title: The clinical management of preterm infants with bronchiolitis.
abstract: OBJECTIVE
  The goal of this study was to determine physician management choices for hospitalized premature infants with bronchiolitis compared with erm infants and to evaluate predictors of steroid use in premature infants.
  
  
  METHODS
  A chart review was conducted of premature and nonpremature infants admitted to 2 children's hospitals with bronchiolitis. Reviewers selected charts based on International Classification of Diseases, Ninth Revision diagnosis codes and collected demographic and historical information, as well as evaluation, treatment, treatment effectiveness, length of stay, hospital readmission rates, and adverse outcomes. Reviewers compared documented rates of utilization and effectiveness of inhaled racemic epinephrine and albuterol between patients with and without a history of prematurity. Patients with a history of prematurity underwent subgroup analysis of factors relating to steroid use.
  
  
  RESULTS
  A total of 1223 patients met the study criteria for inclusion. Premature infants represented 19% of all children hospitalized with bronchiolitis. These infants had a longer length of stay (3.8 vs 2.6 days; P < .001) and a more severe hospital course. Rates of inhaled therapy and steroid utilization did not differ between premature and term infants. There was no difference in rates of documented positive response to albuterol, but premature infants were more likely to have a positive response to epinephrine. Steroid use in premature infants was associated with older age, history of wheeze, and albuterol use; documentation of albuterol efficacy did not correlate with steroid use, however.
  
  
  CONCLUSIONS
  Management decisions among term and premature infants with bronchiolitis were similar. Premature infants who received albuterol were more likely to receive steroids; however, the decision regarding steroid use was not associated with documentation of efficacy of albuterol.
authors: Brown University, Providence, Rhode Island, USA. balverson@lifespan.org
authors: Brian
authors: B
authors: Alverson
authors: Russell J
authors: RJ
authors: McCulloh
authors: Elizabeth
authors: E
authors: Dawson-Hahn
authors: Sarah E
authors: SE
authors: Smitherman
authors: Kristin L
authors: KL
authors: Koehn
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000420:Albuterol / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001784:Blood Gas Analysis / Q000706:statistics & numerical data; D001988:Bronchiolitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007251:Influenza, Human / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D064705:Racepinephrine / Q000627:therapeutic use; D018357:Respiratory Syncytial Virus Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents; D064705:Racepinephrine; D000420:Albuterol