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Medical retrieval and needs of infants with bronchiolitis: an analysis by gestational age
Paul F Fleming1, Susie Richards, Kelly Waterman
1Newborn Emergency Transport Service (NETS) Victoria, Melbourne, Victoria, Australia. drpaulfleming@gmail.com
Insights
Premature infants with viral bronchiolitis show increased severity, requiring more invasive ventilation and fluid resuscitation than full-term infants. This highlights the need for early medical retrieval for ex-preterm infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Viral bronchiolitis is a common lower respiratory tract infection in infants under 12 months.
- Prematurity is a significant risk factor for severe bronchiolitis, often necessitating hospital transfer and assisted ventilation.
Purpose of the Study:
- To compare the clinical presentation and treatment needs of preterm infants with bronchiolitis against their term-born counterparts.
- To identify specific risk factors and management requirements for preterm infants with severe bronchiolitis.
Main Methods:
- Retrospective review of infants with bronchiolitis transported by a specialized service between 2003 and 2007.
- Comparison of clinical data, including ventilation requirements and fluid resuscitation, between preterm and term infants.
Main Results:
- Preterm infants were younger at transport and significantly more likely to require invasive ventilation (60% vs. 32%).
- Apnea was more prevalent in preterm infants (70% vs. 36%), often accompanying respiratory distress.
- Preterm infants received fluid boluses more frequently (47% vs. 34%).
Conclusions:
- Ex-preterm infants with bronchiolitis exhibit higher illness severity.
- Preterm infants with bronchiolitis require a lower threshold for medical referral and retrieval due to increased need for ventilation and fluid resuscitation.
Aim:
Viral bronchiolitis is the most common lower respiratory tract infection in children less than 12 months of age. Prematurity is an independent risk factor for disease severity. Many infected infants require hospitalisation and those living in regional centres frequently require transfer to metropolitan hospitals capable of providing assisted ventilation.
Method:
We reviewed infants with bronchiolitis transported by the Victorian Newborn Emergency Transport Service between January 2003 and June 2007. We compared the clinical presentation and treatment required by infants born preterm with those of their term counterparts.
Results:
Of the 192 infants transported, 92 were born preterm. Preterm infants were younger at time of transport (mean post-menstrual age 41 weeks vs. 45 weeks) and were more likely to require invasive ventilation (60% vs. 32%, P < 0.001) and to receive a fluid bolus (47% vs. 34%, P = 0.04) when compared with infants who had been born at term. Apnoea, either as a presenting symptom or in combination with respiratory distress, was more common in the preterm group (70% vs. 36%, P < 0.001).
Conclusion:
Higher illness severity should be anticipated in ex-preterm infants who present with bronchiolitis. Preterm infants with bronchiolitis are more likely to require invasive ventilation and fluid resuscitation than term infants, suggesting the need for a lower threshold for referral and medical retrieval.
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