Frequency of Apnea and Respiratory Viruses in Infants with Bronchiolitis

Ricart, Sílvia; Rovira, Núria; García‐García, Juan José; Pumarola, Tomás; Pons, Martí; Muñoz-Almagro, Carmen; Marcos, M.Á.

doi:10.1097/inf.0000000000000365

Cited by 34 publications

(29 citation statements)

References 7 publications

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“…Exhaustion, or obstructive processes, may also explain why it observed apnea in infants older than 6 months. Our results were more similar to Ricart et al, 9 that found apnea alone was the first presenting symptom of bronchiolitis in 33% of infants with apnea and bronchiolitis. Similarly, younger age and prematurity were important risk factors.…”

Section: Discussionsupporting

confidence: 92%

“…9 Even when infants presenting with apnea have clinically evident bronchiolitis, it is the apnea that catches the attention of parents and clinicians. Moreover, the auscultatory signs used to diagnose bronchiolitis are often difficult to elicit in infants younger than 16 weeks, and suffer poor interrater reliability.…”

Section: Discussionmentioning

confidence: 99%

“…8 Apparently isolated apnea is followed by bronchiolitis 33% of the time; this percentage rises if even early signs of upper respiratory tract infection (URI) are present. 9 Apnea complicates bronchiolitis 5% of the time, but emerges after the clinical appearance of bronchiolitis in just 1%. 8–10 …”

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confidence: 99%

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

et al. 2015

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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“…[111] Predominant pathogens were RSV (33.3%), rhinovirus (13.7%) and viral coinfections (23.5%), and main risk factors were young age and a history of prematurity. In contrast to findings in animal models, testing of cerebrospinal fluid from infants with RSV infection with neurological manifestations for respiratory RNA viruses (including RSV, influenza A and B, pandemic influenza H1N1, parainfluenza-3, human metapneumovirus, adenovirus, parechovirus, and enterovirus) was negative in all patients, supporting the notion that the mechanism of RSV-induced neurologic manifestations, including apnea, is not direct central nervous system invasion.…”

Section: Review Articlementioning

confidence: 99%

Prematurity and the burden of influenza and respiratory syncytial virus disease

et al. 2015

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The particular burden of both viral diseases in preterm infants is dominated by RSV and its associated rehospitalizations during the first two years of life. Prophylactic measures include vaccination against influenza virus of family members and caregivers and active immunization starting at the age of 6 months, and monthly injections of palivizumab during the cold season to avoid severe RSV disease and its sequelae.

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“…Recent prospective studies estimated that the rate of apnea among the hospitalized infants with bronchiolitis is about 5%. [30,55,56] There is not an excess risk for apnea for any type of isolated viral pathogen, whereas prematurity and younger corrected age seem to confer to an excess risk. [56] A systematic review [57] of apnea in hospitalized infants with RSV bronchiolitis found the rates ranged widely from 1.2% to 23.8%; but the majority of the studies were retrospective and included infants with serious underlying conditions.…”

Section: Clinical Features (Symptoms and Signs)mentioning

confidence: 99%