Medical retrieval and needs of infants with bronchiolitis: An analysis by gestational age

Authors

  • Paul F Fleming,

    Corresponding author
    • Newborn Emergency Transport Service (NETS) Victoria, Melbourne, Victoria, Australia
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  • Susie Richards,

    1. Newborn Emergency Transport Service (NETS) Victoria, Melbourne, Victoria, Australia
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  • Kelly Waterman,

    1. Newborn Emergency Transport Service (NETS) Victoria, Melbourne, Victoria, Australia
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  • Peter G Davis,

    1. The Royal Women's Hospital, Melbourne, Victoria, Australia
    2. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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  • C Omar F Kamlin,

    1. Newborn Emergency Transport Service (NETS) Victoria, Melbourne, Victoria, Australia
    2. The Royal Women's Hospital, Melbourne, Victoria, Australia
    3. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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  • Michael Stewart,

    1. Newborn Emergency Transport Service (NETS) Victoria, Melbourne, Victoria, Australia
    2. The Royal Women's Hospital, Melbourne, Victoria, Australia
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  • Jenni Sokol

    1. Newborn Emergency Transport Service (NETS) Victoria, Melbourne, Victoria, Australia
    2. The Royal Women's Hospital, Melbourne, Victoria, Australia
    3. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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  • Conflict of interest: None declared.
  • Institution where work was undertaken: Newborn Emergency Transport Service, The Royal Women's Hospital, Parkville, Victoria.

Correspondence: Dr Paul F Fleming, Centre for Paediatrics, Blizzard Institute of Cell and Molecular Science, Barts and the London School of Medicine and Dentistry, 4 Newark Street, London E12AT, UK. Fax: +44 2 07 943 1382; email: drpaulfleming@gmail.com

Abstract

Aim

Viral bronchiolitis is the most common lower respiratory tract infection in children less than 12 months of age. Prematurity is an independent risk factor for disease severity. Many infected infants require hospitalisation and those living in regional centres frequently require transfer to metropolitan hospitals capable of providing assisted ventilation.

Method

We reviewed infants with bronchiolitis transported by the Victorian Newborn Emergency Transport Service between January 2003 and June 2007. We compared the clinical presentation and treatment required by infants born preterm with those of their term counterparts.

Results

Of the 192 infants transported, 92 were born preterm. Preterm infants were younger at time of transport (mean post-menstrual age 41 weeks vs. 45 weeks) and were more likely to require invasive ventilation (60% vs. 32%, P < 0.001) and to receive a fluid bolus (47% vs. 34%, P = 0.04) when compared with infants who had been born at term. Apnoea, either as a presenting symptom or in combination with respiratory distress, was more common in the preterm group (70% vs. 36%, P < 0.001).

Conclusion

Higher illness severity should be anticipated in ex-preterm infants who present with bronchiolitis. Preterm infants with bronchiolitis are more likely to require invasive ventilation and fluid resuscitation than term infants, suggesting the need for a lower threshold for referral and medical retrieval.

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