Elsevier

The Journal of Pediatrics

Volume 155, Issue 5, November 2009, Pages 728-733
The Journal of Pediatrics

Original Article
Incidence of Apnea in Infants Hospitalized with Respiratory Syncytial Virus Bronchiolitis: A Systematic Review

https://doi.org/10.1016/j.jpeds.2009.04.063Get rights and content

Objective

To determine the incidence of apnea in infants hospitalized with respiratory syncytial virus (RSV) bronchiolitis and identify relevant risk factors from the available literature.

Study design

A systematic search of available databases for studies reporting the rate of apnea in a consecutive cohort of infants hospitalized with RSV infection was performed. The overall incidence of apnea was extracted and analyzed in relation to preterm birth, age, and potentially confounding illnesses.

Results

The incidence of apnea in the study population of 5575 hospitalized patients with RSV ranged from a high of 23.8% to a low of 1.2%. Comparison of the cohort by term and preterm birth revealed an expected excess in apnea incidence in preterms, even in the absence of information about chronologic age. Many studies appeared to be confounded by the inclusion of impaired infants with neuromuscular disorders.

Conclusions

Based on the available data, precisely quantifying the risk of apnea attributable to RSV infection is not possible. Factors intrinsic to the individual infants may account for a significant percentage of the apnea attributed to RSV. Recent studies have found a < 1% incidence of apnea with RSV in previously healthy term infants.

Section snippets

Methods

A search of the MEDLINE, CINAHL Plus, EMBASE, and Cochrane Registry databases up to June 1, 2008 was conducted using the search terms “bronchiolitis AND apnea,” “apnea AND respiratory syncytial virus (RSV),” “severity AND respiratory syncytial virus,” and “apnea AND lower respiratory tract infection (LRTI)” as text words and medical subject headings, where appropriate. The alternative English language spelling of apnea, “apnoea,” also was used. Other pertinent literature was identified based on

Results

Using the initial search strategy produced a return of 564 abstracts. Eighteen articles were reviewed, of which 13 met the inclusion criteria.13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 Articles were excluded for any of the following reasons: apparent inclusion of duplicate patient populations,26, 27 inclusion of intensive care unit admissions only,28, 29 and defining apnea as “apnea and/or cyanosis.”30 Data were collected on a total of 5575 patients documented to be RSV-positive,

Discussion

We found a trend toward decreasing rates of apnea in more recent studies that does not seem to be explained by study design or inclusion criteria alone. One possible explanation for this may be the impact of RSV prophylaxis. Although preterm infants are included in more recent study populations, it may be that the infants at greatest risk have modified disease or are acquiring RSV later in life, when their intrinsic risk of apnea is diminished. Other authors have hypothesized a general trend

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    The authors declare no conflicts of interest.

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