Association of Serum Albumin With Apnea in Infants With Bronchiolitis

Jonathan M Mansbach,Ashley F Sullivan,Carlos A Camargo,Janice A Espinola,Ruth J Geller,Kohei Hasegawa,Michelle D Stevenson

doi:10.1001/jamanetworkopen.2019.7100

Jonathan M Mansbach, Ashley F Sullivan + Show 5 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2019.7100

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Abstract

Apnea is a rare, life-threatening complication of bronchiolitis, the leading cause of infant hospitalization in the United States. Currently, no objective method exists for identifying which infants will become apneic. To investigate whether serum albumin levels are associated with apnea in infants with severe bronchiolitis. A secondary data analysis of the 35th Multicenter Airway Research Collaboration, an ongoing multicenter cohort study of infants hospitalized for bronchiolitis, was conducted from December 11, 2018, to May 30, 2019. Seventeen hospitals across the United States enrolled infants (n = 1016) during 3 consecutive bronchiolitis seasons (November 1 to April 30) between 2011 and 2014. Infants with heart-lung disease or a gestational age less than 32 weeks were excluded. Serum albumin level was categorized as low (<3.8 g/dL) or normal (≥3.8 g/dL). Apnea during the hospitalization. Of the 1016 infants hospitalized for bronchiolitis, the median (interquartile range [IQR]) age was 3 (2-6) months, 610 (60.0%) were male, and 186 (18.3%) were born preterm (32-37 weeks' gestation). Among the 25 infants (2.5%) with apnea while hospitalized, the median (IQR) serum albumin level was 3.5 (3.1-3.6) g/dL, and 22 (88.0%) had low serum albumin levels. The prevalence of apnea was 5.7% among all infants with low albumin levels, compared with 0.5% prevalence in infants with normal serum albumin levels. In unadjusted analyses, apnea was associated with younger age, preterm birth, weight-for-age z score, and low albumin (odds ratio [OR], 12.69; 95% CI, 3.23-49.82). After adjustment for age, preterm birth, and weight-for-age z score, low serum albumin levels remained statistically significantly associated with apnea (OR, 4.42; 95% CI, 1.21-16.18). Low serum albumin levels appeared to be associated with increased risk of apnea after adjustment for known apnea risk factors. This finding provides a path to potentially identifying apnea, a life-threatening complication of bronchiolitis.

Highlights

Infants with bronchiolitis usually have mild symptoms, but every year in the United States approximately 130 000 hospitalizations, 50 known deaths, and an unclear number of sudden unexplained deaths among infants occur are associated with bronchiolitis.[1,2,3] One of the potentially life-threatening complications of bronchiolitis is apnea.[4]
Apnea was associated with younger age, preterm birth, weight-for-age z score, and low albumin
After adjustment for age, preterm birth, and weight-for-age z score, low serum albumin levels remained statistically significantly associated with apnea (OR, 4.42; 95% CI, 1.21-16.18)

Summary

Introduction

Infants with bronchiolitis usually have mild symptoms, but every year in the United States approximately 130 000 hospitalizations, 50 known deaths, and an unclear number of sudden unexplained deaths among infants occur are associated with bronchiolitis.[1,2,3] One of the potentially life-threatening complications of bronchiolitis is apnea.[4] The incidence of apnea among infants with bronchiolitis varies by the population under study. Retrospective and prospective studies over the past 20 years have found the incidence of apnea to range from 1% in healthy term infants to 17% in preterm infants.[5] risk factors have been identified for apnea (eg, young age, preterm birth), it remains unclear which infants with bronchiolitis will develop this rare outcome. Clinicians try to balance the safety of infants who have bronchiolitis and are at risk for apnea with potentially unnecessary hospitalizations for observation.[4]

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