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INFANTS WITH RSV BRONCHIOLITIS MAY SUFFER NEUROLOGICAL COMPLICATIONS

MIAMI BEACH — Physicians, particularly neurologists, should be aware that children with respiratory syncytial virus (RSV) bronchiolitis can suffer neurological complications, predominantly seizures and encephalopathy, researchers reported here last fall at the Annual Meeting of the Child Neurology Society.

The detailed chart review of 964 RSV bronchiolitis patients under age 14 years showed that 1.2 percent of the children developed neurological complications, said John B. Bodensteiner, MD, Chief of Pediatric Neurology at St. Joseph's Hospital in Phoenix and Professor of Pediatrics and Neurology at the University of Arizona in Tucson.

“Our previous study showed that neurologists are asked to consult in the ICU for unexplained neurological abnormalities in children with RSV several times a year,” he said. “That finding triggered this study; we wanted to see if there was a positive association between the two.”

While the study showed that the incidence of neurological complications in children with RSV bronchiolitis “is pretty low and probably not higher than the incidence associated with other viruses, there clearly is a positive association for neurological abnormalities in kids with RSV bronchiolitis,” Dr. Bodensteiner said.

All of the 12 children who developed neurological complications in the study were younger than two years old. “That is not surprising,” he said, “as that is the chief age group of the infection.”

Seven of the infants had seizures, three had generalized encephalopathy, and two developed isolated esotropia, the study showed. The major neurological symptoms, according to Dr. Bodensteiner, are altered consciousness, decreased responsiveness, and apnea.

ABOUT RSV

Max Wiznitzer, MD, Associate Professor of Pediatrics and Neurology at Case Western University and a child neurologist at Rainbow Babies and Children's Hospital in Cleveland, OH, said the study is an important reminder that “children with an acute neurological syndrome and RSV infection may have RSV as a primary causation.

“Many of us have seen this,” he said, “but it is nice to have confirmation so that people are attuned and aware.”

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Dr. John B. Bodensteiner: “Our previous study showed that neurologists are asked to consult in the ICU for unexplained neurological abnormalities in children with RSV several times a year. That finding triggered this study.”

RSV is the leading cause of serious respiratory tract infections in infants and children, the researchers noted. Each year, there are over 125,000 hospitalizations and 450 deaths attributable to RSV in the US, according to data cited in the poster.

A negative-sense, enveloped RNA virus, RSV most often strikes during late fall, winter, or early spring months, according to the Centers for Disease Control and Prevention. During their first RSV infection, between 25 and 40 percent of infants and young children have signs or symptoms of bronchiolitis or pneumonia, and 0.5 to 2 percent require hospitalization.

For the study, the researchers reviewed the coded diagnoses of all RSV bronchiolitis patients younger than 14 years old admitted to St. Joseph's Hospital over the past five years. A detailed chart review was performed for any case consistent with a diagnosis of neurological disease.

The researchers identified 964 patients, aged from newborn to 13 years, with a diagnosis of RSV bronchiolitis; 36 of them also had a neurological disorder. Eleven patients with pre-existent neurological disorders, six patients with probable simple febrile seizures, and seven patients with a history of seizure disorders were excluded from the analysis.

NEUROLOGICAL COMPLICATIONS

The other 12 children with RSV bronchiolitis had neurological complications without any other recognized cause. Of the seven infants who developed seizures, one had status epilepticus. Three infants had generalized encephalopathy with marked hypotonia and decreased responsiveness, and two of them developed esotropia. Also, two children developed isolated esotropia.

A case example, the researchers said, was a three-month-old boy with a history significant only for reactive airway disorder. He came to the emergency room with respiratory distress and had two generalized tonic-clonic seizures while still in the ER. Otherwise findings on physical examination were normal.

Immunoflourescence assay proved that the boy had RSV bronchiolitis. CSF contents were normal, blood cultures showed no growth, and CT and MRI of the brain were also normal. EEG did, however, show focal slowing in the right posterior temporal region.

The bottom line, Dr. Bodensteiner said, is that “neurologists need to be aware of this association.”

ARTICLE IN BRIEF

✓ A study led by Dr. John B. Bodensteiner, of the University of Arizona in Tucson, found an association between respiratory syncytial virus bronchiolitis and neurological complications, predominantly seizures and encephalopathy.