Derivation of Candidate Clinical Decision Rules to Identify Infants at Risk for Central Apnea

Abstract

BACKGROUND AND OBJECTIVES Central apnea complicates, and may be the presenting complaint in, bronchiolitis. Our objective was to prospectively derive candidate clinical decision rules (CDRs) to identify infants in the emergency department (ED) who are at risk for central apnea. METHODS We conducted a prospective observational study over 8 years. The primary outcome was central apnea subsequent to the initial ED visit. Infants were enrolled if they presented with central apnea or bronchiolitis. We excluded infants with obstructive apnea, neonatal jaundice, trauma, or suspected sepsis. We developed 3 candidate CDRs by using 3 techniques: (1) Poisson regression clustered on the individual, (2) classification and regression tree analysis (CART), and (3) a random forest (RF). RESULTS We analyzed 990 ED visits for 892 infants. Central apnea subsequently occurred in the hospital in 41 (5%) patients. Parental report of apnea, previous history of apnea, congenital heart disease, birth weight ≤2.5 kg, lower weight, and age ≤6 weeks all identified a group at high risk for subsequent central apnea. All CDRs and RFs were 100% sensitive (95% confidence interval [CI] 91%–100%) and had a negative predictive value of 100% (95% CI 99%–100%) for the subsequent apnea. Specificity ranged from 61% to 65% (95% CI 58%–68%) for CDRs based on Poisson models; 65% to 77% (95% CI 62%–90%) for CART; and 81% to 91% (95% CI 78%–92%) for RF models. CONCLUSIONS All candidate CDRs had a negative predictive value of 100% for subsequent central apnea.

Acute Bronchiolitis in Children

“…In a prospective observational study that included infants presented to the ED due to bronchiolitis, subsequent apnea occurred in 5% of patients. It was associated with parental report of apnea, previous history of apnea, congenital heart disease, LBW, lower weight, and age ≤6 weeks [17]. Another multicenter prospective study reported apnea in 5% of patients hospitalized with bronchiolitis [18].…”

Akutni bronhiolitis

“…Apneja -komplikacija koja se javlja osobito u prematurno rođene dojenčadi i one mlađe od dva mjeseca. 65,[67][68][69][70][71][72][73] Rizik od nastanka apneje nije specifičan za određeni virusni patogen. 71,74 Apneja je značajan čimbenik rizika za zatajenje disanja i potrebu za mehaničkom ventilacijom, a njezina je pojavnost veća u dojenčadi mlađe od osam tjedana.…”

Lung ultrasound allows for earlier diagnosis of bronchiolitis than auscultation: an animal experiment and human case series

“…Central apnea complicates 1% of bronchiolitis and typically occurs early in the disease, when the characteristic auscultatory findings may be missed or have not manifest [8]. Infants who are at risk of central apnea, typically younger than six weeks of age, premature, or with comorbidities, may be admitted to the hospital for fear that apnea may occur when the parents are sleeping resulting in an unexpected potentially avoidable infant death [9][10][11].…”