{"title":"呼吸道合胞病毒导致的严重急性呼吸道感染临床表型的异质性：需要超越住院治疗。","authors":"Côme Horvat MD , Lélia Duclaux-Loras MD , Antoine Ouziel MD , Marine Butin MD, PhD , Sandrine Couray-Targe MD , Anne-Florence Myard-Dury BSc , Julie Haesebaert MD, PhD , Mona Massoud MD, PhD , Mehdi Benchaib MD, PhD , Anne Ploin BSc , Yves Gillet MD, PhD , Bruno Lina MD, PhD , Jean-Sebastien Casalegno MD, PhD , Dominique Ploin MD, PhD","doi":"10.1016/j.jpeds.2024.114441","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To use a pre-COVID-19 birth cohort database to describe the clinical heterogeneity of severe acute respiratory infection (SARI) cases of the past seasons as a basis to investigate further distribution of clinical phenotypes in the era of immunization for respiratory syncytial virus (RSV).</div></div><div><h3>Study design</h3><div>Infants with RSV-SARI were identified from a 2014 through 2019 birth cohort in a tertiary care center in Lyon, France, and their medical records extensively reviewed. Using the criteria of the World Health Organization severity definitions, we classified SARI as having nutritional (inability to feed), respiratory (SpO<sub>2</sub> <93%), or neurological (failure to respond, apneas) impairments.</div></div><div><h3>Results</h3><div>We described 3 phenotypes: nutritional impairment, respiratory impairment, and neurological (with respiratory and nutritional) impairment. Respiratory impairment could overlap with nutritional impairment, or not. There was a significant difference in age categories distribution regarding nutritional impairment (greater proportion in 1.5- to 3.0-month-olds; <em>P</em> = .01) and neurological impairment (greater proportion in <1.5-month-olds; <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>The present study highlights the presence of 3 potentially overlapping phenotypes as a new way to consider and describe RSV disease. To adapt care and healthcare policies in the RSV immunization era, it is necessary to investigate further and monitor the residual SARI burden of each phenotype.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114441"},"PeriodicalIF":3.9000,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Heterogeneity of Clinical Phenotypes in Severe Acute Respiratory Infections Owing to Respiratory Syncytial Virus: A Need to Look Beyond Hospitalization\",\"authors\":\"Côme Horvat MD , Lélia Duclaux-Loras MD , Antoine Ouziel MD , Marine Butin MD, PhD , Sandrine Couray-Targe MD , Anne-Florence Myard-Dury BSc , Julie Haesebaert MD, PhD , Mona Massoud MD, PhD , Mehdi Benchaib MD, PhD , Anne Ploin BSc , Yves Gillet MD, PhD , Bruno Lina MD, PhD , Jean-Sebastien Casalegno MD, PhD , Dominique Ploin MD, PhD\",\"doi\":\"10.1016/j.jpeds.2024.114441\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>To use a pre-COVID-19 birth cohort database to describe the clinical heterogeneity of severe acute respiratory infection (SARI) cases of the past seasons as a basis to investigate further distribution of clinical phenotypes in the era of immunization for respiratory syncytial virus (RSV).</div></div><div><h3>Study design</h3><div>Infants with RSV-SARI were identified from a 2014 through 2019 birth cohort in a tertiary care center in Lyon, France, and their medical records extensively reviewed. Using the criteria of the World Health Organization severity definitions, we classified SARI as having nutritional (inability to feed), respiratory (SpO<sub>2</sub> <93%), or neurological (failure to respond, apneas) impairments.</div></div><div><h3>Results</h3><div>We described 3 phenotypes: nutritional impairment, respiratory impairment, and neurological (with respiratory and nutritional) impairment. Respiratory impairment could overlap with nutritional impairment, or not. There was a significant difference in age categories distribution regarding nutritional impairment (greater proportion in 1.5- to 3.0-month-olds; <em>P</em> = .01) and neurological impairment (greater proportion in <1.5-month-olds; <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>The present study highlights the presence of 3 potentially overlapping phenotypes as a new way to consider and describe RSV disease. To adapt care and healthcare policies in the RSV immunization era, it is necessary to investigate further and monitor the residual SARI burden of each phenotype.</div></div>\",\"PeriodicalId\":54774,\"journal\":{\"name\":\"Journal of Pediatrics\",\"volume\":\"278 \",\"pages\":\"Article 114441\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-12-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022347624005444\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022347624005444","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Heterogeneity of Clinical Phenotypes in Severe Acute Respiratory Infections Owing to Respiratory Syncytial Virus: A Need to Look Beyond Hospitalization
Objective
To use a pre-COVID-19 birth cohort database to describe the clinical heterogeneity of severe acute respiratory infection (SARI) cases of the past seasons as a basis to investigate further distribution of clinical phenotypes in the era of immunization for respiratory syncytial virus (RSV).
Study design
Infants with RSV-SARI were identified from a 2014 through 2019 birth cohort in a tertiary care center in Lyon, France, and their medical records extensively reviewed. Using the criteria of the World Health Organization severity definitions, we classified SARI as having nutritional (inability to feed), respiratory (SpO2 <93%), or neurological (failure to respond, apneas) impairments.
Results
We described 3 phenotypes: nutritional impairment, respiratory impairment, and neurological (with respiratory and nutritional) impairment. Respiratory impairment could overlap with nutritional impairment, or not. There was a significant difference in age categories distribution regarding nutritional impairment (greater proportion in 1.5- to 3.0-month-olds; P = .01) and neurological impairment (greater proportion in <1.5-month-olds; P = .002).
Conclusions
The present study highlights the presence of 3 potentially overlapping phenotypes as a new way to consider and describe RSV disease. To adapt care and healthcare policies in the RSV immunization era, it is necessary to investigate further and monitor the residual SARI burden of each phenotype.
期刊介绍：
The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy.
Topics covered in The Journal of Pediatrics include, but are not limited to:
General Pediatrics
Pediatric Subspecialties
Adolescent Medicine
Allergy and Immunology
Cardiology
Critical Care Medicine
Developmental-Behavioral Medicine
Endocrinology
Gastroenterology
Hematology-Oncology
Infectious Diseases
Neonatal-Perinatal Medicine
Nephrology
Neurology
Emergency Medicine
Pulmonology
Rheumatology
Genetics
Ethics
Health Service Research
Pediatric Hospitalist Medicine.
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