Typical admission considerations for patients with bronchiolitis are work of breathing, hypoxia, and dehydration. The patients risk of apnea should also be considered. Younger infants with bronchiolitis are at a risk for apnea. Studies have cited anywhere from a 16-25% risk in younger infants. The problem lies in identifying those patients who are at risk and those who are not. This older study looked at 691 infants and developed criteria which identified all of the 2.7% of patients who developed apnea.
The high risk criteria used in this study were: 1) Full term and younger than 1 month; 2) Born < 37 weeks gestation and younger than 48 weeks post conception or 3) Parents already noted an episode of apnea with this illness.
Bottom line: Incorporate the infants risk of apnea into your disposition decision for patients with bronchiolitis.
References
Willwerth B, Harper M and Greenes D. Identifying Hospitalized Infants Who Have Bronchiolitis and Are at High Risk for Apnea. Annals of Emergency Medicine 48 (4) 2006.
