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Nosocomial respiratory infections in neonates associated with increased morbidity, costs
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Nosocomial viral respiratory tract infections are associated with higher rates of respiratory morbidity and cost of care in neonates in the United Kingdom, researchers reported.
“Nosocomial [viral respiratory tract infections (VRTIs)] are often unrecognized or clinically underdiagnosed in the NICU, with up to 52% of admissions testing positive for viral DNA according to PCR,” Shairbanu Zinna, MBBS, MRCPCH, from the Nottingham University Hospitals NHS Trust, and colleagues wrote in Pediatrics. “It is therefore plausible that VRTIs acquired during the NICU period could worsen [bronchopulmonary dysplasia (BDP)] in preterm infants, although previous studies have mostly been small observational cohorts.”
The investigators conducted a matched case-control study in two tertiary NICUs in Nottingham, U.K., between 2007 and 2013 — a timeframe that included the influenza A(H1N1) pandemic — to determine the correlation between nosocomial VRTIs neonates acquired in the NICU and challenges to the respiratory system leading up to discharge, in addition to neonatal respiratory disease and health care-related costs. Patients’ mean gestational age was 29 weeks. They were considered cases if they were symptomatic and had a real-time PCR diagnosis of VRTI. Matched controls did not have a positive VRTI diagnosis.
Researchers matched 92 case neonates to 183 control neonates. Rhinovirus was significantly associated with the NICU and affected 74% of infants during the 6-year period. In case patients, 51% needed escalated respiratory support during VRTIs, and cases also required increased support overall vs. controls (25 days vs. 7 days; P < .001). Additionally, two times as many cases needed home oxygen compared with controls (37%; OR = 3.94; 95% CI, 1.92-8.06), and they experienced extended length of hospital stays (76 days vs. 41 days; P < .001). In-patient health care costs also were significantly increased for case infants compared with control infants ($71,861 vs. $32,057; P < .001).
“As the dominant pathogen in our cases, rhinovirus was associated with a need for increased respiratory support in one-half of the infants, with many of the premature infants requiring additional pressure support ventilation, similar to other smaller studies,” the researchers wrote. “This scenario results in an increase in the level of care and barrier nursing, and it requires additional nursing and medical input to manage.” – by Kate Sherrer
- Reference:
- Zinna S, et al. Pediatrics. 2016;doi:10.1542/peds.1675.
Disclosure: The researchers report they have no relevant financial disclosures.