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Respiratory syncytial virus nosocomial outbreak in neonatal intensive care: A review of the incidence, management, and outcomes

Published:November 01, 2021DOI:https://doi.org/10.1016/j.ajic.2021.10.027

      Highlights

      • The estimated incidence of neonatal RSV nosocomial infection (RSVNI) was 23.8%.
      • RSVNI outbreaks are mainly managed by hand hygiene, isolation, and patient cohorting.
      • Palivizumab controlled RSVNI in 10 studies after containment strategies failed.
      • RSVNI mortality was 8.0% (7/87) when infection control was solely employed.
      • Overall RSVNI-related mortality across the review of 17 articles was 8.5% (15/177).

      Background

      The main objective was to determine the incidence, management, and outcomes of respiratory syncytial virus nosocomial infection (RSVNI) outbreaks in neonatal intensive care units.

      Methods

      A comprehensive search of RSVNI in 9 databases was conducted from January 1, 2000 to May 1, 2021, of which the Cochrane Library comprised the Cochrane central register of controlled trials and the Cochrane database of systematic reviews. Two hundred and twenty-eight articles were retrieved and 17 were retained. A descriptive analysis was performed, and frequencies are reported as mean, median, and range where pertinent.

      Results

      One hundred and seventeen infants were analyzed and comprised preterms (88.1%) and those with pre-existing co-morbidities. The estimated proportional incidence of RSVNI was 23.8% (177/744) infants. Outbreaks were principally managed by conventional protective measures, neonatal intensive care unit closure, and visitor restriction. Palivizumab was used to control RSVNI in 10 studies. RSVNI-related mortality was 8.5% (15/177) and 8.0% (7/87) among infants where infection control was solely employed.

      Conclusion

      RSVNI is associated with significant morbidity and mortality. The use of palivizumab should be a multidisciplinary decision, based on rapidly spreading infection. Prospective studies are essential to determine the cost-benefit of palivizumab versus standard prevention control for an RSVNI outbreak.

      Key Words

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