Epidemiology and Clinical Presentation of Respiratory Syncytial Virus (RSV) in Newborns: Experience of Neonatology Service CHU Mohammed VI OUJDA during Winter 2024 ()
1. Introduction
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infections in newborns. It is an enveloped, single-stranded, non-segmented, negative-strand RNA virus, a member of the Pneumoviridae family. Globally, RSV is responsible for 2.3% of deaths among newborns aged 0 to 27 days [1]. It’s a fairly common, benign-looking infection, but it can be fatal in low-birth-weight premature babies or newborns with co-morbidities.
It’s a retrospective study designed to describe the epidemiological, clinical, therapeutic and prognostic profile of RSV infection.
2. Materials and Methods
A retrospective study in which we collected 7 cases of newborn infants < 28 days of age hospitalized in the department of neonatology and neonatal intensive care CHU Mohammed VI-OUJDA, who presented clinical signs of bronchiolitis with a positive PCR Triplex via nasopharyngeal sampling.
3. Results
In the 7 cases with positive RSV via triplex PCR during the winter of 2024 from December 2023 to March 2024, we note that the peak incidence was in February.
We note a female predominance in 71% of cases in our study (n = 5) with a sex ratio of 0.28, and 86% (n = 6) are at term.
The median age at admission was 25 days (between 16 and 27 days), the median weight was 3400g (between 2500 and 4500 g), the average length of hospitalization was 9 days.
29% of patients (n = 2) presented with congenital heart disease (Figure 1).
Figure 1. A bar shows the distribution of cases according to month.
3.1. Functional Signs
As shown in the table below (Table 1), all patients in our study presented hypotonia (n = 7), 72% presented rhinorrhea (n = 5), cough was present in 57% of patients (n = 4), 3 patients or 42% presented a refusal to breastfeed, while fever was present in only one patient (14%).
Table 1. Table shows the main functional signs of RSV infection.
NOT |
Rhinorrhea |
Cough |
Fever |
Hypotonia |
Refusal to breastfeed |
Vomiting |
1 |
Yes |
Yes |
No |
Yes |
No |
No |
2 |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
3 |
No |
No |
No |
Yes |
Yes |
No |
4 |
Yes |
No |
No |
Yes |
No |
Yes |
5 |
No |
No |
No |
Yes |
No |
Yes |
6 |
Yes |
Yes |
No |
Yes |
No |
No |
7 |
Yes |
Yes |
No |
Yes |
Yes |
No |
3.2. Data from the Clinical Examination
As shown in the table below (Table 2); all patients presented with dyspnea with a Silvermann score varying from 2/10 to 4/10.
On auscultation all patients (n = 7) presented pathological rales; with crackles (n = 3), rumbles and sibilants (n = 2).
2 patients, i.e., 29%, presented polypnea (breathing frequency > 60 cpm).
Hepatomegaly was also found in 42% of newborns (n = 3).
Table 2. Table shows main physicals signs of RSV infection.
NOT |
SS |
Auscultation |
Polypnea |
Others |
1 |
2/10 |
Crackling |
No |
Hepatomegaly |
2 |
2/10 |
Crackling |
No |
DHA |
3 |
2/10 |
Snorers |
No |
Nothing to report |
4 |
4/10 |
sibilants |
No |
Hepatomegaly |
5 |
3/10 |
Snorers |
Yes |
Nothing to report |
6 |
2/10 |
Crackling |
Yes |
Hepatomegaly |
7 |
2/10 |
Sibilants |
No |
Nothing to report |
3.3. Chest X-Ray
All patients (n = 7) had a chest x-ray, none of which came back normal (Figure 2).
Figure 2. Curve shows the different X-rays lesions of RSV infection.
3.4. Biology Data
CBC:
As shown in Table 3: 57% of patients (n = 4) had an anemia and 42% (n = 3) had thrombocytosis, while 1 patient (14%) had anemia and thrombocytosis.
Median of haemoglobin was 13.7.
Median of leukocytes was 12,270.
Median of platelets was 387,000.
Table 3. Table shows table showing CBC of our patients.
NOT |
Haemoglobin |
Leukocytes |
Neutrophils |
Lymphocytes |
Platelets |
1 |
17 |
14780 |
7260 |
3930 |
387,000 |
2 |
13.2 |
9260 |
5450 |
3260 |
341,000 |
3 |
13.7 |
27510 |
16380 |
5850 |
743,000 |
4 |
15 |
12270 |
5500 |
5330 |
528,000 |
5 |
11 |
13200 |
4810 |
5790 |
378,000 |
6 |
12.3 |
12096 |
7180 |
3280 |
442,000 |
7 |
15.5 |
9070 |
2440 |
5370 |
201,000 |
3.5. CRP: C-Reactive Protein
All patients underwent CRP, 4 of whom (57%) came back positive, with a median CRP of 12.
3.6. Therapeutic Care
As shown in Table 4; all patients (n = 7) received oxygen therapy.
2 patients received active pressure by CPAP, i.e. 29%.
Antibiotic therapy was used in all patients with positive CRP (n = 4).
Corticosteroid therapy was used in only one patient (14%).
Table 4. Different treatment options.
NOT |
Oxygen therapy |
Antibiotic therapy |
Corticosteroid therapy |
CPAP |
1 |
Yes |
Yes |
No |
No |
2 |
Yes |
Yes |
No |
Yes |
3 |
Yes |
No |
No |
No |
4 |
Yes |
Yes |
No |
No |
5 |
Yes |
No |
Yes |
Yes |
6 |
Yes |
Yes |
No |
No |
7 |
Yes |
No |
No |
No |
3.7. Evolution
6 patients in our study were declared cured (86%), but only one died (14%) despite knowing that he had an underlying congenital heart disease. It was a congenital ventricular hypoplasia.
4. Discussion
All series noted a peak in incidence in the winter season either in Europe, Asia, North America or the Middle East and Turkey, which is similar to our study [2]-[17].
Unlike our study, almost all of the studies had a male predominance unlike the South Korean study [18].
For most studies the median age at admission was over D15 of life, something in common with our study, except for the study by Smit et al. where the median age was 1.3D.
Comorbidities, notably congenital heart disease, are important risk factors either for the disease or for mortality, but they do not have a great impact on the duration of hospitalization which was around 10 days in most series including ours [3] [10].
The clinical signs of RSV bronchiolitis are respiratory distress, cough, rhinorrhea, refusal to breastfeed and pathological groans on auscultation reaching apnea in extreme cases [2]-[16] [18].
Therapeutic management is based on oxygen therapy and symptomatic treatment (nasal decongestion, respiratory physiotherapy), antibiotic therapy has been used in patients with an associated infection (newborns with positive CRP), corticosteroid therapy is rarely [2] [3] or not used at all for the treatment of RSV bronchiolitis except for severe cases [2].
Respiratory assistance is used particularly in premature babies [3] [9] [10].
Acute broncho-alveolitis of RSV is generally a benign condition with a cure rate of over 85% in the majority of studies, but it can be fatal in premature infants and comorbidities [2] [3] [10] [12] [13].
5. Conclusion
RSV bronchiolitis is an infection that can affect all age groups, but it can cause serious complications in newborns, including death. It is therefore important to raise awareness among parents in order to limit the spread of the virus.