Öz

Objective: Viral pathogens are an important cause of lower respiratory tract infection (LRTI) leading to hospitalization in neonates and young infants. This study evaluated the etiologic distribution, clinical course, and management of multiplex RT-PCR–confirmed LRTI among neonatal intensive care unit (NICU) admissions.

Materials and Methods: Between September 2022 and November 2023, neonates admitted to the NICU with LRTI and a positive respiratory viral panel (multiplex RT-PCR) were retrospectively analyzed (n=44). Disease severity at admission was assessed using the Downes score. Demographics, seasonality, respiratory support, treatments, and outcomes were recorded. Correlations between Downes score, oxygen requirement (FiO₂), and length of stay were examined.

Results: Median age at admission was 17 days (range: 1–45). Admissions peaked in January (29.5%) and November (18.1%). The most common presenting findings were respiratory distress/tachypnea, cough, and feeding difficulties. Median Downes score was 2 (range: 1–8) and median FiO₂ requirement was 31% (range: 25–45%). Respiratory support was required in 32 infants: mechanical ventilation in 11.4% (n=5), non-invasive ventilation in 22.7% (n=10), and supplemental oxygen in 38.6% (n=17). The most common agents were SARS-CoV-2 (n=22; 50%) and respiratory syncytial virus (RSV) ( n=14; 31.8%). Downes score correlated positively with FiO₂ (r=0.39, p=0.008) and length of hospital stay (r=0.42, p=0.004). Oseltamivir was administered to three infants with influenza. Median length of stay was 6 days (range: 2–56) and no mortality occurred.

Conclusion: In this multiplex RT-PCR era snapshot, SARS-CoV-2 and RSV predominated among NICU-admitted neonates and young infants with viral LRTI. Management was primarily supportive, and admission Downes score may help anticipate oxygen requirement and hospitalization duration.

Anahtar Kelimeler: Neonate, NICU, respiratory syncytial virus, SARS-CoV-2, viral pneumonia

Kaynakça

  1. Bosch Castells V, Mira-Iglesias A, López-Labrador FX, Mengual-Chuliá B, et al. Pediatric Respiratory Hospitalizations in the Pre-COVID-19 Era: The Contribution of Viral Pathogens and Comorbidities to Clinical Outcomes, Valencia, Spain. Viruses. 2024;16:1519. https://doi.org/10.3390/v16101519.
  2. Kurskaya O, Ryabichenko T, Leonova N, Shi W, Bi H, Sharshov K, et al. Viral etiology of acute respiratory infections in hospitalized children in Novosibirsk City, Russia (2013-2017). PLoS One. 2018;13(9):e0200117. https://doi.org/10.1371/journal.pone.0200117.
  3. Pichler K, Assadian O, Berger A. Viral Respiratory Infections in the Neonatal Intensive Care Unit-A Review. Front Microbiol. 2018;9:2484. https://doi.org/10.3389/fmicb.2018.02484.
  4. Bravo-Queipo-de-Llano B, Sánchez García L, Casas I, Pozo F, et al. Surveillance of Viral Respiratory Infections in the Neonatal Intensive Care Unit-Evolution in the Last 5 Years. Pathogens. 2023;12:644. https://doi.org/10.3390/pathogens12050644.
  5. Kalaycı F, Çelebier K. Differential laboratory findings of common respiratory viruses in hospitalized children: a retrospective study. Turk J Pediatr Dis. 2025;19(3):130-6. https://doi.org/10.12956/tchd.1666545.
  6. Downes JJ, Vidyasagar D, Morrow GM, Boggs TR Jr. Respiratory distress syndrome of newborn infants. I. New clinical scoring system (RDS score) with acid-base and blood-gas correlations. Clin Pediatr (Phila). 1970;9(6):325-31. https://doi.org/10.1177/000992287000900607.
  7. Özer EA, Demirel G, Tüzün F, Turkish Neonatal Society. Guideline for Diagnosis, Treatment, and Prevention of Respiratory Distress in Term Newborns. Ankara: Güneş Tıp Kitabevleri; 2021. p.12-13.
  8. Aydın B, Zenciroğlu A, Dilli D, et al. Clinical Course of Community-Acquired Respiratory Syncytial Virus Pneumonia in Newborns Hospitalized in Neonatal Intensive Care Unit. Tuberk Toraks. 2013;61(3):235-44. https://doi.org/10.5578/tt.4598
  9. Wilkinson DJ, Buttery JP, Andersen CC. Influenza in the neonatal intensive care unit. J Perinatol. 2006;26:772-6. https://doi.org/10.1038/sj.jp.7211625.
  10. Moriyama M, Hugentobler WJ, Iwasaki A. Seasonality of Respiratory Viral Infections. Annu Rev Virol. 2020;7(1):83-101. https://doi.org/10.1146/annurev-virology-012420-022445.
  11. Liu H-F, Wang Y-Y, Zhang X-Z, et al. Comparison of characteristics of children hospitalized for respiratory syncytial virus infection during the pre- and post-COVID-19 eras: a multicenter retrospective study. BMC Infect Dis. 2024;24:1009. https://doi.org/10.1186/s12879-024-09783-2.
  12. Treggiari D, Pomari C, Zavarise G, et al. Characteristics of respiratory syncytial virus infections in children in the post-COVID seasons: A Northern Italy hospital experience. Viruses. 2024;16(1):126. https://doi.org/10.3390/v16010126
  13. Mostafa HH, Fall A, Norton JM, et al. Respiratory virus disease and outcomes at a large academic medical center in the United States: a retrospective observational study of the early 2023/2024 respiratory viral season. Microbiol Spectr. 2024;12(10):e0111624. https://doi.org/10.1128/spectrum.01116-24.
  14. Fu C, Zhou C, Zheng C, Li S, Song W, Yao J, Fu C, Yin Z. Etiological analysis of acute respiratory infections in hospitalized children after the relaxation of COVID-19 non-pharmacological interventions in Quzhou, China. BMC Infect Dis. 2024;24(1):1362. https://doi.org/10.1186/s12879-024-10257-8
  15. Cohen R, Pettoello-Mantovani M, Somekh E, Levy C. European pediatric societies call for an implementation of regular vaccination programs to contrast the immunity debt associated to coronavirus disease-2019 pandemic in children. J Pediatr. 2022;242:260-e261263. https://doi.org/10.1016/j.jpeds.2021.11.061
  16. Kasap T, Takcı Ş, Özcan P. Evaluation of babies with viral lower respiratory tract infections in neonatal intensive care unit. J Curr Pediatr 2021;19:106-12. https://doi.org/10.4274/jcp.2021.0015
  17. Okulu E, Akduman H, Tunç G, Çiftçi E, İnce E, Erdeve Ö, et al. The Epidemiological and Clinical Features of Neonates Hospitalized with Lower Respiratory Tract Viral Infections. Turk J Pediatr Dis. 2018;12(1):31-5. https://doi.org/10.12956/tjpd.2017.294
  18. Koc E, Dilli D. How does Covid-19 affect maternal and neonatal outcomes? Perinat Med. 2023;51(2):277-83. https://doi.org/10.1515/jpm-2022-0509
  19. Heikkinen T. Respiratory viruses and children. J Infect. 2016(Suppl 72):29-33. https://doi.org/10.1016/j.jinf.2016.04.019
  20. Homaira N, Sheils J, Stelzer-Braid S, et al. Respiratory syncytial virus is present in the neonatal intensive care unit. J Med Virol. 2016;88:196-201. https://doi.org/10.1002/jmv.24325
  21. Nair H, Nokes DJ, Gessner BD, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010;375:1545-55. https://doi.org/10.1016/S0140-6736(10)60206-1
  22. Annamalay AA, Abbott S, Sikazwe C, et al. Respiratory viruses in young South African children with acute lower respiratory infections and interactions with HIV. J Clin Virol. 2016;81:58-63. https://doi.org/10.1016/j.jcv.2016.06.002
  23. Avcu G, Sahbudak Bal Z, Cicek C, Vardar F. Clinical and Epidemiological Evaluation of Hospitalized Children with Respiratory Virus Infections. J Pediatr Inf. 2017;11(3):111-5. https://doi.org/10.5578/ced.201730
  24. Shorten R, Pickering K, Goolden C, Harris C, Clegg A, Hill J. Diagnostic stewardship in infectious diseases: A scoping review. Journal of Medical Microbiology, 2024;73. https://doi.org/10.1099/jmm.0.001831
  25. Kidszun A, Klein L, Winter J, et al. Viral infections in neonates with suspected late-onset bacterial sepsis: a prospective cohort study. Am J Perinatol. 2017;34:1-7. https://doi.org/10.1055/s-0036-1584150
  26. Epalza C, Hallin M, Busson L, et al. Role of viral molecular panels in diagnosing the etiology of fever in infants younger than 3 months. Clin Pediatr (Phila). 2020;59:45-52. https://doi.org/10.1177/0009922819884582
  27. Celik IH, Arslan Z, Unal S, Mollamahmutoglu L, Bas AY, Demirel N. Clinical and Virological Characteristics of Neonates Admitted with Acute Lower Respiratory Tract Infections. Turk J Womens Health Neonatol 2021;3(2): 33-8. https://doi.org/10.46969/ezh.946825
  28. Celik K, Arun Ozer E, Alkan S, İlhan O. Evaluation of the Frequency and Risk Factors of Lower Respiratory Tract Infections in Premature Infants Discharged from the Neonatal Intensive Care Unit. Journal of Child Health and Diseases. 2014;57:8-15.
  29. Outbridge EW, Nogrady MB, Beaudry PH, Stern L. Idiopathic Respiratory Distress Syndrome: Recurrent Respiratory Illness in Survivors. AJDC. 1972;123:99-104. https://doi.org/10.1001/archpedi.1972.02110080077003
  30. Rangelova V, Kevorkyan A, Raycheva R, Krasteva M. Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit-Incidence and Strategies for Prevention. Diagnostics. 2024;14:240. https://doi.org/10.3390/diagnostics14030240. https://doi.org/10.3390/diagnostics14030240
  31. Gomella TL. Neonatology: Management, Procedures, On-Call Problems, Diseases and Drugs. 6th ed. USA: McGraw-Hill; 2009:665-672.
  32. Kenar A, Hırfanoğlu İM. Viral Infections in the Newborn. In: Satar M, editor. Neonatal Infections. 1st ed. Ankara: Türkiye Klinikleri; 2021. p.30-38.

Telif hakkı ve lisans

Telif hakkı © 2026 Yazar(lar). Açık erişimli bu makale, orijinal çalışmaya uygun şekilde atıfta bulunulması koşuluyla, herhangi bir ortamda veya formatta sınırsız kullanım, dağıtım ve çoğaltmaya izin veren Creative Commons Atıf Lisansı (CC BY) altında dağıtılmıştır.

Nasıl atıf yapılır

1.
Candemir A, Dilli D, Özyazıcı A, Özyazıcı Özkan SE, Yıldırım Yıldız N, Akduman H, et al. The changing etiology of NICU-Admitted neonatal viral pneumonia: A multiplex RT-PCR era snapshot. Turk J Pediatr Dis. 2026;Early View:1-6. https://doi.org/10.12956/TJPD.2025.1293