Value of Chest Radiographic Pattern in RSV Disease of the Newborn: A Multicenter Retrospective Cohort Study

Abstract

Respiratory syncytial virus (RSV) lower respiratory tract infection is the most common viral respiratory infection in infants. Several authors have sought to determine which risk factors are the best predictors for severe RSV disease. Our aim was to evaluate if a specific chest radiographic pattern in RSV disease can predict the disease severity. We conducted a multicenter retrospective cohort study in term and preterm neonates with confirmed lower respiratory tract RSV infection, admitted to neonatal intensive care units (NICU) from 2000 to 2010. To determine which factors independently predicted the outcomes, multivariate logistic regression analysis was performed. A total of 259 term and preterm neonates were enrolled. Patients with a consolidation pattern on the chest radiograph at admission (n = 101) had greater need for invasive mechanical ventilation (OR: 2.5; P = .015), respiratory support (OR: 2.3; P = .005), supplemental oxygen (OR: 3.0; P = .008), and prolonged stay in the NICU (>7 days) (OR: 1.8; P = .025). Newborns with a consolidation pattern on admission chest radiograph had a more severe disease course, with greater risk of invasive mechanical ventilation, respiratory support, supplemental oxygen, and prolonged hospitalization.

Epidemiological and clinical profiles of respiratory syncytial virus infection in hospitalized neonates in Suzhou, China

“…As for the chest radiographic pattern in neonates with RSV-related LRIs, RSV infected neonatespresented with more abnormal patterns such as patches, consolidation and atelectasis when compared to non-RSV infected neonates from our study. A recent study [ 25 ] reported that neonates with a consolidation pattern on admission had a more severe disease phenotype, with greater risk of invasive mechanical ventilation which is consistent with our study.…”

“…With regard to clinical profiles in neonates with LRIs due to RSV, several studies have focused on the clinical characteristics in neonates with RSV-related LRIs [ 10 , 23 – 25 ]. Cho et al [ 23 ] reported thatneonates with RSV-related LRIs had a greater incidence for the requirement of supplemental oxygen after birth, prolonging their hospitalization when compared to neonates infected with other respiratory viruses.…”

Retrospective Review of Clinical and Chest X-Ray Findings in Children Admitted to a Community Hospital for Respiratory Syncytial Virus Infection

“…This bias is suggested by comparing other fully blinded studies that reported a higher percentage of “normal” chest radiographs, ranging from 22% to 30%, compared with our finding of 13.9%. 10,20 Second, follow-up chest radiographs performed after admission were not included in the study; therefore, data on the percent of patients with normal chest radiographs progressing into abnormal radiographs are not available.…”

“…[5][6][7][8][9] However, despite the magnitude of disease burden on the pediatric population, there are limited studies that correlate admission radiographic findings with severity of clinical course. 10 This study focuses on the clinical and radiographic findings associated with severity of RSV manifestations in a community hospital in Phoenix, Arizona, serving a low socioeconomic status and largely Hispanic population.…”

“…Similarly, other studies have reported that newborns with a consolidation chest pattern had more severe disease with greater need for supplemental oxygen, respiratory support, invasive mechanical ventilation, and longer length of stay in the neonatal intensive care unit. 8,10 Another study reported that any abnormal chest radiograph was more prevalent in the sicker and younger groups among RSV-infected children. 17 Likewise, our study showed that an overwhelming 90.2% of patients with an abnormal chest radiograph on admission had severe clinical outcomes.…”