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

Authors

Shannon B. Leland, Boston Children's Hospital, Boston, MA
Laura D. Zambrano, Centers for Disease Control and Prevention, Atlanta, GA
Steven J. Staffa, Boston Children's Hospital, Boston, MA
Elizabeth R. McNamara, Boston Children's Hospital, Boston, MA
Margaret M. Newhams, Boston Children's Hospital, Boston, MA
Natasha Halasa, Vanderbilt University Medical Center, Nashville, TN
Justin Z. Amarin, Vanderbilt University Medical Center, Nashville, TN
Laura S. Stewart, Vanderbilt University Medical Center, Nashville, TN
Steven L. Shein, Rainbow Babies and Children's Hospital, Cleveland, OH
Christopher L. Carroll, Connecticut Children's Medical Center, Hartford, CT
Julie C. Fitzgerald, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
Marian G. Michaels, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
Katherine Bline, Nationwide Children's Hospital, Columbus, OH
Melissa L. Cullimore, Children's Nebraska, Omaha, NE
Laura Loftis, Texas Children's Hospital, Houston, TX
Vicki L. Montgomery, University of Louisville and Norton Children's Hospital, Louisville, KY
Asumthia S. Jeyapalan, University of Miami Miller School of Medicine, Miami, FL
Pia S. Pannaraj, University of California San Diego, and Rady Children's Hospital, San Diego, CA
Adam J. Schwarz, Children's Hospital Orange County, Orange, CA
Natalie Z. Cvijanovich, UCSF Benioff Children's Hospital Oakland, Oakland, CA
Matt S. Zinter, UCSF Benioff Children's Hospital San Francisco, CA
Aline B. Maddux, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
Melania M. Bembea, Johns Hopkins University School of Medicine, Baltimore, MD
Katherine Irby, Arkansas Children's Hospital, Little Rock, AR
Danielle M. Zerr, University of Washington and Seattle Children's Hospital, Seattle, WA
Joseph D. Kuebler, University of Rochester Medical Center, Rochester, NY
Christopher J. Babbitt, Miller Children's and Women's Hospital of Long Beach, Long Beach, CA
Mary G. Gaspers, Banner Children's at Diamond Children's Medical Center, Tucson, AZ
Tamara T. Bradford, LSU Health Sciences Center - New OrleansFollow
et al

Document Type

Article

Publication Date

1-15-2025

Publication Title

The Journal of Infectious Diseases

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.

PubMed ID

39812486

Share

COinS