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Risk factors for respiratory syncytial virus associated apnoea
M C Kneyber1, A H Brandenburg, R de Groot
1Department of Paediatrics, Sophia Children's Hospital, University Hospital Rotterdam, The Netherlands.
Insights
Young infants with respiratory syncytial virus (RSV) are at higher risk for apnea. Apnea at admission predicts further episodes and increases the need for mechanical ventilation in children with RSV.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Respiratory syncytial virus (RSV) commonly causes respiratory tract infections in infants.
- Apnea can be an initial indicator of severe RSV disease in children.
- Identifying risk factors for RSV-associated apnea and mechanical ventilation is crucial for timely intervention.
Purpose of the Study:
- To identify independent risk factors for respiratory syncytial virus (RSV)-associated apnea in infants.
- To predict the risk of requiring mechanical ventilation in children with RSV-associated apnea.
Main Methods:
- Retrospective review of medical records for infants under 12 months admitted with RSV infection.
- Comparison of demographic, clinical, and laboratory parameters between infants with and without apnea.
- Univariate and multivariate logistic and linear regression analyses to determine risk factors and prediction models.
Main Results:
- Of 185 infants with RSV, 38 (21%) presented with apnea.
- Infants with apnea were younger, had lower temperatures, higher pCO2, and lower pH.
- Apnea at admission was a strong predictor of recurrent apnea and significantly increased the risk for mechanical ventilation.
Conclusions:
- Infants younger than 2 months are at the highest risk for RSV-associated apnea.
- The presence of apnea at admission increases the likelihood of recurrent apnea.
- Recurrent apnea in children with RSV significantly elevates the risk for mechanical ventilation.
Unlabelled:
Respiratory syncytial virus (RSV) infections are characterized by upper or lower respiratory tract symptoms including bronchiolitis and pneumonia. Apnoea may be the first sign of disease in children with RSV infection. The aims of this study were the identification of independent risk factors for RSV associated apnoea and the prediction of the risk for mechanical ventilation in children with RSV associated apnoea. Medical records of children younger than 12 months of age admitted with RSV infection between 1992 and 1995 to the Sophia Children's Hospital, were reviewed. Demographic parameters, clinical features and laboratory parameters (SaO2, pCO2 and pH) were obtained upon admission and during hospitalization. Children with and without apnoea were compared using univariate and multivariate logistic and linear regression analysis. One hundred and eighty-five patients with RSV infection were admitted of whom 38 (21%) presented with apnoea. Patients with apnoea were significantly younger, had a significantly lower temperature, higher pCO2 and lower pH and had on chest radiographs also more signs of atelectasis. The number of patients admitted to the ICU because of mechanical ventilation and oxygen administration was significantly higher in children with RSV associated apnoea. Apnoea at admission was a strong predictor for recurrent apnoea. The relative risk for mechanical ventilation increased with the number of episodes of apnoea: 2.4 (95% CI 0.8-6.6) in children with one episode of apnoea (at admission) versus 6.5 (95% CI 3.3-12.9) in children with recurrent episodes of apnoea.
Conclusions:
Age below 2 months is the strongest independent risk factor for RSV associated apnoea. Apnoea at admission increases the risk for recurrent apnoea. The risk for mechanical ventilation significantly increases in children who suffer from recurrent apnoea.