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February 1991, Vol 145, No. 2 >
Article | February 1991

Outpatient Assessment of Infants With Bronchiolitis FREE

Kathy N. Shaw, MD, MS; Louis M. Bell, MD; Nancy H. Sherman, MD
[+] Author Affiliations

Accepted for publication August 17, 1990.

Presented in part at the Annual Meeting of the Ambulatory Pediatric Association, Washington, DC, May 3, 1988.

Reprint requests to Department of Emergency Medicine, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104 (Dr Shaw).


Am J Dis Child. 1991;145(2):151-155. doi:10.1001/archpedi.1991.02160020041012.
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• Two hundred thirteen infants younger than 13 months with bronchiolitis were prospectively followed up to identify the historical, physical, and laboratory clues at initial emergency department evaluation that would help to predict disease severity. Based on their total course of illness, the patients were classified as having mild (139 patients) or severe (74 patients) disease, and the initial emergency department evaluation findings of these two groups were compared. Six independent clinical and laboratory findings were identified that were strongly associated with more severe illness: (1) "ill" or "toxic" general appearance; (2) oxygen saturation less than 95%, as determined by pulse oximetry; (3) gestational age, younger than 34 weeks; (4) respiratory rate, 70/min or greater; (5) atelectasis on a chest roentgenogram; and (6) age, younger than 3 months. The infant's oxygen saturation as determined by pulse oximetry was the single best objective predictor of more severe disease.

(AJDC. 1991;145:151–155)

REFERENCES

1 +
Hall CB.  When to suspect respiratory syncytial virus . J Respir Dis . 1980;;1:18-22.
2 +
Medical Research Council Subcommittee on Respiratory Syncytial Virus Vaccines.  Respiratory syncytial virus infection: admissions to hospital in industrial, urban, and rural areas . BMJ . 1978;;2:796-798.
3 +
Paisley JW, Lauer BA, McIntosh K, Glode MP, Schachter J, Rumack C.  Pathogens associated with acute lower respiratory tract infection in young children . Pediatr Infect Dis . 1984;;3:14-19.
4 +
Chanock RM, Parrott RH.  Acute respiratory disease in infancy and childhood: present understanding and prospects for prevention . Pediatrics . 1965;;36:21-39.
5 +
Henderson FW, Clyde WA, Collier AM, et al.  The etiologic and epidemiologic spectrum of bronchiolitis in pediatric practice . J Pediatr . 1979;;95:183-190.
6 +
Glezen WP, Denny FW.  Epidemiology of acute lower respiratory disease in children . N Engl J Med . 1973;;288:498-505.
7 +
Eriksson M, Forsgren M, Sjoberg S, von Sydow M, Wolontis S.  Respiratory syncytial virus infection in young hospitalized children: identification of risk patients and prevention of nosocomial spread by rapid diagnosis . Acta Paediatr Scand . 1983;;72:47-51.
8 +
Parrott RH, Kim HW, Brandt CD, Chanock RM.  Respiratory syncytial virus in infants and children . Prev Med . 1974;;3:473-480.
9 +
Glezen WP, Paredes A, Allison JE, Taber LH, Frank AL.  Risk of RSV infection for infants from low-income families in relationship to age, sex, ethnic group and maternal antibody level . J Pediatr . 1981;;98:708-715.
10 +
Hall CB, Hall WJ, Speers DM.  Clinical and physiological manifestations of bronchiolitis and pneumonia . AJDC . 1979;;133:798-802.
11 +
Anas N, Boettrich C, Hall CB, Brooks JG.  The association of apnea and respiratory syncytial virus infection in infants . J Pediatr . 1982;;101:65-68.
12 +
Church NR, Anas NG, Hall CB, Brooks JG.  Respiratory syncytial virus—related apnea in infants . AJDC . 1984;;138:247-250.
13 +
Bruhn FW, Mokrohisky ST, McIntosh K.  Apnea associated with respiratory syncytial virus infection in young children . J Pediatr . 1977;;90:382-386.
14 +
Outwater KM, Crone RK.  Management of respiratory failure in infants with acute viral bronchiolitis . AJDC . 1984;;138:1071-1075.
15 +
McConnochie KM, Roghmann KJ.  Parental smoking, presence of older siblings, and family history of asthma increase risk of bronchiolitis . AJDC . 1986;;140:806-812.
16 +
MacDonald NE, Hall CB, Suffin SC, Alexson C, Harris PJ, Manning JA.  RSV infection in infants with congenital heart disease . N Engl J Med . 1982;;307:397-400.
17 +
McMillan JA, Tristram DA, Weiner LB, Higgins AP, Sandstorm C, Brandon R.  Prediction of the duration of hospitalization in patients with RSV infection: use of clinical parameters . Pediatrics . 1988;;81:22-26.
18 +
Welliver RC, Wong DT, Sun M, McCarthy N.  Parainfluenza virus bronchiolitis . AJDC . 1986;;140:34-40.
19 +
Hall CB, Kopelman AE, Douglas RG, Geiman JM, Meagher MP.  Neonatal RSV infection . N Engl J Med . 1979;;300:393-396.
20 +
Hall CB, Powell KR, MacDonald WE, et al.  RSV infection in children with compromised immune function . N Engl J Med . 1986;;315:77-81.
21 +
Pullan CR, Toms GL, Martin AJ, Gardner PS, Webb JKG, Appleton DR.  Breast-feeding and respiratory syncytial virus infection . BMJ . 1980;;281:1034-1036.
22 +
Wood DW, Downes JJ, Lecks HI.  A clinical scoring system for the diagnosis of respiratory failure . AJDC . 1972;;123:227-228.
23 +
McCarthy PL, Sharpe MR, Spiegel SZ, et al.  Observation scales to identify serious illness in febrile children . Pediatrics . 1982;;70:802-809.
24 +
McIntosh K, Hendry RM, Fahnestock ML, Pierik L.  Enzyme-linked-immunoabsorbent assay for detection of RSV infection: application to clinical samples . J Clin Microbiol . 1982;;16:329-333.
25 +
Braffman M, Bacheson M, Forrer C, Friedman H. Superiority of ELISA for rapid diagnosis of respiratory syncytial virus. In: Program and abstracts of the 26th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 28-October 1, 1986; New Orleans, La. Abstract 1986.
26 +
Wildin SR, Chonmaitree T, Swischuck LE.  Roentgenographic features of common pediatric viral respiratory tract infections . AJDC . 1988;;142:43-46.
27 +
Fanconi S, Doherty P, Edmonds JF, Barker GA, Bohn DJ.  Pulse oximetry in pediatric intensive care: comparison with measured saturations and transcutaneous oxygen tension . J Pediatr . 1985;;107:362-366.
28 +
Southall DP, Bignall S, Stebbens VA, Alexander JR, Rivers RPA, Lissauer T. Pulse oximeter and transcutaneous arterial oxygen measurements in neonatal and paediatric intensive care . Arch Dis Child . 1987;;62:882-888.
29 +
Kulick RM.  Pulse oximetry . Pediatr Emerg Care . 1987;;3:127-130.
30 +
Swedlow DB, Stern S.  Continuous non-invasive oxygen saturation monitoring in children with a new pulse oximeter . Crit Care Med . 1983;;11:228. Abstract.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Hall CB.  When to suspect respiratory syncytial virus . J Respir Dis . 1980;;1:18-22.
2 +
Medical Research Council Subcommittee on Respiratory Syncytial Virus Vaccines.  Respiratory syncytial virus infection: admissions to hospital in industrial, urban, and rural areas . BMJ . 1978;;2:796-798.
3 +
Paisley JW, Lauer BA, McIntosh K, Glode MP, Schachter J, Rumack C.  Pathogens associated with acute lower respiratory tract infection in young children . Pediatr Infect Dis . 1984;;3:14-19.
4 +
Chanock RM, Parrott RH.  Acute respiratory disease in infancy and childhood: present understanding and prospects for prevention . Pediatrics . 1965;;36:21-39.
5 +
Henderson FW, Clyde WA, Collier AM, et al.  The etiologic and epidemiologic spectrum of bronchiolitis in pediatric practice . J Pediatr . 1979;;95:183-190.
6 +
Glezen WP, Denny FW.  Epidemiology of acute lower respiratory disease in children . N Engl J Med . 1973;;288:498-505.
7 +
Eriksson M, Forsgren M, Sjoberg S, von Sydow M, Wolontis S.  Respiratory syncytial virus infection in young hospitalized children: identification of risk patients and prevention of nosocomial spread by rapid diagnosis . Acta Paediatr Scand . 1983;;72:47-51.
8 +
Parrott RH, Kim HW, Brandt CD, Chanock RM.  Respiratory syncytial virus in infants and children . Prev Med . 1974;;3:473-480.
9 +
Glezen WP, Paredes A, Allison JE, Taber LH, Frank AL.  Risk of RSV infection for infants from low-income families in relationship to age, sex, ethnic group and maternal antibody level . J Pediatr . 1981;;98:708-715.
10 +
Hall CB, Hall WJ, Speers DM.  Clinical and physiological manifestations of bronchiolitis and pneumonia . AJDC . 1979;;133:798-802.
11 +
Anas N, Boettrich C, Hall CB, Brooks JG.  The association of apnea and respiratory syncytial virus infection in infants . J Pediatr . 1982;;101:65-68.
12 +
Church NR, Anas NG, Hall CB, Brooks JG.  Respiratory syncytial virus—related apnea in infants . AJDC . 1984;;138:247-250.
13 +
Bruhn FW, Mokrohisky ST, McIntosh K.  Apnea associated with respiratory syncytial virus infection in young children . J Pediatr . 1977;;90:382-386.
14 +
Outwater KM, Crone RK.  Management of respiratory failure in infants with acute viral bronchiolitis . AJDC . 1984;;138:1071-1075.
15 +
McConnochie KM, Roghmann KJ.  Parental smoking, presence of older siblings, and family history of asthma increase risk of bronchiolitis . AJDC . 1986;;140:806-812.
16 +
MacDonald NE, Hall CB, Suffin SC, Alexson C, Harris PJ, Manning JA.  RSV infection in infants with congenital heart disease . N Engl J Med . 1982;;307:397-400.
17 +
McMillan JA, Tristram DA, Weiner LB, Higgins AP, Sandstorm C, Brandon R.  Prediction of the duration of hospitalization in patients with RSV infection: use of clinical parameters . Pediatrics . 1988;;81:22-26.
18 +
Welliver RC, Wong DT, Sun M, McCarthy N.  Parainfluenza virus bronchiolitis . AJDC . 1986;;140:34-40.
19 +
Hall CB, Kopelman AE, Douglas RG, Geiman JM, Meagher MP.  Neonatal RSV infection . N Engl J Med . 1979;;300:393-396.
20 +
Hall CB, Powell KR, MacDonald WE, et al.  RSV infection in children with compromised immune function . N Engl J Med . 1986;;315:77-81.
21 +
Pullan CR, Toms GL, Martin AJ, Gardner PS, Webb JKG, Appleton DR.  Breast-feeding and respiratory syncytial virus infection . BMJ . 1980;;281:1034-1036.
22 +
Wood DW, Downes JJ, Lecks HI.  A clinical scoring system for the diagnosis of respiratory failure . AJDC . 1972;;123:227-228.
23 +
McCarthy PL, Sharpe MR, Spiegel SZ, et al.  Observation scales to identify serious illness in febrile children . Pediatrics . 1982;;70:802-809.
24 +
McIntosh K, Hendry RM, Fahnestock ML, Pierik L.  Enzyme-linked-immunoabsorbent assay for detection of RSV infection: application to clinical samples . J Clin Microbiol . 1982;;16:329-333.
25 +
Braffman M, Bacheson M, Forrer C, Friedman H. Superiority of ELISA for rapid diagnosis of respiratory syncytial virus. In: Program and abstracts of the 26th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 28-October 1, 1986; New Orleans, La. Abstract 1986.
26 +
Wildin SR, Chonmaitree T, Swischuck LE.  Roentgenographic features of common pediatric viral respiratory tract infections . AJDC . 1988;;142:43-46.
27 +
Fanconi S, Doherty P, Edmonds JF, Barker GA, Bohn DJ.  Pulse oximetry in pediatric intensive care: comparison with measured saturations and transcutaneous oxygen tension . J Pediatr . 1985;;107:362-366.
28 +
Southall DP, Bignall S, Stebbens VA, Alexander JR, Rivers RPA, Lissauer T. Pulse oximeter and transcutaneous arterial oxygen measurements in neonatal and paediatric intensive care . Arch Dis Child . 1987;;62:882-888.
29 +
Kulick RM.  Pulse oximetry . Pediatr Emerg Care . 1987;;3:127-130.
30 +
Swedlow DB, Stern S.  Continuous non-invasive oxygen saturation monitoring in children with a new pulse oximeter . Crit Care Med . 1983;;11:228. Abstract.

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