title: Medical and economic impact of a respiratory syncytial virus outbreak in a neonatal intensive care unit.
abstract: BACKGROUND
  Respiratory syncytial virus (RSV) causes frequent nosocomial outbreaks in general pediatric wards but is less commonly reported in neonatal intensive care units (NICUs). We investigated an outbreak of RSV infection in a NICU and its impact on health care delivery, outcomes and costs.
  
  
  METHODS
  Retrospective chart review was performed after an RSV outbreak occurred in the NICU. A case was defined as an infant with a nasopharyngeal aspirate positive for RSV by viral culture. Nucleotide sequencing of the isolates was done to determine relatedness. Hospital bills for all RSV culture-positive infants were reviewed.
  
  
  RESULTS
  Nine infants (mean age, 34 days; mean birth weight, 1757 g; and mean estimated gestational age 31 weeks and 5 days) were infected with RSV subgroup B during this outbreak. By nucleotide sequencing, the isolates were identical. Clinical manifestations included cough, congestion, increased oxygen requirement, apnea and respiratory failure. The 5 infants requiring intubation had a significantly lower mean birth weight (1301 g versus 2328 g, P = 0.027), mean estimated gestational age (28 weeks and 5 days versus 35 weeks and 2 days, P = 0.014) and mean weight at onset of symptoms (2093 g versus 2989 g, P = 0.049) than the 4 nonintubated infants. More than 1.15 million dollars in hospital charges were attributable to the outbreak. All infants survived.
  
  
  CONCLUSIONS
  Infants in a NICU who develop cough, congestion or apnea should be tested for RSV and other common respiratory viruses during the winter respiratory season. Even in a closed NICU, nosocomial outbreaks of these viruses can occur and have a major effect on healthcare delivery, costs and outcomes.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232-2581, USA. natasha.halasa@vanderbilt.edu
authors.forename: Natasha B
authors.initials: NB
authors.lastname: Halasa
authors.forename: John V
authors.initials: JV
authors.lastname: Williams
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Wilson
authors.forename: William F
authors.initials: WF
authors.lastname: Walsh
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.forename: Peter F
authors.initials: PF
authors.lastname: Wright
mesh_terms: D003428:Cross Infection / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D004196:Disease Outbreaks; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000191:economics / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D018113:Respiratory Syncytial Virus, Human / Q000302:isolation & purification; D012720:Severity of Illness Index