From the Guidelines
Ruling out sepsis in a Respiratory Syncytial Virus (RSV) positive infant requires careful clinical evaluation and monitoring of hemodynamic variables.
Key Considerations
- Clinical signs of sepsis, such as hypothermia or hyperthermia, altered mental status, and peripheral vasodilation or vasoconstriction, should be closely monitored 1.
- Hemodynamic variables, including heart rate, blood pressure, and capillary refill, should be assessed and used to direct treatment 1.
- The presence of RSV infection does not rule out the possibility of sepsis, and clinicians should maintain a high index of suspicion for sepsis in infants with RSV infection who exhibit signs of clinical deterioration.
Diagnostic Approach
- Clinical examination is recommended for early recognition of pediatric septic shock, rather than relying solely on biochemical tests such as lactate concentration 1.
- Threshold heart rates associated with increased mortality in critically ill infants are <90 beats per minute or > 160 bpm, and in children are <70 bpm or >150 bpm 1.
- Monitoring of oxygen utilization variables, such as oxygen saturation and arterial oxygen tension, can also provide valuable information on the infant's hemodynamic status.
Treatment Considerations
- Standard practices in resuscitation of preterm infants in septic shock use a more graded approach to volume resuscitation and vasopressor therapy compared with resuscitation of term neonates and children 1.
- The use of antibiotics, such as ampicillin and gentamicin, may be considered in infants with suspected sepsis, although resistance patterns should be taken into account 1.
- Supportive care, including maintenance of serum glucose concentration and attention to thermogenesis, is also crucial in the management of septic infants.
From the Research
Ruling out Sepsis in RSV Positive Infants
To rule out sepsis in a Respiratory Syncytial Virus (RSV) positive infant, it is essential to consider the clinical presentation and risk factors associated with severe RSV infection.
- RSV infection can present with a variety of clinical syndromes, including bronchiolitis, pneumonia, and asthma exacerbation 2, 3.
- The severity of RSV-induced illness depends on multiple intrinsic and extrinsic factors, including host, virus, and environmental interactions 3.
- Certain conditions, such as premature birth, congenital heart disease, and immunodeficiency, predispose infants to more severe forms of RSV infection 4.
- Co-infections, such as pertussis, can also occur in RSV-positive infants and may present with similar clinical symptoms 5.
Clinical Evaluation
A thorough clinical evaluation is necessary to assess the severity of RSV infection and rule out sepsis.
- This evaluation should include a review of the infant's medical history, physical examination, and laboratory tests, such as complete blood counts and blood cultures.
- The use of a risk scoring tool (RST) has been explored to predict the severity of RSV infection and need for hospitalization in term infants, but its accuracy has been questioned 6.
- A study found that RST scores did not accurately predict the clinical severity of RSV bronchiolitis in term infants nor did it correlate with risk for RSV-related hospitalization 6.
Laboratory Tests
Laboratory tests, such as real-time polymerase-chain reaction (RT-PCR), can be used to detect RSV and other co-infections, such as pertussis 5.
- These tests can help identify infants at risk for severe RSV infection and guide management decisions.
- However, the presence of RSV or other co-infections does not necessarily rule out sepsis, and a comprehensive evaluation is still necessary to assess the infant's overall condition.