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RSV Related Apnea - A Multicenter Regional Review of Incidence, Risk Factors and Outcomes

Sunday, October 21, 2012: 11:15 AM
Room 210 (Morial Convention Center)
Simon Li, MD, MPH1, Michael F. Canarie, MD2, Christopher L. Carroll, MD3, E. Vincent S. Faustino, MD4, John S. Giuliano Jr., MD5, Aalok R. Singh, MD1 and Matthew G. Pinto, MD1, (1)Pediatric Critical Care, New York Medical College, Valhalla, NY, (2)Pediatric Critical Care, Tufts School of Medicine, Springfield, MA, (3)Pediatric Critical Care, Connecticut Children's Medical Center, Hartford, CT, (4)Pediatric Critical Care, Yale School of Medicine, New Haven, CT, (5)Pediatric Critical Care, Yale University School of Medicine, New Haven, CT

Purpose:

Respiratory syncytial virus (RSV) is the leading infectious agent for young children who are admitted to the hospital with respiratory illnesses. RSV is known to cause apnea in these children with a wide-ranging incidence of 1.7-23.8%. Infants are the predominant group to manifest apnea secondary to RSV. Development of apnea in RSV is thought to lead to increased healthcare utilization. We conducted this study to determine the incidence, risk factors and outcomes of children admitted in the pediatric intensive care unit (PICU) with RSV related apnea.

Methods:

We conducted a retrospective cohort study of 312 children admitted to the PICU of four children's hospitals in the northeast United States with RSV bronchiolitis between July 2009 and July 2011. Children were classified as having apnea according to a priori established definition including both historical and witnessed apnea. Univariate and multivariate analytic methods were used to determine the association of risk factors for apnea and for the association of apnea with outcomes. Collinearity was assessed and those with high correlation were eliminated from the multivariate models.

Results:

In this cohort, 18.27% had RSV related apnea. The age ranged from newborn to 2 years old. In the univariate analysis, patients who developed apnea were significantly younger, weighed less, had history of prematurity and were more likely to have received palivizumab. Ninety-five percent of apneic patients were <6 months old and weighed <6 kg. In the multivariate analysis, apnea was more likely to occur in children who weighed less (OR 0.56, 95% CI 0.44-0.72). Both prematurity and RSV seasonality trended towards significance in positive association with apnea. Children with apnea were more likely to be invasively mechanically ventilated in the univariate analysis (OR 1.97, 95% CI 1.06-3.66). However, after factoring in PIM 2 score, race/ethnicity, and site there was no association between apnea and invasive or noninvasive ventilation. There was also no association between apnea and length of mechanical ventilation, ICU stay, or overall hospital stay.

Conclusion:

Nearly 1 in 5 children admitted to the PICU with RSV had apnea. RSV patients with apnea seem to have outcomes similar to those without apnea.  Younger children who weighed less were more likely to present with apnea due to RSV infection. Interestingly, there was a trend of association between apnea with different RSV seasons and history of prematurity. Further research is needed to explore these possibly important relationships.

 

Table: Multivariate adjusted risk for apneaa

Characteristics

% Apnea Cases

Adjusted OR (95% CI)

p

Weight (kg)

 

0.56 (0.44-0.72)

<0.001

Gestational Age

 

 

 

     Full term

14.74%

Reference

---

     Preterm (<36 weeks)

32.79%

1.94 (0.88-4.30)

0.101

RSV Season

 

 

 

     2009-2010

20.56%

Reference

---

     2010-2011

15.15%

0.47 (0.22-1.01)

0.053

a Adjusted factors were weight, history of prematurity (<36 weeks gestation), RSV season