NEONATAL RESPIRATORY SYNCYTIAL VIRUS-INFECTION

Respiratory syncytial virus infections are thought to be uncommon in the first month of life. During a community outbreak, we prospectively studied such infection in our neonatal units. Of 82 neonates studied, 66 were hospitalized for six days or longer, and 23 (35 per cent) acquired this virus. Four infants died, two unexpectedly. Infected infants had a significantly shorter gestation and birth weight. Illness was often atypical, with nonspecific signs, especially in infants under three weeks of age, who had significantly less lower-respiratory-tract involvement and lower quantities of virus in their nasal washes. The titer of virus shed correlated with the infants’ postnatal, but not gestational, age. Infection was also acquired by 34 per cent of the staff, who appeared to be important in the spread of the virus. These findings suggest that respiratory syncytial virus may readily infect neonates, but the disease may be atypical and may be overlooked. (N Engl J Med 300:393–396, 1979) RESPIRATORY syncytial virus, the most important viral respiratory pathogen of infants and young children,1 2 3 produces its most severe disease in the first six months of life, when specific maternal antibody is uniformly present. Indeed, an immune reaction involving maternal antibody has been postulated as contributing to the severity of the disease seen in infancy.4,5 Despite this peak incidence in the first six months of life, the virus is uncommon in the first four weeks of life.6 The reasons for this phenomenon are unclear, but if delineated, might help in the understanding of the pathogenesis and immunity of infection with the. © 1979, Massachusetts Medical Society. All rights reserved.