Respiratory Viruses in the Neonatal Intensive Care Unit

Wozniak, Phillip S.

Respiratory viral infections (RVIs) pose a unique challenge for clinicians in the neonatal intensive care unit (NICU) due to preterm infants’ increased susceptibility to infections (Maitre NL and Williams JV, Res Rep Neonatol. 6:41–49, 2016). RVIs often present with nonspecific symptoms and currently lack effective treatments (Baraldi et al., Ital J Pediatr. 40:65, 2014). Death due to viral bronchiolitis is a major cause of morbidity and mortality in developing nations and industrialized nations alike, and patients with bronchiolitis frequently require intensive care and use of mechanical ventilation (Thompson et al., JAMA 289:179–186, 2003). Infants who acquire RVI during their birth hospitalizations have significantly longer length of stay and are more likely to develop chronic respiratory disease, particularly bronchopulmonary dysplasia (Bennett et al., J Pediatr 161:814–818, 2012). Furthermore, infants with RVIs are often placed on empiric antibiotic therapy, which can frustrate antimicrobial stewardship efforts (Bennett et al., J Pediatr 161:814–818, 2012; Cantey et al., Lancet Infect Dis 2016;16:1178–1184). RVIs are also associated with increased costs to both health systems and families due to increased care and lost productivity. In 2016, Zinna et al. (Pediatrics 138:e20161675, 2016) showed that infants with hospital-acquired RVI in the United Kingdom had hospital charges more than double those of uninfected infants. Similarly, the Sentinel-1 Study (Anderson et al., Am J Perinatol 34:51–61, 2017) in the United States demonstrated that each hospitalization for respiratory syncytial virus (RSV), the most common etiological agent of viral bronchiolitis in children age <1 year, costs more than $55,000, even excluding the additional outpatient visits before and after hospitalization. The goal of this chapter is to address the epidemiology, pathogenesis, diagnosis, treatment, and prevention of respiratory viruses in the highly vulnerable patient population in the NICU.