Acute deteriorations in neonatal chronic lung disease

Preterm infants with chronic lung disease (CLD) have frequent respiratory relapses. The aim of this study was to assess the aetiology of such deteriorations and in particular the proportion due to viral infections. During the study period 118 preterm infants with birth weight <1500g were consecutively admitted to the neonatal intensive care unit; 22 (18.6%) developed CLD. At the onset of all respiratory deteriorations, infants were examined for the presence of patent ductus arteriosus, apnoea or aspiration; they were also carefully screened for both viral and bacterial infection. The 22 infants had a total of 74 episodes of respiratory deterioration; median 3 per baby (range 1–8). Two episodes were associated with patent ductus arteriosus, 18 with apnoea and 5 with aspiration. Infection was suspected or proven in association with all other episodes. On ten occasions the infants had positive blood cultures and on a further eight, bacteria were isolated only from the endotracheal or nasopharyngeal secretions. On the remaining 31 occasions, 27 associated with chest X-ray film abnormalities, infection was suspected, but no bacteria isolated. Viral infections were identified in association with 8 (11%) of these episodes. We conclude viral infection should be considered as a cause of otherwise unexplained respiratory deteriorations in infants with neonatal CLD.