Multiplex PCR testing to detect respiratory viruses in infants in NICUs

Abstract

Investigators from two neonatal intensive care units (NICUs) in Syracuse performed a prospective one-year study, testing nasopharyngeal specimens from prematurely born infants twice weekly using multiplex polymerase chain reaction (PCR) testing for respiratory viruses. No infant had clinical symptoms that led to virus testing, but a remarkable 52% of 50 infants studied had one or more virus detections. Infected infants had an average of 2.5 positive specimens. Some had a single virus detected repeatedly, others had different viruses detected sequentially or simultaneously. The mean time to first virus detection was 24 days (range 0 to 92 days). Viruses detected clustered during times of expected community activity of the virus. Virus detection was significantly associated with duration of intubation, use of supplemental oxygen, as well as the outcomes of length of hospital stay and diagnosis of bronchopulmonary dysplasia. Although no infant had clinically suspected viral respiratory tract infection, virus detection was associated with oxygen desaturation events and clinical deteriorations. Path analysis of the effects of viral infection on length of NICU stay after adjusting for possible confounding factors showed both significant direct effects of infection and indirect effects (ie, oxygen use and intubation). This type of study cannot address causal relationships between infection and outcomes, but the striking frequency of virus detection, the associated immediate negative events, and the possibility of important longer term negative outcomes makes this a sentinel study. Multiple hypotheses should be tested, including modes of acquisition of infection and methods of prevention. Article page 814▶ Unrecognized Viral Respiratory Tract Infections in Premature Infants during their Birth Hospitalization: A Prospective Surveillance Study in Two Neonatal Intensive Care UnitsThe Journal of PediatricsVol. 161Issue 5PreviewTo determine the frequency and effects of nosocomial respiratory viral infections (RVIs) in premature neonates, including those who may be asymptomatic. Full-Text PDF