The Clinical Management of Preterm Infants With Bronchiolitis

Abstract

OBJECTIVES:The goal of this study was to determine physician management choices for hospitalized premature infants with bronchiolitis compared with term infants and to evaluate predictors of steroid use in premature infants. METHODS:A chart review was conducted of premature and nonpremature infants admitted to 2 children's hospitals with bronchiolitis. Reviewers selected charts based on International Classifi cation of Diseases, Ninth Revision diagnosis codes and collected demographic and historical information, as well as evaluation, treatment, treatment effectiveness, length of stay, hospital readmission rates, and adverse outcomes. Reviewers compared documented rates of utilization and effectiveness of inhaled racemic epinephrine and albuterol between patients with and without a history of prematurity. Patients with a history of prematurity underwent subgroup analysis of factors relating to steroid use. RESULTS:A total of 1223 patients met the study criteria for inclusion. Premature infants represented 19% of all children hospitalized with bronchiolitis. These infants had a longer length of stay (3.8 vs 2.6 days; P < .001) and a more severe hospital course. Rates of inhaled therapy and steroid utilization did not differ between premature and term infants. There was no difference in rates of documented positive response to albuterol, but premature infants were more likely to have a positive response to epinephrine. Steroid use in premature infants was associated with older age, history of wheeze, and albuterol use; documentation of albuterol effi cacy did not correlate with steroid use, however. CONCLUSIONS:Management decisions among term and premature infants with bronchiolitis were similar. Premature infants who received albuterol were more likely to receive steroids; however, the decision regarding steroid use was not associated with documentation of effi cacy of albuterol. The Clinical Management of Preterm Infants With BronchiolitisBronchiolitis is a leading cause of hospitalization of infants, resulting in more than $500 million in health care expenditures annually in the United States.1 It has been estimated that >20% of infants aged <1 year will have bronchiolitis-associated wheezing.2 In the United States, >12% of infants are born before 37 weeks' gestational age, and this rate is higher now than at any known historical level.3 Prematurity and chronic lung disease of prematurity are known risk factors for hospitalization in bronchiolitis, and chronic lung disease is disproportionately present among infants hospitalized with bronchiolitis. 4 Up to 14% of all premature infants will be hospitalized with bronchiolitis early in life, and they will typically have a more severe course and a longer length of stay (LOS) than full term infants.5-7 More than one-half of premature infants <29 weeks' gestational age may be admitted by guest on May 11, 2018 http://hosppeds.aappublications.org/ Downloaded from

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