Assessing Clinical Improvement of Infants Hospitalized for Respiratory Syncytial Virus-Related Critical Illness.

Summary

In a 39-PICU prospective registry (n=585) of infants with RSV critical illness, CPS-Ped sensitively tracked severity and improvement and identified risk factors for non-improvement by day 7. Power calculations showed CPS-Ped-based endpoints require far fewer participants than length of stay to detect a 15% improvement.

Key Findings

• Among 585 infants, 23.6% required invasive mechanical ventilation and 8.4% worsened by ≥2 CPS-Ped points; one death occurred.
• Failure to improve by day 7 (35%) was independently associated with age <3 months, prematurity, underlying respiratory disease, and IMV within 24 hours.
• Detecting a 15% improvement requires far fewer participants using CPS-Ped (n=584 per arm) than length of stay (n=2,031 per arm).

Clinical Implications

Use CPS-Ped to monitor severity and define trial endpoints in infants with RSV critical illness; early identification of high-risk infants (age <3 months, prematurity, baseline respiratory disease, early IMV) can inform stratification and management.

Limitations

• Observational design cannot infer causality or treatment effects.
• Generalizability is limited to infants with RSV-related critical illness.

Future Directions

Validate CPS-Ped responsiveness across broader pediatric respiratory diseases and embed CPS-Ped as a primary endpoint in interventional RSV trials.