True apenas as a first symptom of viral upper respiratory tract infection in preterm infants on home documented event monitors - abstract

ABSTRACT

Between January, 1992 and September, 1994 all preterm infants followed in the Neonatal High-risk Follow-up Clinic were prospectively evaluated for apneas and/or bradycardias associated with upper respiratory tract infection (URI). 52 infants (mean post-conceptional age 39.2 weeks) had increased apneas with URI. All infants had nasal stuffiness; dry cough was present in 10 (19 percent) and 12 (23 percent) had low grade fever, 16 (31 percent) slept more and had to be awakened for feeds. Respiratory syncytial virus (RSV) antigen was negative in 40; 12 were RSV positive. All bacterial cultures were negative. Hospitalization was necessary in 23 infants (5 with RSV and 19 without RSV). The 9 infants on xanthine therapy had therapeutic levels. The onset of apneas and bradycardias was abrupt, apneas (by report and monitor data) preceded parental suspicion of URI. Monitor data showed 0-5 apneas > 20 sec. per during URI. In addition, 22 percent of infants demonstrated bradycardias with heart rates < 80 minute with URI. Continous pulse oximetry on hospitalized infants showed baseline levels of 93-98 percent with frequent desaturations as low as 78 percent, requiring O 2 supplementation in 14 infants and Xanthine therapy in 16. None of the infants expired. Ex-preterm infants on home monitoring for persistence of apnea of prematurity may be at a high risk for severe apneas and bradycardias with viral upper respiratory infection, and require close surveillance whenever exposed. The relationship of this to SIDS/ALTE needs to be investigated (AU)