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Outcomes of nosocomial viral respiratory infections in high-risk neonates

Zinna, Shairbanu; Lakshmanan, Arthi; Tan, Shin; McClaughry, Rebecca; Clarkson, Martin; Soo, Shiu; Szatkowski, Lisa; Sharkey, Don


Shairbanu Zinna

Arthi Lakshmanan

Shin Tan

Rebecca McClaughry

Martin Clarkson

Shiu Soo

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Professor of Neonatal Medicine and Technologies


BACKGROUND AND OBJECTIVE: Neonatal respiratory disease, particularly bronchopulmonary dysplasia, remains one of the leading causes of morbidity and mortality in newborn infants. Recent evidence suggests nosocomially acquired viral respiratory tract infections (VRTIs) are not uncommon in the NICU. The goal of this study was to assess the association between nosocomial VRTIs, neonatal respiratory disease, and the health care related costs.
METHODS: A matched case–control study was conducted in 2 tertiary NICUs during a 6-year period in Nottingham, United Kingdom. Case subjects were symptomatic neonatal patients with a confirmed real-time polymerase chain reaction diagnosis of a VRTI. Matched controls had never tested positive for a VRTI. Multivariable logistic regression was used to test for associations with key respiratory outcomes.
RESULTS: There were 7995 admissions during the study period, with 92 case subjects matched to 183 control subjects. Baseline characteristics were similar, with a median gestation of 29 weeks. Rhinovirus was found in 74% of VRTIs. During VRTIs, 51% of infants needed escalation of respiratory support, and case subjects required significantly more respiratory pressure support overall (25 vs 7 days; P< .001). Case subjects spent longer in the hospital (76 vs 41 days; P< .001), twice as many required home oxygen (37%; odds ratio: 3.94 [95% confidence interval: 1.92–8.06]; P< .001), and in-hospital care costs were significantly higher (£49 664 [$71 861] vs £22 155 [$32 057]; P< .001).
CONCLUSIONS: Nosocomial VRTIs in neonatal patients are associated with significant greater respiratory morbidity and health care costs. Prevention efforts must be explored.


Zinna, S., Lakshmanan, A., Tan, S., McClaughry, R., Clarkson, M., Soo, S., …Sharkey, D. (2016). Outcomes of nosocomial viral respiratory infections in high-risk neonates. Pediatrics, 138(5), Article e20161675.

Journal Article Type Article
Acceptance Date Aug 9, 2016
Online Publication Date Oct 3, 2016
Publication Date Nov 1, 2016
Deposit Date Nov 30, 2016
Publicly Available Date Nov 30, 2016
Journal Pediatrics
Print ISSN 0031-4005
Electronic ISSN 1098-4275
Publisher American Academy of Pediatrics
Peer Reviewed Peer Reviewed
Volume 138
Issue 5
Article Number e20161675
Public URL
Publisher URL


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