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Publications

Journal Article Ahead of print 1 citation

PubMed: 39812486 DOI: 10.1093/infdis/jiaf018

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

J Infect Dis

Authors: Shannon B Leland, Laura D Zambrano, Steven J Staffa, Elizabeth R McNamara, Margaret M Newhams, Natasha Halasa, Justin Z Amarin, Laura S Stewart, Steven L Shein, Christopher L Carroll, Julie C Fitzgerald, Marian G Michaels, Katherine Bline, Melissa L Cullimore, Laura Loftis, Vicki L Montgomery, Asumthia S Jeyapalan, Pia S Pannaraj, Adam J Schwarz, Natalie Z Cvijanovich, Matt S Zinter, Aline B Maddux, Melania M Bembea, Katherine Irby, Danielle M Zerr, Joseph D Kuebler, Christopher J Babbitt, Mary G Gaspers, Ryan A Nofziger, Michele Kong, Bria M Coates, Jennifer E Schuster, Shira J Gertz, Elizabeth H Mack, Benjamin R White, Helen Harvey, Charlotte V Hobbs, Heda Dapul, Andrew D Butler, Tamara T Bradford, Courtney M Rowan, Kari Wellnitz, Mary Allen Staat, Cassyanne L Aguiar, Saul R Hymes, Angela P Campbell, Adrienne G Randolph

Affiliations

  • Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
  • Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
  • Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
  • Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA.
  • Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
  • Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
  • Division of Infectious Diseases, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
  • Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
  • Division of Pediatric Critical Care, Department of Pediatrics, Children's Nebraska, Omaha, Nebraska, USA.
  • Department of Pediatrics, Baylor College of Medicine, Division of Pediatric Critical Care, Texas Children's Hospital, Houston, Texas, USA.
  • Department of Pediatrics, University of Louisville and Norton Children's Hospital, Louisville, Kentucky, USA.
  • Division of Pediatric Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
  • Division of Infectious Diseases, Departments of Pediatrics, University of California San Diego, and Rady Children's Hospital. San Diego, California, USA.
  • Division of Critical Care Medicine, Children's Hospital Orange County, Orange, California, USA.
  • Division of Critical Care, Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA.
  • Division of Critical Care, Department of Pediatrics, UCSF Benioff Children's Hospital San Francisco, California, USA.
  • Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
  • Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
  • Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
  • Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA.
  • Division of Pediatric Critical Care, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York, USA.
  • Division of Pediatric Critical Care, Miller Children's and Women's Hospital of Long Beach, Long Beach, California, USA.
  • Division of Critical Care, Department of Pediatrics, Banner Children's at Diamond Children's Medical Center, Tucson, Arizona, USA.
  • Division of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio, USA.
  • Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
  • Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
  • Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA.
  • Division of Pediatric Critical Care, Department of Pediatrics, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA.
  • Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
  • Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
  • Division of Pediatric Critical Care, Department of Pediatrics, University of California - San Diego, Rady Children's Hospital, San Diego, California, USA.
  • Division of Infectious Diseases, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.
  • Division of Pediatric Critical Care Medicine, Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, USA.
  • Division of Pediatric Critical Care, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
  • Division of Cardiology, Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital of New Orleans, New Orleans, Louisiana, USA.
  • Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA.
  • Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
  • Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
  • Division of Pediatric Rheumatology, Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Norfolk, Virginia, USA.
  • Division of Pediatric Infectious Diseases, Department of Pediatrics, Bernard and Millie Duker Children's Hospital, Albany Med Health System, Albany, New York, USA.
  • Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.

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.

MeSH

Sample Size, Respiratory Syncytial Viruses, Critical Illness, Viruses, Intensive Care Units, Communicable Diseases, Infant