Incidence of apnea in infants hospitalized with respiratory syncytial virus bronchiolitis: a systematic review.

OBJECTIVE To determine the incidence of apnea in infants hospitalized with respiratory syncytial virus (RSV) bronchiolitis and identify relevant risk factors from the available literature. STUDY DESIGN A systematic search of available databases for studies reporting the rate of apnea in a consecutive cohort of infants hospitalized with RSV infection was performed. The overall incidence of apnea was extracted and analyzed in relation to preterm birth, age, and potentially confounding illnesses. RESULTS The incidence of apnea in the study population of 5575 hospitalized patients with RSV ranged from a high of 23.8% to a low of 1.2%. Comparison of the cohort by term and preterm birth revealed an expected excess in apnea incidence in preterms, even in the absence of information about chronologic age. Many studies appeared to be confounded by the inclusion of impaired infants with neuromuscular disorders. CONCLUSIONS Based on the available data, precisely quantifying the risk of apnea attributable to RSV infection is not possible. Factors intrinsic to the individual infants may account for a significant percentage of the apnea attributed to RSV. Recent studies have found a < 1% incidence of apnea with RSV in previously healthy term infants.

[1]  E. Walsh,et al.  Variation in severity of respiratory syncytial virus infections with subtype. , 1990, The Journal of pediatrics.

[2]  T. Newman,et al.  Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations. , 2004, Archives of pediatrics & adolescent medicine.

[3]  S. Horn,et al.  Effect of practice variation on resource utilization in infants hospitalized for viral lower respiratory illness. , 2001, Pediatrics.

[4]  Volker Stephan,et al.  Hospitalized Children With Respiratory Syncytial Virus Infection and Neuromuscular Impairment Face an Increased Risk of a Complicated Course , 2007, The Pediatric infectious disease journal.

[5]  K. Schechtman,et al.  Severity of Respiratory Syncytial Virus Bronchiolitis Is Affected by Cigarette Smoke Exposure and Atopy , 2005, Pediatrics.

[6]  S. Suter,et al.  Local variability in respiratory syncytial virus disease severity , 1997, Archives of disease in childhood.

[7]  Richard N. Shiffman,et al.  Diagnosis and management of bronchiolitis. , 2006, Pediatrics.

[8]  C. Hall,et al.  Respiratory syncytial virus-related apnea in infants. Demographics and outcome. , 1984, American journal of diseases of children.

[9]  K. Mcintosh,et al.  Apnea associated with respiratory syncytial virus infection in young infants. , 1977, The Journal of pediatrics.

[10]  C. Cox,et al.  Encephalopathy Associated With Respiratory Syncytial Virus Bronchiolitis , 2001, Journal of child neurology.

[11]  J. Barreira,et al.  Relación entre el subtipo del virus respiratorio sincitial y la gravedad clínica en la bronquiolitis , 2001 .

[12]  A. Simon,et al.  Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database , 2007, European Journal of Pediatrics.

[13]  H. Moll,et al.  Risk factors for respiratory syncytial virus associated apnoea , 1998, European Journal of Pediatrics.

[14]  J. F. Kerrigan,et al.  Respiratory Syncytial Virus Infection and Neurologic Abnormalities: Retrospective Cohort Study , 2004, Journal of child neurology.

[15]  R. Holman,et al.  Infectious Disease Hospitalizations Among Infants in the United States , 2008, Pediatrics.

[16]  L. Brown,et al.  Pulse oximetry in discharge decision-making: a survey of emergency physicians. , 2002, CJEM.

[17]  M. Harper,et al.  Identifying hospitalized infants who have bronchiolitis and are at high risk for apnea. , 2006, Annals of emergency medicine.

[18]  C. Lindgren,et al.  Reflex apnoea response and inflammatory mediators in infants with respiratory tract infection * , 1996, Acta paediatrica.

[19]  C. Hall,et al.  The association of apnea and respiratory syncytial virus infection in infants. , 1982, The Journal of pediatrics.

[20]  A. Wahab,et al.  Clinical characteristics of respiratory syncytial virus infection in hospitalized healthy infants and young children in Qatar. , 2001, Journal of tropical pediatrics.

[21]  E. Simões.  Environmental and demographic risk factors for respiratory syncytial virus lower respiratory tract disease. , 2003, The Journal of pediatrics.

[22]  D. Shay,et al.  Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. , 2003, Pediatrics.

[23]  P. Reix,et al.  Upper airways and neonatal respiration , 2005, Respiratory Physiology & Neurobiology.

[24]  S. Heidemann,et al.  Clinical characteristics of respiratory syncytial virus infections in healthy versus previously compromised host , 1989, Pediatric pulmonology.

[25]  J. Forster,et al.  The clinical picture presented by premature neonates infected with the respiratory syncytial virus , 1995, European Journal of Pediatrics.

[26]  M. Cardoso,et al.  [Relationship between respiratory syncytial virus subtype and clinical severity in bronchiolitis]. , 2001, Anales espanoles de pediatria.

[27]  S. Heidemann,et al.  Does prematurity alter the course of respiratory syncytial virus infection? , 1990, Critical care medicine.

[28]  R. Railton,et al.  Frequency and severity of apnoea in lower respiratory tract infection in infancy. , 1983, Archives of disease in childhood.

[29]  E. Wang,et al.  Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of admission and management variation in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. , 1996, The Journal of pediatrics.

[30]  G. Schefft,et al.  Characterization of prolonged apneic episodes associated with respiratory syncytial virus infection , 1989, Pediatric pulmonology.

[31]  M. Eisenhut.  Extrapulmonary manifestations of severe respiratory syncytial virus infection – a systematic review , 2006, Critical care.

[32]  D. Snydman,et al.  A simultaneous outbreak of respiratory syncytial virus and parainfluenza virus type 3 in a newborn nursery. , 1984, The Journal of pediatrics.

[33]  R. Holman,et al.  Respiratory Syncytial Virus Hospitalizations Among American Indian and Alaska Native Infants and the General United States Infant Population , 2004, Pediatrics.

[34]  J. C. Flores,et al.  Bronquiolitis grave. Epidemiologa y evolucin de 284 pacientes , 2007 .

[35]  J. Bodensteiner,et al.  Neurologic complications associated with respiratory syncytial virus. , 2005, Pediatric neurology.

[36]  Kevin Purcell,et al.  Driscoll Children’s Hospital Respiratory Syncytial Virus Database: Risk Factors, Treatment and Hospital Course in 3308 Infants and Young Children, 1991 to 2002 , 2004, The Pediatric infectious disease journal.

[37]  F. VivianLuchsinger,et al.  Apnea como forma de presentacin de una infeccin por metapneumovirus humano , 2007 .

[38]  Richard J Martin,et al.  Neonatal Apnea: What's New? , 2008, Pediatric pulmonology.

[39]  A. Simon,et al.  Acute life threatening event (ALTE) in an infant with human coronavirus HCoV‐229E infection , 2007, Pediatric pulmonology.