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Predicting which infants with RSV infection will need intensive care continues to be difficult

Respiratory syncytial virus (RSV) is a common cause of bronchiolitis and pneumonia in young children and can cause serious breathing problems. Previously healthy infants who become infected with RSV generally don't deteriorate to the point that they need intensive care. In fact, a new study shows that only 2 percent of these infants had to be transferred to the pediatric intensive care unit (PICU) for closer monitoring of progressive respiratory distress. However, it is difficult to predict which infants infected with RSV will require intensive care. Thus, they need to be cared for in a medical unit that has sufficient resources to provide careful observation and timely transfer of deteriorating infants to a PICU, conclude researchers from the University of Rochester School of Medicine, Rochester, NY.

In the study, which was supported in part by the Agency for Health Care Policy and Research (HS09062), Ann-Marie Brooks, M.D., John T. McBride, M.D., principal investigator Kenneth M. McConnochie, M.D., M.P.H., and colleagues examined the clinical signs and symptoms of 542 previously healthy, full-term, RSV-infected infants admitted to the Children's Hospital at Strong or Rochester General Hospital's general pediatric unit. They compared presenting signs and symptoms of infants who remained on the unit with those of the 2 percent of infants who were transferred to the PICU and found no significant differences. Infants transferred to the PICU had breathing problems that deteriorated over hours rather than minutes, and attending physicians' assessments led to PICU transfer.

Abnormally rapid breathing (respiratory rate greater than 80) and extreme oxygen deficiency (hypoxemia, oxygen saturation less than 85 percent) were both associated with subsequent respiratory deterioration. However, only a small proportion of infants who deteriorated initially showed these signs, limiting the ability of the signs to predict which infants would need intensive care. Upon admission to the emergency department (ED), infants eventually transferred to the PICU had only a modestly different mean respiratory rate (63 vs. 50) and oxygen saturation (88 vs. 93 percent) compared with those who were not admitted to the PICU. Wheezing and chest x-rays did not differ between the two groups.

See "Predicting deterioration in previously healthy infants hospitalized with respiratory syncytial virus infection," by Drs. Brooks, McBride, McConnochie, and others, in the September 1999 Pediatrics 104(3), pp. 463-467.

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