Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지

Acute Respiratory Infections in the Neonatal Intensive Care Unit: Isolation of Viruses and the Characteristics of Respiratory Syncytial Virus Infection

신생아집중치료실에서의 급성 호흡기 감염-바이러스의 검출 및 respiratory syncytial virus 감염의 임상적 특징

  • Park, Sun-Hee (Department of Pediatrics, Gil Hospital, Gachon University of Medicine and Science) ;
  • Cho, Hye-Jung (Department of Pediatrics, Gil Hospital, Gachon University of Medicine and Science) ;
  • Shim, So-Yeon (Department of Pediatrics, Gil Hospital, Gachon University of Medicine and Science) ;
  • Son, Dong-Woo (Department of Pediatrics, Gil Hospital, Gachon University of Medicine and Science) ;
  • Eun, Byung-Wook (Department of Pediatrics, Gil Hospital, Gachon University of Medicine and Science) ;
  • Sun, Yong-Han (Department of Pediatrics, Gil Hospital, Gachon University of Medicine and Science) ;
  • Tchah, Hann (Department of Pediatrics, Gil Hospital, Gachon University of Medicine and Science) ;
  • Jeon, In-Sang (Department of Pediatrics, Gil Hospital, Gachon University of Medicine and Science)
  • 박선희 (가천의과학대학교 길병원 소아청소년과) ;
  • 조혜정 (가천의과학대학교 길병원 소아청소년과) ;
  • 심소연 (가천의과학대학교 길병원 소아청소년과) ;
  • 손동우 (가천의과학대학교 길병원 소아청소년과) ;
  • 은병욱 (가천의과학대학교 길병원 소아청소년과) ;
  • 선용한 (가천의과학대학교 길병원 소아청소년과) ;
  • 차한 (가천의과학대학교 길병원 소아청소년과) ;
  • 전인상 (가천의과학대학교 길병원 소아청소년과)
  • Published : 2009.11.30

⟨ Previous Next ⟩

Abstract

Purpose: Recently, it is easy to find the causal virus of acute respiratory infections using multiplex RT-PCR. The aim of this study is to show the distribution of respiratory viruses and to define the characteristics of respiratory syncytial virus (RSV) infections compared to other respiratory viral infections. Methods: This was a prospective observational study conducted in the NICU. The infants with acute respiratory infections were performed multiplex RT-PCR using nasal swabs. The demographics, initial symptoms, course of illness, and laboratory and imaging findings were recorded. The infants were divided into RSV and No RSV groups. Results: Twenty-three infants (50%) were in the RSV group. Rhinovirus was the second most common virus. Coinfections with two viruses accounted for 6.5% of respiratory infections. The number of preterm infants, exposure to cigarette smoke and having siblings were not different between the two groups. Infections in the postnatal care center were more common in the RSV group than the No RSV group (60.9% vs. 21.7%, P=.007). Dyspnea (34.8% vs. 8.7%, P=.032) and pneumonia (73.9% vs. 43.5%, P=.036) were more common in the RSV group. The RSV group frequently needed oxygen (52.5% vs. 13.0%, P=.005) and received nothing by mouth (43.5% vs. 13.0%, P=.022). The incidence of right upper consolidation was higher in RSV group (56.5% vs. 8.7%, P=.001). Conclusion: This study showed that other viruses than RSV can induce respiratory infections in neonates and young infants born prematurely. RSV infections have a more severe course of illness than other respiratory viruses. We have to be careful of prevention even for healthy neonates especially in crowed situations, such as the postnatal care center.

목 적 : 최근 multiplex RT-PCR의 개발로 급성 호흡기 감염에서 바이러스의 검출이 용이해졌다. 지금까지 respiratory syncytial virus (RSV)에 대한 연구는 많았지만 이전에 건강했던 신생아나 미숙아로 출생한 어린 영아에 대한 연구는 많지 않고 더욱이 이들에서의 다른 호흡기 바이러스에 대한 연구는 거의 없다. 저자들은 신생아집중치료실에 입원한 급성 호흡기 감염 환아를 대상으로 바이러스를 검출하고 다른 바이러스와 비교한 RSV 감염의 특성을 알아보고자 하였다. 방 법 : 신생아집중치료실에 급성 호흡기 감염으로 입원하여 multiplex RT-PCR을 시행한 환아를 대상으로 전향적 관찰 연구를 시행하였다. 모든 환아를 RSV군과 RSV가 검출되지 않은 No RSV 군으로 나누어 인구학적 특징과 임상양상 및 혈액검사와 흉부X-선 검사결과를 비교하였다. 결 과 : RSV 군은 23명(50%)이었다. Rhinovirus는 15.2%로 두 번째로 많이 검출되었다. RSV는 1월과 2월에, rhinovirus는 4월에 중점적으로 발생하였다. 중복감염 된 환아는 세 명(6.5%)이었다. 미숙아 수와 형제가 있거나 흡연에 노출 된 경우는 두 군간 차이가 없었으나 RSV 군에서 조리원 감염이 유의하게 많았다(60.9% vs. 21.7%, P=.007). RSV 군에서 No RSV 군에 비해 호흡곤란(34.8% vs. 8.7%, P=.032)과 폐렴(73.9% vs. 43.5%, P=.036)으로 입원한 환아가 많았고 산소 투여(52.5% vs. 13.0%, P=.005)와 금식(43.5% vs. 13.0%, P=.022)이 필요한 경우가 많았다. 우측상엽의 침윤도 RSV 군에서 많았다(56.5% vs. 8.7%, P=.001). 결 론 : 신생아나 미숙아로 출생했던 어린 영아는 RSV 뿐만 아니라 다른 다양한 호흡기 바이러스 감염으로 입원하게 된다. RSV 감염은 다른 감염에 비해 중증도가 높으므로 건강한 신생아에 대해서도 주의를 요하며 특히 조리원 등 밀집도가 높은 곳에서는 철저한 감염예방 관리가 필요하다.

Keywords

References

  1. Kim KH, Lee JH, Sun DS, Kim YB, Choi YJ, Park JS, et al. Detection and clinical manifestations of twelve respiratory viruses in hospitalized children with acute lower respiratory tract infections: Focus on human metapneumovirus, human rhinovirus and human coronavirus. Korean J Pediatr 2008;51:834-41. https://doi.org/10.3345/kjp.2008.51.8.834
  2. Cilia G, Onate E, Perez-Yarza EG, Montes M, Vicente D, Perez-Trallero E. Viruses in community-acquired pneumonia in children aged less than 3 years old: High rate of viral coinfection. J Med Virol 2008;80:1843-9. https://doi.org/10.1002/jmv.21271
  3. Shin SH, Kim JR, Lee JA, Choi CW, Kim EK, Choi EH, et al. Clinical characteristics of severe respiratory syncytial virus infection requiring mechanical ventilation in neonatal period and early infancy. Korean J Pediatr 2008;51:372-6. https://doi.org/10.3345/kjp.2008.51.4.372
  4. Calvo C, Garcia-Garcia ML, Blanco C, Pozo F, Flecha IC, Perez-Brena P. Role of rhinovirus in hospitalized infants with respiratory tract infections in Spain. Pediatr Infect Dis J 2007;26:904-8. https://doi.org/10.1097/INF.0b013e31812e52e6
  5. Counihan ME, Shay DK, Holman RC, Lowther SA, Anderson LJ. Human parainfluenza virus-associated hospitalizations among children less than five years of age in the United States. Pediatr Infect Dis J 2001;20:646-53. https://doi.org/10.1097/00006454-200107000-00003
  6. Crowcroft NS, Zambon M, Harrison TG, Mok Q, Heath P, Miller E. Respiratory syncytial virus infection in infants admitted to paediatric intensive care units in London, and in their families. Eur J Pediatr 2008;167:395-9. https://doi.org/10.1007/s00431-007-0509-9
  7. Syrmis MW, Whiley DM, Thomas M, Mackay IM, Williamson J, Siebert DJ, et al. A sensitive, specific, and cost-effective multiplex reverse transcriptase-PCR assay for the detection of seven common respiratory viruses in respiratory samples. J Mol Diagn 2004;6:125-31. https://doi.org/10.1016/S1525-1578(10)60500-4
  8. Bonzel L, Tenenbaum T, Schroten H, Schildgen O, Schweitzer-Krantz S, Adams O. Frequent detection of viral coinfection in children hospitalized with acute respiratory tract infection using a real-time polymerase chain reaction. Pediatr Infect Dis J 2008;27:589-94. https://doi.org/10.1097/INF.0b013e3181694fb9
  9. Papadopoulos NG, Bates PJ, Bardin PG, Papi A, Leir SH, Fraenkel DJ, et al. Rhinoviruses infect the lower airways. J Infect Dis 2000;181:1875-84. https://doi.org/10.1086/315513
  10. Henderson FW. Pulmonary infections with respiratory syncytial virus and the parainfluenza viruses. Semin Respir Infect 1987;2:112-21.
  11. Park GO, Kim JH, Lee JH, Lee JJ, Yun SW, Lim IS, et al. Epidemiologic and clinical features in children with acute lower respiratory tract infection caused by human metapneumovirus in 2006-2007. Korean J Pediatr 2009;52:330-8. https://doi.org/10.3345/kjp.2009.52.3.330
  12. Drews AL, Atmar RL, Glezen WP, Baxter BD, Piedra PA, Greenberg SB. Dual respiratory virus infections. Clin Infect Dis 1997;25:1421-9. https://doi.org/10.1086/516137
  13. Choi EH, Lee HJ, Kim SJ, Eun BW, Kim NH, Lee JA, et al. The association of newly identified respiratory viruses with lower respiratory tract infections in Korean children, 2000-2005. Clin Infect Dis 2006;43:585-92. https://doi.org/10.1086/506350
  14. Rossi GA, Medici MC, Arcangeletti MC, Lanari M, Merolla R, Paparatti UD, et al. Osservatorio RSV Study Group. Risk factors for severe RSV-induced lower respiratory tract infection over four consecutive epidemics. Eur J Pediatr 2007;166:1267-72. https://doi.org/10.1007/s00431-007-0418-y
  15. Simon A, Muller A, Khurana K, Engelhart S, Exner M, Schildgen O, et al. DSM RSV Paed Study Group. Nosocomial infection: a risk factor for a complicated course in children with respiratory syncytial virus infection--results from a prospective multicenter German surveillance study Int J Hyg Environ Health 2008;211:241-50. https://doi.org/10.1016/j.ijheh.2007.07.020
  16. Simon A, Ammann RA, Wilkesmann A, Eis-Hu-binger AM, Schildgen O, Weimann E, et al. DSM RSV Paed Study Group. Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database. Eur J Pediatr 2007;166:1273-83. https://doi.org/10.1007/s00431-007-0426-y
  17. Carbonell-Estrany X, Bont L, Doering G, Gouyon JB, Lanari M. Clinical relevance of prevention of respiratory syncytial virus lower respiratory tract infection in preterm infants born between 33 and 35 weeks gestational age. Eur J Clin Microbiol Infect Dis 2008;27:891-9. https://doi.org/10.1007/s10096-008-0520-8
  18. Fodha I, Vabret A, Ghedira L, Seboui H, Chouchane S, Dewar J, et al. respiratory syncytial virus infections in hospitalized infants: association between viral load, virus subgroup, and disease severity J Med Virol 2007;79:1951-8. https://doi.org/10.1002/jmv.21026
  19. Law BJ, Langley JM, Allen U, Paes B, Lee DS, Mitchell I, et al. The Pediatric Investigators Collaborative Network on Infections in Canada study of predictors of hospitalization for respiratory syncytial virus infection for infants born at 33 through 35 completed weeks of gestation. Pediatr Infect Dis J 2004;23:806-14. https://doi.org/10.1097/01.inf.0000137568.71589.bd
  20. Horn SD, Smout RJ. Effect of prematurity on respiratory syncytial virus hospital resource use and outcomes. J Pediatr 2003;143:S133-41.
  21. Anas N, Boettrich C, Hall CB, Brooks JG. The association of apnea and respiratory syncytial virus infection in infants. J Pediatr 1982;101:65-8. https://doi.org/10.1016/S0022-3476(82)80184-4
  22. Wright PF, Gruber WC, Peters M, Reed G, Zhu Y, Robinson F, et al. Illness severity, viral shedding, and antibody responses in infants hospitalized with bronchiolitis caused by respiratory syncytial virus. J Infect Dis 2002;185:1011-8. https://doi.org/10.1086/339822
  23. Cevey-Macherel M, Galetto-Lacour A, Gervaix A, Siegrist CA, Bille J, Bescher-Ninet B, Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines. Eur J Pediatr 2009 Feb 24. [Epub ahead of print]