Review of treatment of bronchiolitis related apnoea in two centres.
OBJECTIVE
To determine whether the use of negative pressure ventilation (NPV) was associated with a lower rate of endotracheal intubation in infants with recurrent apnoea secondary to acute bronchiolitis.


METHODS
Retrospective review of two paediatric intensive care units (PICU) databases and case notes; one PICU offered NPV.


RESULTS
Fifty two infants with bronchiolitis related apnoea were admitted to the two PICUs (31 to the NPV centre). There were no significant differences between infants in the two centres in age and weight on admission, gestational age at birth, birth weight, history of apnoea of prematurity or chronic lung disease, days ill before referral, respiratory syncytial virus status, oxygen requirement before support, and numbers retrieved from secondary care centres. Respiratory support was provided to all 31 infants in the NPV centre (23 NPV, 8 PPV), and 19/21 in the non-NPV centre (18 PPV, 1 CPAP); the NPV centre had lower rates of endotracheal intubation rates (8/31 v 18/21), shorter durations of stay (median 2 v 7 days), and less use of sedation (16/31 v 18/21). In the two years after the NPV centre discontinued use of NPV, 14/17 (82%) referred cases were intubated, with a median PICU stay of 7.5 days.


CONCLUSIONS
The use of NPV was associated with a reduced rate of endotracheal intubation, and shorter PICU stay. A prospective randomised controlled trial of the use of NPV in the treatment of bronchiolitis related apnoea is warranted.
Al-balkhi
A
A
Department of Paediatrics, University Hospital, Queen's Medical Centre, Nottingham, UK.
Klonin
H
H
Marinaki
K
K
Southall
D P
DP
Thomas
D A
DA
Jones
P
P
Samuels
M P
MP
D001049:Apnea / Q000209:etiology / Q000534:rehabilitation*; D001988:Bronchiolitis / Q000150:complications*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D015931:Intensive Care, Neonatal; D007902:Length of Stay; D008297:Male; D012008:Recurrence; D012121:Respiration, Artificial; D016896:Treatment Outcome; D015919:Ventilators, Negative-Pressure
BMJ. 1989 Nov 18;299(6710):1253-7
2513900
South Med J. 2000 Mar;93(3):294-6
10728517
J Pediatr. 1977 Mar;90(3):382-6
839330
J Pediatr. 1982 Jul;101(1):65-8
7086623
Arch Dis Child. 1989 Oct;64(10):1431-7
2684031
Eur J Pediatr. 1998 Apr;157(4):331-5
9578972
Clin Pediatr (Phila). 1993 Aug;32(8):455-60
8403742
J Pediatr. 1995 Feb;126(2):212-9
7844667
N Z Med J. 1996 Apr 26;109(1020):137-9
8649668
Pediatr Pulmonol. 1997 Sep;24(3):218-21
9330419