Assessing Clinical Improvement of Infants Hospitalized for Respiratory Syncytial Virus–Related Critical Illness - Scorecard - MDSpire
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Evaluating Clinical Outcomes in Infants Admitted for Severe Respiratory Syncytial Virus Infections

  • By

  • Shannon B Leland

  • Laura D Zambrano

  • Steven J Staffa

  • Elizabeth R McNamara

  • Margaret M Newhams

  • Natasha Halasa

  • Justin Z Amarin

  • Laura S Stewart

  • Steven L Shein

  • Christopher L Carroll

  • Julie C Fitzgerald

  • Marian G Michaels

  • Katherine Bline

  • Melissa L Cullimore

  • Laura Loftis

  • Vicki L Montgomery

  • Asumthia S Jeyapalan

  • Pia S Pannaraj

  • Adam J Schwarz

  • Natalie Z Cvijanovich

  • Matt S Zinter

  • Aline B Maddux

  • Melania M Bembea

  • Katherine Irby

  • Danielle M Zerr

  • Joseph D Kuebler

  • Christopher J Babbitt

  • Mary G Gaspers

  • Ryan Nofziger

  • Michele Kong

  • Bria M Coates

  • Jennifer E Schuster

  • Shira J Gertz

  • Elizabeth H Mack

  • Benjamin R White

  • Helen Harvey

  • Charlotte V Hobbs

  • Heda Dapul

  • Andrew D Butler

  • Tamara T Bradford

  • Courtney M Rowan

  • Kari Wellnitz

  • Mary Allen Staat

  • Cassyanne L Aguiar

  • Saul R Hymes

  • Angela P Campbell

  • Adrienne G Randolph

  • Respiratory Syncytial Virus - Pediatric Intensive Care (RSV-PIC) Investigators

  • Merry Tomcany

  • Kelly N Michelson

  • Heather E Price

  • Ronald C Sanders

  • Lexie Dixon

  • Katri V Typpo

  • Ilana Harwayne-Gidansky

  • Suden Kucukak

  • SabrinaR Chen

  • Eve Listerud

  • Ofelia Vargas-Shiraishi

  • Betty Oberle

  • Frances Zorensky

  • Rachel Mansour

  • Jaycee Jumarang

  • Marla Johnston

  • Jenny L Bush

  • Shawn Dickey

  • Shannon Hill

  • Melissa Sullivan

  • Abigail Kietzman

  • Candice Colston

  • Meghan Murdock

  • Heather Kelley

  • Laura Wright-Sexton

  • Maygan Martin

  • Lora Martin

  • Lacy Malloch

  • Kayla Patterson

  • Cameron Sanders

  • Chelsea Rohlfs

  • Marilyn Rice

  • Miranda Howard

  • Makayla Murphy

  • Vijaya L Soma

  • Adam J Ratner

  • Megan J Job

  • Colleen Mennie

  • Kamala Simkhada

  • Kristina A Betters

  • Haya Hayek

  • Molly Maranto

  • Aubrie Waters

  • Maggie Flowers

  • Kevin Havlin

  • Jamie Furlong-Dillard

  • Melissa Porter

  • Jennifer Nason

  • Madison Ray

  • Kristen Gossett

  • Hillary Crandall

  • Evan Heller

  • Jennifer Foley

  • Rajashri Rasal

  • Christine Marlow

  • Anurithi Senthil

  • Kimberly Myers

  • Betsy Tudor

  • Amanda Adler

  • Nereyda Garcia

  • Natalie Treister

  • Patrick S McQuillen

  • Kathleen Sun

  • Denise Villarreal-Chico

  • Sophia Kainaroi

  • John V Williams

  • January 15, 2025

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Clinical Scorecard: Evaluating Clinical Outcomes in Infants Admitted for Severe Respiratory Syncytial Virus Infections

At a Glance

CategoryDetail
ConditionSevere respiratory syncytial virus (RSV)–related acute lower respiratory tract infection (LRTI) in infants
Key MechanismsRSV causes acute hypoxic respiratory failure requiring varying levels of respiratory support including HFNC, NIPPV, and invasive mechanical ventilation (IMV)
Target PopulationInfants hospitalized with severe RSV-related respiratory illness, especially those <3 months, premature, or with underlying respiratory conditions
Care SettingPediatric intensive care units (PICUs) and high-acuity pediatric units

Key Highlights

  • The Clinical Progression Scale–Pediatrics (CPS-Ped) effectively measures respiratory support level and hypoxia severity in infants with RSV-LRTI.
  • Failure to clinically improve by day 7 (CPS-Ped ≤2 or 3-point decrease) is associated with age <3 months, prematurity, underlying respiratory conditions, and early IMV use.
  • CPS-Ped requires smaller sample sizes for clinical trials detecting improvement compared to hospital length of stay, facilitating evaluation of therapeutic interventions.

Guideline-Based Recommendations

Diagnosis

  • Confirm RSV infection by laboratory testing within 72 hours of hospital admission.
  • Assess disease severity using CPS-Ped to capture respiratory support needs and hypoxia.

Management

  • Provide supportive care including high-flow nasal cannula (HFNC), noninvasive positive pressure ventilation (NIPPV), and invasive mechanical ventilation (IMV) as clinically indicated.
  • Monitor infants closely, especially those <3 months, premature, or with underlying respiratory conditions, due to higher risk of severe disease.

Monitoring & Follow-up

  • Use CPS-Ped scores at admission and serially (days 2–7, 10, and 14) to track clinical progression and improvement.
  • Identify failure to improve by day 7 to guide clinical decision-making and potential escalation of care.

Risks

  • Prematurity and underlying respiratory conditions increase risk of severe RSV disease and failure to improve.
  • Early need for invasive mechanical ventilation within 24 hours is associated with worse outcomes.

Patient & Prescribing Data

Infants hospitalized with RSV-related critical illness in PICUs across the United States during the 2022 RSV season.

Most infants recover with supportive care; mortality is rare. Use of CPS-Ped can facilitate clinical trial enrollment and outcome assessment by capturing a range of respiratory support levels.

Clinical Best Practices

  • Employ CPS-Ped as a standardized tool to assess and monitor disease severity and clinical improvement in infants with RSV-LRTI.
  • Prioritize early identification of high-risk infants (<3 months, premature, underlying respiratory conditions) for closer monitoring and management.
  • Utilize noninvasive respiratory support modalities when possible to reduce invasive mechanical ventilation use.
  • Consider CPS-Ped scores as primary outcome measures in clinical trials to reduce required sample sizes and improve sensitivity to clinical changes.

References

Original Source(s)

Assessing Clinical Improvement of Infants Hospitalized for Respiratory Syncytial Virus–Related Critical Illness

  • by Shannon B Leland, Laura D Zambrano, Steven J Staffa, Elizabeth R McNamara, Margaret M Newhams, Natasha Halasa, Justin Z Amarin, Laura S Stewart, Steven L Shein, Christopher L Carroll, Julie C Fitzgerald, Marian G Michaels, Katherine Bline, Melissa L Cullimore, Laura Loftis, Vicki L Montgomery, Asumthia S Jeyapalan, Pia S Pannaraj, Adam J Schwarz, Natalie Z Cvijanovich, Matt S Zinter, Aline B Maddux, Melania M Bembea, Katherine Irby, Danielle M Zerr, Joseph D Kuebler, Christopher J Babbitt, Mary G Gaspers, Ryan Nofziger, Michele Kong, Bria M Coates, Jennifer E Schuster, Shira J Gertz, Elizabeth H Mack, Benjamin R White, Helen Harvey, Charlotte V Hobbs, Heda Dapul, Andrew D Butler, Tamara T Bradford, Courtney M Rowan, Kari Wellnitz, Mary Allen Staat, Cassyanne L Aguiar, Saul R Hymes, Angela P Campbell, Adrienne G Randolph, Respiratory Syncytial Virus - Pediatric Intensive Care (RSV-PIC) Investigators, Merry Tomcany, Kelly N Michelson, Heather E Price, Ronald C Sanders, Lexie Dixon, Katri V Typpo, Ilana Harwayne-Gidansky, Suden Kucukak, SabrinaR Chen, Eve Listerud, Ofelia Vargas-Shiraishi, Betty Oberle, Frances Zorensky, Rachel Mansour, Jaycee Jumarang, Marla Johnston, Jenny L Bush, Shawn Dickey, Shannon Hill, Melissa Sullivan, Abigail Kietzman, Candice Colston, Meghan Murdock, Heather Kelley, Laura Wright-Sexton, Maygan Martin, Lora Martin, Lacy Malloch, Kayla Patterson, Cameron Sanders, Chelsea Rohlfs, Marilyn Rice, Miranda Howard, Makayla Murphy, Vijaya L Soma, Adam J Ratner, Megan J Job, Colleen Mennie, Kamala Simkhada, Kristina A Betters, Haya Hayek, Molly Maranto, Aubrie Waters, Maggie Flowers, Kevin Havlin, Jamie Furlong-Dillard, Melissa Porter, Jennifer Nason, Madison Ray, Kristen Gossett, Hillary Crandall, Evan Heller, Jennifer Foley, Rajashri Rasal, Christine Marlow, Anurithi Senthil, Kimberly Myers, Betsy Tudor, Amanda Adler, Nereyda Garcia, Natalie Treister, Patrick S McQuillen, Kathleen Sun, Denise Villarreal-Chico, Sophia Kainaroi, John V Williams

  • January 15, 2025

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