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High Mortality in Infants Who Require Inpatient Polysomnography
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A2010 - High Mortality in Infants Who Require Inpatient Polysomnography
Author Block: E. MacKintosh, K. Evans, M. Chen; Seattle Children's Hospital, Seattle, WA, United States.
Rationale: Our institution performs approximately 25 inpatient infant polysomnograms (PSG) annually. Anecdotally, these infants are medically complex and at high risk for adverse outcomes, including death. This study aimed to characterize the infants, their clinical courses, PSG results, and related outcomes including death, with eventual goal to identify risk factors for mortality in this population.
Methods: A retrospective chart review was performed of those who had inpatient diagnostic PSG before 12 months of age from 2009-2016. We excluded subjects who had previous PSG, or who had tracheotomy prior to first PSG. Study data were managed and analyzed using REDCap, hosted at the University of Washington. Summary statistics are presented.
Results: Nineteen subjects, from a total of 187, subsequently died, with all-cause mortality of 10% during the study period. Characteristics of the deceased subjects are provided here. Average age at time of PSG was 4.9 months (SD 3.6). Average gestational age at birth was 37 weeks (SD 3). Comorbid conditions included: feeding difficulty and/or GERD (79%), suspected or confirmed genetic syndrome (58%), hypotonia (47%), congenital heart disease (47%), craniofacial malformations (42%), and seizure disorder (37%). All subjects had abnormal PSGs. Mean apnea-hypopnea index (AHI) was markedly elevated (median 31.5, range 4-206 ). Most were diagnosed with obstructive sleep apnea (90%), and 15% had central respiratory abnormalities. Mean baseline saturations were 93% (SD 8). Mean CO2 was 49 mmHg (SD 8). Common indications for PSG were desaturations (46%), witnessed apneas (32%), and multiple congenital anomalies (23%). PSG recommendations included to increase level of respiratory support (62%), with recommendation for tracheotomy in 20% of subjects. In follow-up, 25% of these subjects eventually underwent tracheotomy (5/19). Average age at death was 12 months (SD 11, range 1-51). Location of death was 47% in-hospital, 37% at home or long-term care facility, and 16% unknown. Documented causes of death included compassionate redirection of care (42%), progressive course of underlying disorder (37%), acute on chronic respiratory failure (21%), sudden/unexpected event (16%), and heart failure (11%).
Conclusions: Infants who undergo inpatient PSG prior to 12 months of age have 10% all-cause mortality. For reference, 3.6% of all infants hospitalized during the same period at this institution have died, and Washington state infant mortality is 0.9%. Subjects were medically complex and had major changes to clinical course dictated by PSG results. Further investigation on the predictive role of PSG on medically complex infants, particularly when considering mortality, is needed.
Author Block: E. MacKintosh, K. Evans, M. Chen; Seattle Children's Hospital, Seattle, WA, United States.
Rationale: Our institution performs approximately 25 inpatient infant polysomnograms (PSG) annually. Anecdotally, these infants are medically complex and at high risk for adverse outcomes, including death. This study aimed to characterize the infants, their clinical courses, PSG results, and related outcomes including death, with eventual goal to identify risk factors for mortality in this population.
Methods: A retrospective chart review was performed of those who had inpatient diagnostic PSG before 12 months of age from 2009-2016. We excluded subjects who had previous PSG, or who had tracheotomy prior to first PSG. Study data were managed and analyzed using REDCap, hosted at the University of Washington. Summary statistics are presented.
Results: Nineteen subjects, from a total of 187, subsequently died, with all-cause mortality of 10% during the study period. Characteristics of the deceased subjects are provided here. Average age at time of PSG was 4.9 months (SD 3.6). Average gestational age at birth was 37 weeks (SD 3). Comorbid conditions included: feeding difficulty and/or GERD (79%), suspected or confirmed genetic syndrome (58%), hypotonia (47%), congenital heart disease (47%), craniofacial malformations (42%), and seizure disorder (37%). All subjects had abnormal PSGs. Mean apnea-hypopnea index (AHI) was markedly elevated (median 31.5, range 4-206 ). Most were diagnosed with obstructive sleep apnea (90%), and 15% had central respiratory abnormalities. Mean baseline saturations were 93% (SD 8). Mean CO2 was 49 mmHg (SD 8). Common indications for PSG were desaturations (46%), witnessed apneas (32%), and multiple congenital anomalies (23%). PSG recommendations included to increase level of respiratory support (62%), with recommendation for tracheotomy in 20% of subjects. In follow-up, 25% of these subjects eventually underwent tracheotomy (5/19). Average age at death was 12 months (SD 11, range 1-51). Location of death was 47% in-hospital, 37% at home or long-term care facility, and 16% unknown. Documented causes of death included compassionate redirection of care (42%), progressive course of underlying disorder (37%), acute on chronic respiratory failure (21%), sudden/unexpected event (16%), and heart failure (11%).
Conclusions: Infants who undergo inpatient PSG prior to 12 months of age have 10% all-cause mortality. For reference, 3.6% of all infants hospitalized during the same period at this institution have died, and Washington state infant mortality is 0.9%. Subjects were medically complex and had major changes to clinical course dictated by PSG results. Further investigation on the predictive role of PSG on medically complex infants, particularly when considering mortality, is needed.
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