4 month-old M PMH low birth weight presents with a 3 day history cough and runny nose. Today his mother reports a low grade fever. His immunizations are up to date. He has no known sick contacts, but he attends day care. His respiratory rate is 39 and is coughing frequently. On lung exam he has mild wheezes, but sp O2 is 96% on room air. The remainder of his physical exam is normal. His nasal swab is positive for RSV and you make the diagnosis of bronchiolitis. What factors may cause you to admit the child for apnea observation?
Statistically significant independent predictors of inpatient apnea in patients with bronchiolitis:
Age <2 weeks and 2-8 weeks
Birthweight <2.3 kg
Caretaker report of previous episode of apnea
Preadmission respiratory rates <30, 30-39, or >70
Room air oxygen saturation <90%