Newhams, M., Halasa, N., Amarin, J., Stewart, L., Shein, S., Carroll, C., Fitzgerald, J., Michaels, M., Bline, K., Cullimore, M., Loftis, L., Montgomery, V., Jeyapalan, A., Pannaraj, P., Schwarz, A., Cvijanovich, N., Zinter, M., Maddux, A., Bembea, M., Irby, K., Zerr, D., Kuebler, J., Babbitt, C., Gaspers, M., Nofziger, R., Kong, M., Coates, B., Schuster, J., Gertz, S., Mack, E., White, B., Harvey, H., Hobbs, C., Dapul, H., Butler, A., Bradford, T., Rowan, C., Wellnitz, K., Staat, M., Aguiar, C., Hymes, S., Campbell, A., & Randolph, A. (2025). Assessing Clinical Improvement of Infants Hospitalized for Respiratory Syncytial Virus-Related Critical Illness.. The Journal of infectious diseases https://doi.org/https://urlisolation.com/browser?url=https%3A%2F%2Fdoi.org%2F10.1093%2Finfdis%2Fjiaf018&traceToken=1740586555;readinghosp_hosted;https:/pubmed.ncbi.nlm.nih.gov/?&clickId=ED054D6C-54EB-479A-AE0A-2EE54127E162
Comments
Online ahead of print