Comparison of clinical findings and lung ultrasound scores in newborns with RSV and non-RSV viral lower respiratory tract infections: a prospective observational study.

The study compared quantitative lung ultrasound (LUS) findings and LUS aeration scores in neonates with respiratory syncytial virus (RSV) associated lower respiratory tract infections (LRTI) and those with LRTI due to other viral agents. Also, it was to evaluate the disease progression of all newborns with viral LRTI during their hospital stay at predetermined time points using quantitative LUS findings and aeration scores. This prospective observational study was conducted in the level 3 NICU. Term and late preterm neonates admitted with viral LRTI were included in the study. Viral pathogens were detected by RT-PCR. Quantitative LUS was performed at four time points: admission, at 24 h after admission, clinical deterioration, and discharge. On admission, clinical severity of LRTI (mild, moderate, severe) was assessed. The study was also registered at ClinicalTrials.gov (Identifier: NCT06204367). A total of 37 newborns with viral LRTI were evaluated: 20 with RSV and 17 with other viral agents. Normal quantitative LUS findings were more frequent at "discharge" but not significant (p = 0.201). The percentage of pleural line abnormalities was highest at "24th hour" (p = 0.003), and consolidation was more common during "clinical deterioration" (p = 0.026) on quantitative LUS. Moderate disease was more prevalent among the RSV-positive infants (60% vs. 11.8%), while mild disease was more prevalent among the non-RSV cases (64.7% vs. 20%; p = 0.029) according to clinical severity scores at the admission. RSV-positive neonates had significantly higher LUS aeration scores at the admission compared with those with the non-RSV cases (p = 0.008). In all neonates with viral LRTI, LUS aeration scores on admission were moderately correlated with clinical scores (p < 0.01, r:0.555).

conclusionAlthough our sample size was limited, no RSV-specific findings were observed in quantitative lung ultrasound (LUS). However, abnormal quantitative LUS findings and high LUS aeration scores were more frequent in cases of respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRTI), which had a more severe course compared to LRTI caused by other viral agents. WHAT IS KNOWN: • Lung ultrasound is a valuable diagnostic tool for lung imaging. • Quantitative LUS could play a role in diagnosing viral LRTI and predicting the need for pediatric intensive care unit admission, length of hospital stays and respiratory support. WHAT IS NEW: • It is the first to evaluate LUS aeration scoring in viral LRTI during the neonatal period. • This study found that neonates with RSV LRTI had significantly higher LUS aeration score and clinical severity scores upon admission to the NICU than those with non-RSV viral agents.