Kneyber M C, Brandenburg A H, de Groot R, Joosten K F, Rothbarth P H, Ott A, Moll H A
Department of Paediatrics, Sophia Children's Hospital, University Hospital Rotterdam, The Netherlands.
Eur J Pediatr. 1998 Apr;157(4):331-5. doi: 10.1007/s004310050822.
Respiratory syncytial virus (RSV) infections are characterized by upper or lower respiratory tract symptoms including bronchiolitis and pneumonia. Apnoea may be the first sign of disease in children with RSV infection. The aims of this study were the identification of independent risk factors for RSV associated apnoea and the prediction of the risk for mechanical ventilation in children with RSV associated apnoea. Medical records of children younger than 12 months of age admitted with RSV infection between 1992 and 1995 to the Sophia Children's Hospital, were reviewed. Demographic parameters, clinical features and laboratory parameters (SaO2, pCO2 and pH) were obtained upon admission and during hospitalization. Children with and without apnoea were compared using univariate and multivariate logistic and linear regression analysis. One hundred and eighty-five patients with RSV infection were admitted of whom 38 (21%) presented with apnoea. Patients with apnoea were significantly younger, had a significantly lower temperature, higher pCO2 and lower pH and had on chest radiographs also more signs of atelectasis. The number of patients admitted to the ICU because of mechanical ventilation and oxygen administration was significantly higher in children with RSV associated apnoea. Apnoea at admission was a strong predictor for recurrent apnoea. The relative risk for mechanical ventilation increased with the number of episodes of apnoea: 2.4 (95% CI 0.8-6.6) in children with one episode of apnoea (at admission) versus 6.5 (95% CI 3.3-12.9) in children with recurrent episodes of apnoea.
Age below 2 months is the strongest independent risk factor for RSV associated apnoea. Apnoea at admission increases the risk for recurrent apnoea. The risk for mechanical ventilation significantly increases in children who suffer from recurrent apnoea.
呼吸道合胞病毒（RSV）感染的特征是出现上呼吸道或下呼吸道症状，包括细支气管炎和肺炎。呼吸暂停可能是RSV感染儿童疾病的首发症状。本研究的目的是确定RSV相关呼吸暂停的独立危险因素，并预测RSV相关呼吸暂停儿童机械通气的风险。回顾了1992年至1995年间因RSV感染入住索菲亚儿童医院的12个月以下儿童的病历。入院时和住院期间获取人口统计学参数、临床特征和实验室参数（动脉血氧饱和度、二氧化碳分压和pH值）。采用单因素和多因素逻辑回归及线性回归分析对有呼吸暂停和无呼吸暂停的儿童进行比较。185例RSV感染患者入院，其中38例（21%）出现呼吸暂停。出现呼吸暂停的患者年龄明显更小，体温明显更低，二氧化碳分压更高，pH值更低，胸部X光片上肺不张的迹象也更多。因机械通气和吸氧入住重症监护病房的RSV相关呼吸暂停儿童患者数量明显更多。入院时呼吸暂停是反复呼吸暂停的有力预测指标。机械通气的相对风险随着呼吸暂停发作次数的增加而增加：入院时有一次呼吸暂停发作的儿童为2.4（95%可信区间0.8 - 6.6），而反复出现呼吸暂停发作的儿童为6.5（95%可信区间3.3 - 12.9）。
2个月以下的年龄是RSV相关呼吸暂停最强的独立危险因素。入院时呼吸暂停会增加反复呼吸暂停的风险。反复出现呼吸暂停的儿童机械通气风险显著增加。
