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RSV Apnea Risk
It’s RSV season and you’re seeing a 30 day old ex-39 week infant with a runny nose. The resident has ordered a POC RSV, which is positive. The baby is afebrile, feeding well, and nontoxic. Do you admit the infant just for being RSV positive due to the risk of apnea in this age group?
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Kelly January 23, 2017 - 3:17 am
There’s not a lot of good evidence here. The best study I know of is a retrospective cohort study of 691 infants < 6 months old hospitalized for bronchiolitis (Wilwerth et al, Ann Emerg Med 2006;48:441-447). They found 2.7% developed apnea while hospitalized. Using high risk criteria of: full term and age < 1 month, preterm (<37 weeks) and age < 48 weeks post conceptual age, or witnessed prior apnea episode with this illness, was 100% sensitive (95% CI 82-100%) in identifying the infants that developed apnea. However, high risk criteria identified 262 high risk patients, of whom only 19 developed apnea.