Department of Obstetrics and Gynecology, Medical University of Sofia, Zdrave 2 street, 1431, Sofia, Bulgaria.
Neonatology Clinic, University Hospital of Obstetrics and Gynecology "Maichin Dom", Sofia, Bulgaria.
BMC Pediatr. 2021 Dec 11;21(1):567. doi: 10.1186/s12887-021-03053-9.
Respiratory syncytial virus (RSV) is the predominant cause of lower respiratory tract infections (LRTI) in infancy. Preterm infants with bronchopulmonary dysplasia (BPD) are at the highest risk of severe RSV-LRTI. This is a retrospective study that analyses a nosocomial outbreak of RSV infections in the Neonatology clinic of the University Hospital of Obstetrics and Gynecology, Sofia, 2019.
Two groups of infants without contact between them were diagnosed with RSV-infection: 14 infants were treated in the Department for healthy newborns - Group 1, and 7 preterm infants were treated in the Neonatal Intensive Care Unit (NICU) - Group 2. The detection of RSV was performed using Real-Time PCR in nasal/throat swabs.
Respiratory symptoms occurred 2-5 days after discharge in 14 of 148 healthy term infants born February 5 to 18, 2019; 12 babies were re-hospitalized with LRTI and recovered in a few days. RSV-PCR was positive in 6 infants, while in the others, RSV etiology was suggested, due to similar symptoms and contact between them. The first NICU patient with RSV-LRTI was one of the 26 gestational weeks (GW) twins, who had severe BPD. The other twin was always discharged home without LRTI-symptoms. In the period February 19 to March 15, 2019, 26 premature babies born at 26-34 GW, were tested for RSV (33 nasal/throat swabs). They received a first or subsequent palivizumab injection. We identified 11 positive samples in 7 of the babies. Despite the clinical recovery, the second RSV-PCR remained positive in 4 babies. Six of the 7 NICU patients had symptoms of LRTI, and two of them needed mechanical ventilation. Six babies were discharged home after stabilization, one was transferred to the Pediatric department for further treatment of BPD and later discharged too.
This was the most serious outbreak of RSV infections in neonates since the RSV-PCR diagnostic in Bulgaria was introduced. The course of RSV-LRTI was severe in extremely preterm patients with underlying BPD. So, routine in-hospital RSV-prophylaxis with palivizumab should be considered for infants at the highest risk.
呼吸道合胞病毒（RSV）是婴儿下呼吸道感染（LRTI）的主要原因。患有支气管肺发育不良（BPD）的早产儿患严重 RSV-LRTI 的风险最高。这是一项回顾性研究，分析了 2019 年索非亚妇产医院新生儿科的 RSV 感染医院内暴发情况。
两组婴儿无接触，均被诊断为 RSV 感染：14 名婴儿在新生儿科治疗-第 1 组，7 名早产儿在新生儿重症监护病房（NICU）治疗-第 2 组。使用实时 PCR 在鼻/咽拭子中检测 RSV。
2019 年 2 月 5 日至 18 日出生的 148 名健康足月婴儿中，有 14 名在出院后 2-5 天出现呼吸道症状；12 名婴儿因 LRTI 再次住院，数天内康复。6 名婴儿的 RSV-PCR 阳性，而其他婴儿由于类似症状和接触，提示 RSV 病因。第一个患 RSV-LRTI 的 NICU 患者是 26 孕周（GW）双胞胎之一，患有严重的 BPD。另一个双胞胎始终无 LRTI 症状出院。在 2019 年 2 月 19 日至 3 月 15 日期间，对 26-34 GW 出生的 26 名早产儿进行了 RSV 检测（33 份鼻/咽拭子）。他们接受了第一或后续的帕利珠单抗注射。在 7 名婴儿中发现了 11 个阳性样本。尽管临床康复，但 4 名婴儿的第二次 RSV-PCR 仍为阳性。7 名 NICU 患者中有 6 名出现 LRTI 症状，其中 2 名需要机械通气。6 名婴儿稳定后出院，1 名因 BPD 转至儿科进一步治疗，后也出院。
这是保加利亚引入 RSV-PCR 诊断以来新生儿中最严重的 RSV 感染暴发。患有潜在 BPD 的极早产儿的 RSV-LRTI 病程严重。因此，应考虑对高危婴儿进行常规住院 RSV 预防用帕利珠单抗治疗。
