Respiratory Syncytial Virus Bronchiolitis Complicated by Necrotizing Enterocolitis: A Case Series

In rare instances, severe respiratory syncytial virus (RSV) infections of the lower respiratory tract can cause life-threatening extrapulmonary complications. In this report, we describe 4 previously healthy, term and late-preterm infants admitted to the PICU with respiratory failure due to RSV bron...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2021-05, Vol.147 (5), p.1
Main Authors: Arias, Anita V, Lucas, Donald J, Shafi, Nadeem I
Format: Article
Language:English
Subjects:
Anastomosis
Antibiotics
Ascites
Blood flow
Bronchiolitis
Bronchopneumonia
Cancer therapies
Colon
Complications and side effects
Diagnosis
Enteral feeding
Enterocolitis
Gastrointestinal diseases
Ileostomy
Infants
Inflammation
Inflammatory bowel disease
Intolerance
Necrosis
Necrotizing enterocolitis
Neonates
Ostomy
Pediatrics
Peritoneum
Respiratory failure
Respiratory syncytial virus
Respiratory syncytial virus infection
Respiratory tract
Risk factors
Septic shock
Small intestine
Stricture
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Summary:In rare instances, severe respiratory syncytial virus (RSV) infections of the lower respiratory tract can cause life-threatening extrapulmonary complications. In this report, we describe 4 previously healthy, term and late-preterm infants admitted to the PICU with respiratory failure due to RSV bronchiolitis who developed necrotizing enterocolitis shortly after admission. All infants exhibited progressive abdominal distention, had typical radiographic findings, and developed simple or complex ascites. In addition to being managed with broad-spectrum antibiotics and bowel rest, 1 infant was treated with colon resection and ileostomy, 2 had peritoneal drainage procedures for ascites, and one of those later developed small bowel strictures treated with delayed resection and anastomosis. Three were discharged from the hospital without further complications; 1 died of septic shock. In this case series, we describe development of necrotizing enterocolitis in otherwise healthy neonates with severe RSV disease in the absence of traditional risk factors. We hypothesize that a dysregulated proinflammatory response associated with severe RSV disease may alter intestinal blood flow and compromise barriers to bacterial translocation. Enteral feeding intolerance, septic ileus, and/or complex ascites may represent important clinical corollaries in these patients.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2020-022707