Variations of care with bronchiolitis associated apneas in infants: A retrospective study.

BACKGROUND

Bronchiolitis-associated apneas are a life-threatening complication that are observed more frequently in younger infants born premature. Although apneas associated with viral bronchiolitis are relatively common, at present there is no consensus on management.

METHODS

This study was a retrospective chart review of viral bronchiolitis in children less than 2 years old, admitted to the pediatric intensive care unit (PICU) between July 1st 2020 and June 30th 2024, with at least one reported pre-hospital apnea. Electronic chart reviews were completed and documented demographics, pre-PICU clinical metrics, and PICU interventions including maximal respiratory support, caffeine use, and antibiotics. Descriptive statistics were used for demographic data, and the difference of means or Fisher's exact test was used for further data analysis of PICU outcomes.

RESULTS

A total of 48 charts met inclusion criteria. Young age (x̄ = 97.7 days), female (n = 28, 58%), and respiratory syncytial virus infections (n = 30, 64.6%) were common presenting variables, with a history of prematurity in 33.3% (n = 16) of cases. CRP was not significantly different between infants with or without bacterial infections. There was variability in caffeine use, antibiotics, and respiratory supports utilized. There were no deaths, and the mean PICU stay was 3.9 days.

CONCLUSIONS

Our study documented wide variability in the clinical management of patients with bronchiolitis-associated apneas. Discussions around standardized care may include the initial modality for respiratory support, completion of a partial septic workup, biomarkers for bacterial infections, antimicrobial initiation, and the role of short duration caffeine.