RECOGNIZE APNEA RISK FOR BRONCHIOLITIS IN THE FIRST 2 MONTHS OF LIFE

A 5 week old presents with nasal congestion and difficulty breathing. RSV bronchiolitis is ultimately diagnosed. Can the patient go home?

Not every infant with bronchiolitis can be admitted. But the ED provider must be aware that the dreaded complication of apnea tends to occur in patients who are under 2-3 months old.

The studies on apnea from bronchiolitis are heterogeneous and the results are mixed. For example the incidence of apnea in newborns varies from <1% to 24% (Ralston J Pediatrics 2009).

One study of all bronchiolitis patients under one year of age found that all the apnea occurred in patients under 10 weeks of age, and 73% in those under 1 month of adjusted age (adjusting for prematurity).(Ricart Ped Infect Dis J 2014) Numerous studies show similar clustering in the newborn period.( Pruikkonen 2014, Arms 2008)

Take Home Points:

-Apnea in RSV is more likely in those under 2-3 months of age or who were premature