title: Viral respiratory tract infections in the neonatal intensive care unit: the VIRIoN-I study.
abstract: OBJECTIVE
  To determine the frequency of respiratory viral infections among infants who were evaluated for late-onset sepsis in the neonatal intensive care units (NICUs) of Parkland Memorial Hospital, Dallas, Texas; and Women & Infants Hospital, Providence, Rhode Island.
  
  
  METHODS
  Prospective cohort study conducted from January 15, 2012 to January 31, 2013. Infants in the NICU were enrolled if they were inborn, had never been discharged home, and were evaluated for sepsis (at >72 hours of age) and antibiotic therapy was initiated. Infants had a nasopharyngeal specimen collected for detection of respiratory viruses by multiplex polymerase chain reaction within 72 hours of the initiation of antibiotic therapy. Their medical records were reviewed for demographic, clinical, radiographic, and laboratory data until NICU discharge.
  
  
  RESULTS
  During the 13-month study, 8 of 100 infants, or 8 (6%) of the 135 sepsis evaluations, had a respiratory virus detected by polymerase chain reaction (2, enterovirus/rhinovirus; 2, rhinovirus; 2, coronaviruses; and 2, parainfluenza-3 virus). By bivariate analysis, the infants with viral detection were older (41 vs 11 days; P = .007), exposed to individuals with respiratory tract viral symptoms (37% vs 2%; P = .003), tested for respiratory viruses by provider (75% vs 11%; P < .001), and had lower total neutrophil counts (P = .02). In multivariate regression analysis, the best predictor of viral infection was the caregivers' clinical suspicion of viral infection (P = .006).
  
  
  CONCLUSIONS
  A total of 8% of infants, or 6% of all NICU sepsis evaluations, had a respiratory virus detected when evaluated for bacterial sepsis. These findings argue for more respiratory viral testing of infants with suspected sepsis using optimal molecular assays to establish accurate diagnoses, prevent transmission, and inform antibiotic stewardship efforts.
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ronchi
authors.affiliation: Department of Pediatrics, Rhode Island Hospital, Providence, RI; Alpert Medical School of Brown University, Providence, RI.
authors.forename: Ian C
authors.initials: IC
authors.lastname: Michelow
authors.affiliation: Alpert Medical School of Brown University, Providence, RI; Department of Pathology and Medicine, Rhode Island Hospital, Providence, RI.
authors.forename: Kimberle C
authors.initials: KC
authors.lastname: Chapin
authors.affiliation: Alpert Medical School of Brown University, Providence, RI; Department of Pediatrics, Women & Infants Hospital, Providence, RI.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Bliss
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Pugni
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
authors.affiliation: Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; Department of Pediatrics, Center for Perinatal Research, Nationwide Children's Hospital - The Ohio State University, Columbus, OH. Electronic address: Pablo.Sanchez@nationwidechildrens.org.
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004279:DNA, Viral; D005260:Female; D020869:Gene Expression Profiling; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000379:methods; D008297:Male; D015999:Multivariate Analysis; D020411:Oligonucleotide Array Sequence Analysis; D010100:Oxygen / Q000627:therapeutic use; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology*; D012237:Rhode Island; D018805:Sepsis / Q000453:epidemiology* / Q000821:virology*; D013781:Texas
chemical_list: D000900:Anti-Bacterial Agents; D004279:DNA, Viral; D010100:Oxygen