COVINGTON, KY. – Racemic epinephrine may be more effective in premature than in full-term infants who are hospitalized for bronchiolitis, a chart review suggests.
The positive response rate to inhaled racemic epinephrine was significantly higher at 54.3% among premature infants, compared with 28% among full-term infants (P = .003).
In contrast, there was no significant difference in documented positive response rates to albuterol (Proventil, Ventolin, Volmax, Vospire) among premature and full-term infants (43.4% vs. 38%; P = .18), Dr. Russell J. McCulloh reported in a poster at the Pediatric Hospital Medicine 2012 meeting.
He said that few studies have examined the effectiveness of commonly used bronchiolitis therapies in children with a history of premature birth, even though these children are commonly affected by bronchiolitis and are at higher risk of severe outcomes and prolonged stay.
The chart review included 1,222 infants with and without a history of premature birth who were admitted for bronchiolitis to two academic medical centers. Of these, 229 (19%) were premature.
At baseline, preemies were significantly older than full-term infants (6.6 months vs. 5.4 months) and less likely to have day care exposure (15.3% vs. 24%), but more likely to have a history of wheeze (18% vs. 14%).
Premature patients had a significantly longer mean length of stay of 3.8 days compared with 2.5 days among full-term infants, although this did not differ significantly based on systemic steroid use (31% vs. 27.6%; P = .3), noted Dr. McCulloh of the pediatrics division at Rhode Island Hospital, Providence.
Premature infants were significantly more likely than full-term infants to require an ICU stay (23% vs. 11%), and they trended toward more pneumonia diagnosed (9.3% vs. 6%) and IV hydration (63% vs. 58.4%).
Full-term infants had more fever documented (45% vs. 36%) and urinary tract infections diagnosed (2.4% vs. 0%).
In logistic regression analyses, premature birth was independently associated with improved responsiveness to epinephrine (odds ratio, 1.89), Dr. McCulloh reported at the meeting, which was sponsored by the Society of Hospital Medicine, the American Academy of Pediatrics, and the Academic Pediatric Association.
Dr. McCulloh reported having no conflicts of interest.