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

2025; Oxford University Press; Linguagem: Inglês

10.1093/infdis/jiaf018

1537-6613

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 L. Loftis, V. L. Montgomery, Asumthia 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 Glas 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 Butler, Tamara T. Bradford, Courtney M. Rowan, Kari Wellnitz, Mary Allen Staat, Cassyanne L. Aguiar, Saul Hymes, Angela P. Campbell, Adrienne G. Randolph, Merry Tomcany, Kelly Michelson, Heather E. Price, Ronald C. Sanders, Lexie Dixon, Katri Typpo, Ilana Harwayne‐Gidansky, Suden Kücükak, Sabrina Chen, Eve Listerud, Ofelia Vargas-Shiraishi, Betty Oberle, Frances Zorensky, Rachel Mansour, Jaycee Jumarang, Marla Johnston, Jenny L. Bush, Shawn Dickey, Shannon E. Hill, Melissa Sullivan, Abigail Kietzman, Candice Colston, Meghan Murdock, Heather M. Kelley, Laura Wright-Sexton, Maygan Martin, Lora Martin, Lacy Malloch, Kayla Patterson, Cameron Sanders, Chelsea Rohlfs, Marilyn Rice, Miranda Howard, M. Gail Murphy, Vijaya L Soma, Adam J. Ratner, Megan Job, Colleen Mennie, Kamala Simkhada, Kristina Betters, Haya Hayek, Molly Maranto, Aubrie Waters, Maggie Flowers, Kevin M Havlin, Jamie Furlong-Dillard, Melissa Porter, Jennifer Nason, M. Ray, Kristen Gossett, Hillary Crandall, Evan G Heller, Jennifer Foley, Rajashri Rasal, Christine Marlow, Anurithi Senthil, Kimberly R. Myers, Betsy Tudor, Amanda Adler, Nereyda Garcia, Natalie Treister, Patrick S. McQuillen, Kathleen Sun, Denise Villarreal-Chico, Sophia Kainaroi, John V. Williams,

Congenital Diaphragmatic Hernia Studies

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. 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). 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. 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.