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Hahn G, Novak T, Crawford JC, Randolph AG, Lange C. Longitudinal Analysis of Contrasts in Gene Expression Data. Genes (Basel) 2023; 14:1134. [PMID: 37372314 DOI: 10.3390/genes14061134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023] Open
Abstract
We are interested in detecting a departure from the baseline in a longitudinal analysis in the context of multiple organ dysfunction syndrome (MODS). In particular, we are given gene expression reads at two time points for a fixed number of genes and individuals. The individuals can be subdivided into two groups, denoted as groups A and B. Using the two time points, we compute a contrast of gene expression reads per individual and gene. The age of each individual is known and it is used to compute, for each gene separately, a linear regression of the gene expression contrasts on the individual's age. Looking at the intercept of the linear regression to detect a departure from the baseline, we aim to reliably single out those genes for which there is a difference in the intercept among those individuals in group A and not in group B. In this work, we develop testing methodology for this setting based on two hypothesis tests-one under the null and one under an appropriately formulated alternative. We demonstrate the validity of our approach using a dataset created by bootstrapping from a real data application in the context of multiple organ dysfunction syndrome (MODS).
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Affiliation(s)
- Georg Hahn
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Tanya Novak
- Critical Care Medicine, Department of Anesthesiology, Boston Children's Hospital, Boston, MA 02115, USA
| | | | - Adrienne G Randolph
- Critical Care Medicine, Department of Anesthesiology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Christoph Lange
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Lee S, Zhang Y, Newhams M, Novak T, Thomas PG, Mourani PM, Hall MW, Loftis LL, Cvijanovich NZ, Tarquinio KM, Schwarz AJ, Weiss SL, Thomas NJ, Markovitz B, Cullimore ML, Sanders RC, Zinter MS, Sullivan JE, Halasa NB, Bembea MM, Giuliano JS, Typpo KV, Nofziger RA, Shein SL, Kong M, Coates BM, Weiss ST, Lange C, Su HC, Randolph AG. DDX58 Is Associated With Susceptibility to Severe Influenza Virus Infection in Children and Adolescents. J Infect Dis 2022; 226:2030-2036. [PMID: 35986912 PMCID: PMC10205622 DOI: 10.1093/infdis/jiac350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Seasonal influenza virus infection causes a range of disease severity, including lower respiratory tract infection with respiratory failure. We evaluated the association of common variants in interferon (IFN) regulatory genes with susceptibility to critical influenza infection in children. METHODS We performed targeted sequencing of 69 influenza-associated candidate genes in 348 children from 24 US centers admitted to the intensive care unit with influenza infection and lacking risk factors for severe influenza infection (PICFlu cohort, 59.4% male). As controls, whole genome sequencing from 675 children with asthma (CAMP cohort, 62.5% male) was compared. We assessed functional relevance using PICFlu whole blood gene expression levels for the gene and calculated IFN gene signature score. RESULTS Common variants in DDX58, encoding the retinoic acid-inducible gene I (RIG-I) receptor, demonstrated association above or around the Bonferroni-corrected threshold (synonymous variant rs3205166; intronic variant rs4487862). The intronic single-nucleotide polymorphism rs4487862 minor allele was associated with decreased DDX58 expression and IFN signature (P < .05 and P = .0009, respectively) which provided evidence supporting the genetic variants' impact on RIG-I and IFN immunity. CONCLUSIONS We provide evidence associating common gene variants in DDX58 with susceptibility to severe influenza infection in children. RIG-I may be essential for preventing life-threatening influenza-associated disease.
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Affiliation(s)
- Sanghun Lee
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Department of Medical Consilience, Graduate School, Dankook University, Yongin-si, South Korea
| | - Yu Zhang
- Laboratory of Clinical Immunology and Microbiology, Intramural Research Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Margaret Newhams
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Tanya Novak
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul G Thomas
- Department of Immunology, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Peter M Mourani
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Research Institute, Little Rock, Arkansas, USA
| | - Mark W Hall
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Laura L Loftis
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children’s Hospital, Houston, Texas, USA
| | - Natalie Z Cvijanovich
- Division of Critical Care Medicine, UCSF Benioff Children’s Hospital Oakland, Oakland, California, USA
| | - Keiko M Tarquinio
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Adam J Schwarz
- Department of Pediatrics, Children’s Hospital of Orange County, Orange, California, USA
| | - Scott L Weiss
- Division of Critical Care, Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Neal J Thomas
- Department of Pediatrics, Penn State Hershey Children’s Hospital, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Barry Markovitz
- Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Melissa L Cullimore
- Division of Pediatric Critical Care, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ronald C Sanders
- Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Matt S Zinter
- Divisions of Critical Care Medicine and Allergy, Immunology, and Bone Marrow Transplant, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Janice E Sullivan
- Division of Pediatric Critical Care, University of Louisville School of Medicine and Norton Children’s Hospital, Louisville, Kentucky, USA
| | - Natasha B Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John S Giuliano
- Division of Critical Care, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Katri V Typpo
- Department of Pediatrics, Steele Children’s Research Center, University of Arizona, Tucson, Arizona, USA
| | - Ryan A Nofziger
- Division of Critical Care Medicine, Department of Pediatrics, Akron Children’s Hospital, Akron, Ohio, USA
| | - Steven L Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Michele Kong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bria M Coates
- Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christoph Lange
- Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Helen C Su
- Laboratory of Clinical Immunology and Microbiology, Intramural Research Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Adrienne G Randolph
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Cross-reactive immunity against the SARS-CoV-2 Omicron variant is low in pediatric patients with prior COVID-19 or MIS-C. Nat Commun 2022; 13:2979. [PMID: 35624101 PMCID: PMC9142524 DOI: 10.1038/s41467-022-30649-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/10/2022] [Indexed: 02/05/2023] Open
Abstract
Neutralization capacity of antibodies against Omicron after a prior SARS-CoV-2 infection in children and adolescents is not well studied. Therefore, we evaluated virus-neutralizing capacity against SARS-CoV-2 Alpha, Beta, Gamma, Delta and Omicron variants by age-stratified analyses (<5, 5-11, 12-21 years) in 177 pediatric patients hospitalized with severe acute COVID-19, acute MIS-C, and in convalescent samples of outpatients with mild COVID-19 during 2020 and early 2021. Across all patients, less than 10% show neutralizing antibody titers against Omicron. Children <5 years of age hospitalized with severe acute COVID-19 have lower neutralizing antibodies to SARS-CoV-2 variants compared with patients >5 years of age. As expected, convalescent pediatric COVID-19 and MIS-C cohorts demonstrate higher neutralization titers than hospitalized acute COVID-19 patients. Overall, children and adolescents show some loss of cross-neutralization against all variants, with the most pronounced loss against Omicron. In contrast to SARS-CoV-2 infection, children vaccinated twice demonstrated higher titers against Alpha, Beta, Gamma, Delta and Omicron. These findings can influence transmission, re-infection and the clinical disease outcome from emerging SARS-CoV-2 variants and supports the need for vaccination in children.
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Novak T, Hall MW, McDonald DR, Newhams MM, Mistry AJ, Panoskaltsis-Mortari A, Mourani PM, Loftis LL, Weiss SL, Tarquinio KM, Markovitz B, Hartman ME, Schwarz A, Junger WG, Randolph AG. RIG-I and TLR4 responses and adverse outcomes in pediatric influenza-related critical illness. J Allergy Clin Immunol 2020; 145:1673-1680.e11. [PMID: 32035159 PMCID: PMC7323584 DOI: 10.1016/j.jaci.2020.01.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Decreased TNF-α production in whole blood after ex vivo LPS stimulation indicates suppression of the Toll-like receptor (TLR)4 pathway. This is associated with increased mortality in pediatric influenza critical illness. Whether antiviral immune signaling pathways are also suppressed in these patients is unclear. OBJECTIVES We sought to evaluate suppression of the TLR4 and the antiviral retinoic acid-inducible gene-I (RIG-I) pathways with clinical outcomes in children with severe influenza infection. METHODS In this 24-center, prospective, observational cohort study of children with confirmed influenza infection, blood was collected within 72 hours of intensive care unit admission. Ex vivo whole blood stimulations were performed with matched controls using the viral ligand polyinosinic-polycytidylic acid-low-molecular-weight/LyoVec and LPS to evaluate IFN-α and TNF-α production capacities (RIG-I and TLR4 pathways, respectively). RESULTS Suppression of either IFN-α or TNF-α production capacity was associated with longer duration of mechanical ventilation and hospitalization, and increased organ dysfunction. Children with suppression of both RIG-I and TLR4 pathways (n = 33 of 103 [32%]) were more likely to have prolonged (≥7 days) multiple-organ dysfunction syndrome (30.3% vs 8.6%; P = .004) or prolonged hypoxemic respiratory failure (39.4% vs 11.4%; P = .001) compared with those with single- or no pathway suppression. CONCLUSIONS Suppression of both RIG-I and TLR4 signaling pathways, essential for respective antiviral and antibacterial responses, is common in previously immunocompetent children with influenza-related critical illness and is associated with bacterial coinfection and adverse outcomes. Prospective testing of both pathways may aid in risk-stratification and in immune monitoring.
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Affiliation(s)
- Tanya Novak
- Boston Children's Hospital, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Mass; Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Department of Anesthesia, Harvard Medical School, Boston
| | - Mark W Hall
- Nationwide Children's Hospital, Division of Critical Care Medicine, Department of Pediatrics, Columbus, Ohio
| | - Douglas R McDonald
- Boston Children's Hospital, Division of Immunology and Harvard Medical School Department of Pediatrics, Boston, Mass
| | - Margaret M Newhams
- Boston Children's Hospital, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Mass
| | - Anushay J Mistry
- Boston Children's Hospital, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Mass
| | | | - Peter M Mourani
- Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo
| | - Laura L Loftis
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston, Tex
| | - Scott L Weiss
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Keiko M Tarquinio
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta at Egleston, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Barry Markovitz
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, Calif
| | - Mary E Hartman
- Department of Pediatrics, St Louis Children's Hospital, St Louis, Mo
| | - Adam Schwarz
- Department of Pediatrics, Children's Hospital of Orange County, Orange, Calif
| | - Wolfgang G Junger
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Adrienne G Randolph
- Boston Children's Hospital, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Mass; Department of Anesthesia, Harvard Medical School, Boston.
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Kawaguchi A, Bates A, Lee BE, Drews S, Garros D. Virus detection in critically ill children with acute respiratory disease: a new profile in view of new technology. Acta Paediatr 2018; 107:504-510. [PMID: 29131392 PMCID: PMC7159542 DOI: 10.1111/apa.14148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022]
Abstract
AIM To describe the epidemiology of critically ill children admitted to a paediatric intensive care unit (PICU) with acute respiratory disease. The association with intubation was analysed for the three most prevalent viruses and in those with and without viral co-infection. METHODS Patients admitted to the PICU (2004-2014) with acute respiratory disease were included. Analyses were performed utilising each respiratory viral infection or multiple viral infections as an exposure. RESULTS There were 1766 admissions with acute respiratory disease of which 1372 had respiratory virus testing and 748 had one or more viruses detected. The risk of intubation before or during the PICU stay was higher if parainfluenza virus was detected compared to respiratory syncytial virus (RSV) (OR: 2.20; 95% CI: 1.06-4.56). Sixty-three admissions had two or more viruses detected, and the combination of RSV and Rhinovirus/enterovirus was the most common. No significant difference was observed in the risk of intubation between patients with multiple and single viral infections. CONCLUSION Higher risk of intubation was found in patients with parainfluenza as compared to RSV. The risk of intubation comparing parainfluenza virus to other viruses and for patients with multiple versus single virus needs to be further studied.
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Affiliation(s)
- Atsushi Kawaguchi
- Department of Pediatrics; Pediatric Critical Care Medicine; University of Alberta; Edmonton AB Canada
- School of Public Health; University of Alberta; Edmonton AB Canada
| | - Angela Bates
- Department of Pediatrics; Pediatric Critical Care Medicine; University of Alberta; Edmonton AB Canada
| | - Bonita E. Lee
- Department of Pediatrics; Pediatric Infectious Disease; University of Alberta; Edmonton AB Canada
| | - Steven Drews
- Provincial Laboratory for Public Health; Alberta Health Services; Edmonton AB Canada
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
| | - Daniel Garros
- Department of Pediatrics; Pediatric Critical Care Medicine; University of Alberta; Edmonton AB Canada
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Rath B, Conrad T, Myles P, Alchikh M, Ma X, Hoppe C, Tief F, Chen X, Obermeier P, Kisler B, Schweiger B. Influenza and other respiratory viruses: standardizing disease severity in surveillance and clinical trials. Expert Rev Anti Infect Ther 2017; 15:545-568. [PMID: 28277820 PMCID: PMC7103706 DOI: 10.1080/14787210.2017.1295847] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Influenza-Like Illness is a leading cause of hospitalization in children. Disease burden due to influenza and other respiratory viral infections is reported on a population level, but clinical scores measuring individual changes in disease severity are urgently needed. Areas covered: We present a composite clinical score allowing individual patient data analyses of disease severity based on systematic literature review and WHO-criteria for uncomplicated and complicated disease. The 22-item ViVI Disease Severity Score showed a normal distribution in a pediatric cohort of 6073 children aged 0-18 years (mean age 3.13; S.D. 3.89; range: 0 to 18.79). Expert commentary: The ViVI Score was correlated with risk of antibiotic use as well as need for hospitalization and intensive care. The ViVI Score was used to track children with influenza, respiratory syncytial virus, human metapneumovirus, human rhinovirus, and adenovirus infections and is fully compliant with regulatory data standards. The ViVI Disease Severity Score mobile application allows physicians to measure disease severity at the point-of care thereby taking clinical trials to the next level.
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Affiliation(s)
- Barbara Rath
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany.,c Division of Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - Tim Conrad
- d Department of Mathematics and Computer Science , Freie Universität Berlin , Berlin , Germany
| | - Puja Myles
- c Division of Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - Maren Alchikh
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Xiaolin Ma
- b Department of Pediatrics , Charité University Medical Center , Berlin , Germany.,e National Reference Centre for Influenza and Other Respiratory Viruses , Robert Koch Institute , Berlin , Germany
| | - Christian Hoppe
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,d Department of Mathematics and Computer Science , Freie Universität Berlin , Berlin , Germany
| | - Franziska Tief
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Xi Chen
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Patrick Obermeier
- a Division of Pediatric Infectious Diseases , Vienna Vaccine Safety Initiative , Berlin , Germany.,b Department of Pediatrics , Charité University Medical Center , Berlin , Germany
| | - Bron Kisler
- f Clinical Data Standards Interchange Consortium (CDISC) , Austin , TX , USA
| | - Brunhilde Schweiger
- e National Reference Centre for Influenza and Other Respiratory Viruses , Robert Koch Institute , Berlin , Germany
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Chan T, Rodean J, Richardson T, Farris RWD, Bratton SL, Di Gennaro JL, Simon TD. Pediatric Critical Care Resource Use by Children with Medical Complexity. J Pediatr 2016; 177:197-203.e1. [PMID: 27453367 DOI: 10.1016/j.jpeds.2016.06.035] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/12/2016] [Accepted: 06/10/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To examine the proportionate use of critical care resources among children of differing medical complexity admitted to pediatric intensive care units (ICUs) in tertiary-care children's hospitals. STUDY DESIGN This is a retrospective, cross-sectional study of all children (<19 years of age) admitted to a pediatric ICU between January 1, 2012, and December 31, 2013, in the Pediatric Health Information Systems database. Using the Pediatric Medical Complexity Algorithm, we assigned patients to 1 of 3 categories: no chronic disease, noncomplex chronic disease (NC-CD), or complex chronic disease (C-CD). Baseline demographics, hospital costs, and critical care resource use were stratified by these groups and summarized. RESULTS Of 136 133 children with pediatric ICU admissions, 53.0% were categorized as having C-CD. At the individual-encounter level, ICU resource use was greatest among patients with C-CD compared with children with NC-CD and no chronic disease. At the hospital level, patients with C-CD accounted for more than 75% of all examined ICU resources, including ventilation days, ICU costs, extracorporeal membrane oxygenation runs, and arterial and central venous catheters. Children with a progressive condition accounted for one-half of all ICU resources. In contrast, patients with no chronic disease and NC-CD accounted for less than one-quarter of all ICU therapies. CONCLUSION Children with medical complexity disproportionately use the majority of ICU resources in children's hospitals. Efforts to improve quality and provide cost-effective care should focus on this population.
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Affiliation(s)
- Titus Chan
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA
| | | | | | - Reid W D Farris
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA
| | - Susan L Bratton
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Jane L Di Gennaro
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA
| | - Tamara D Simon
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA; Seattle Children's Research Institute, Seattle, WA
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Effect of two-step hygiene management on the prevention of nosocomial influenza in a season with high influenza activity. J Hosp Infect 2016; 94:143-9. [DOI: 10.1016/j.jhin.2016.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 07/10/2016] [Indexed: 12/20/2022]
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Lower Respiratory Tract Infections: Risks Are High in Early Childhood. Pediatr Crit Care Med 2016; 17:806-8. [PMID: 27500621 DOI: 10.1097/pcc.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Multiplex Tests in Critically Ill Children With Severe Lower Respiratory Tract Infections. Pediatr Crit Care Med 2016; 17:586-7. [PMID: 27261663 DOI: 10.1097/pcc.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Does the Site of Sampling and Type of Diagnostic Test for Viruses Matter in Suspected Acute Severe Viral Respiratory Infection? Pediatr Crit Care Med 2016; 17:359-61. [PMID: 27043898 DOI: 10.1097/pcc.0000000000000689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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