Abstract
Background
Current AAP recommendations suggest that incidence of SIDS/BRUE after 43 weeks of corrected gestational age (CGA) age it is not different for term and preterm infants. There is no documented association between apnea of prematurity and risk of SIDS/BRUE. In available literature, we did not find comparison between incidence of BRUE/ALTE in preterm infants who were on caffeine till 46 weeks of CGA and similar group of preterm infants with no medications.
Objectives
Main purpose of this study was to obtain accurate clinical information and to assess safety of current practice discharging infants home on caffeine. The objective of this study was to describe the incidence of BRUE in this population.
Design/Methods
163 infants were divided in three groups i) Study Group: 45 Infants born less than 35 weeks GA that were clinically ready for discharge, except for apneas ii) Control Group: 83 Infants of similar age without apnea of prematurity at the time of discharge iii) Reference Group: 35 healthy infants born 36–37 weeks of GA (normal nursery population)Chart review was performed after 6 and 12 months post –discharge from hospital; all personal information was excluded from collected data. The following records were used for analysis: total number of ER visits within 6 and 12 months post-discharge from hospital; total number of admission to the pediatric wards/ intensive care unit; total number of documented upper respiratory tract infections, including bronchiolitis, and documented BRUE episodes. For patients with confirmed BRUE episodes detailed family, social and medical history was obtained from parents and care providers (pediatricians and family physicians).
Results
Out of 163 infants 5 had documented BRUE, and all these patients were from control group and were born at > 33 weeks of GA. According to BRUE clinical practice guideline 4 patients had 3 risk factors out of 7; and 1 patient had 5 out of 7. All infants came from non-smoker families; 4 were on exclusive breast-feed and 1 was on fortified formula for poor weight gain. 2 infants had events after 43 weeks of PCA. None of the patients had acute medical condition at the time of BRUE (e.g. viral infection).
Conclusion
Ex-preterm infants for whom caffeine was discontinued in hospital had highest incidence of BRUE. Monitoring ex-preterm infants with pulse oximetry after discharge may help to identify which patients are at greatest risk of BRUE.
