Leland Shannon B, Zambrano Laura D, Staffa Steven J, McNamara Elizabeth R, Newhams Margaret M, Halasa Natasha, Amarin Justin Z, Stewart Laura S, Shein Steven L, Carroll Christopher L, Fitzgerald Julie C, Michaels Marian G, Bline Katherine, Cullimore Melissa L, Loftis Laura, Montgomery Vicki L, Jeyapalan Asumthia S, Pannaraj Pia S, Schwarz Adam J, Cvijanovich Natalie Z, Zinter Matt S, Maddux Aline B, Bembea Melania M, Irby Katherine, Zerr Danielle M, Kuebler Joseph D, Babbitt Christopher J, Gaspers Mary G, Nofziger Ryan A, Kong Michele, Coates Bria M, Schuster Jennifer E, Gertz Shira J, Mack Elizabeth H, White Benjamin R, Harvey Helen, Hobbs Charlotte V, Dapul Heda, Butler Andrew D, Bradford Tamara T, Rowan Courtney M, Wellnitz Kari, Staat Mary Allen, Aguiar Cassyanne L, Hymes Saul R, Campbell Angela P, Randolph Adrienne G
Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
J Infect Dis. 2025 Jan 15. doi: 10.1093/infdis/jiaf018.
Pediatric respiratory syncytial virus (RSV)-related acute lower respiratory tract infection (LRTI) commonly requires hospitalization. The Clinical Progression Scale Pediatrics (CPS-Ped) measures level of respiratory support and degree of hypoxia across a range of disease severity, but it has not been applied in infants hospitalized with severe RSV-LRTI.
We analyzed data from a prospective surveillance registry of infants hospitalized for RSV-related complications across 39 U.S. PICUs from October through December 2022. We assigned CPS-Ped (0=discharged home at respiratory baseline to 8=death) at admission, days 2-7,10, and 14. We identified predictors of clinical improvement (CPS-Ped≤2 or 3-point decrease) by day 7 using multivariable log-binomial regression models and estimated the sample size (80% power) to detect 15% between-group clinical improvement with CPS-Ped versus hospital length of stay (LOS).
Of 585 hospitalized infants, 138 (23.6%) received invasive mechanical ventilation (IMV). Of the 49 (8.4%) infants whose CPS-Ped score worsened by 2 points after admission, one died. Failure to clinically improve by day 7 occurred in 205 (35%) infants and was associated with age <3 months, prematurity, underlying respiratory condition, and IMV in the first 24 hours in the multivariable analysis. The estimated sample size per arm required for detecting a 15% clinical improvement in a potential study was 584 using CPS-Ped clinical improvement versus 2,031 for hospital LOS.
CPS-Ped can be used to capture a range of disease severity and track clinical improvement in infants who develop RSV-related critical illness and could be useful for evaluating therapeutic interventions for RSV.
小儿呼吸道合胞病毒（RSV）相关的急性下呼吸道感染（LRTI）通常需要住院治疗。儿科临床进展量表（CPS-Ped）可衡量一系列疾病严重程度下的呼吸支持水平和缺氧程度，但尚未应用于因严重RSV-LRTI住院的婴儿。
我们分析了2022年10月至12月期间美国39家儿科重症监护病房（PICU）中因RSV相关并发症住院的婴儿的前瞻性监测登记数据。我们在入院时、第2-7天、第10天和第14天分配CPS-Ped评分（0=呼吸基线时出院回家至8=死亡）。我们使用多变量对数二项回归模型确定第7天时临床改善（CPS-Ped≤2或下降3分）的预测因素，并估计样本量（80%把握度）以检测CPS-Ped与住院时间（LOS）之间15%的组间临床改善情况。
585名住院婴儿中，138名（23.6%）接受了有创机械通气（IMV）。入院后CPS-Ped评分恶化2分的49名（8.4%）婴儿中，1名死亡。多变量分析显示，205名（35%）婴儿在第7天时未出现临床改善，这与年龄<3个月、早产、潜在呼吸道疾病以及入院后最初24小时内接受IMV有关。在一项潜在研究中，使用CPS-Ped临床改善情况检测15%临床改善所需的每组估计样本量为584例，而使用住院时间则为2031例。
CPS-Ped可用于评估患RSV相关危重症婴儿的一系列疾病严重程度并追踪临床改善情况，可能有助于评估RSV的治疗干预措施。
