Bronchiolitis 2021–2022 epidemic: multicentric analysis of the characteristics and treatment approach in 214 children from different areas in Italy

Abstract

Bronchiolitis causes a remarkable number of hospitalizations; its epidemiology follows that of respiratory syncytial virus (RSV), its main pathogen. The aim of this study was to evaluate the presenting features, treatment approach, and impact of medical therapy in four pediatric hospitals in Italy. Data on infants < 24 months of age hospitalized with bronchiolitis in the 2021–2022 season were collected. Between October 2021 and February 2022, 214 children were admitted. Median hospital stay was 5 days; none of the patients died. The distribution of the presenting features is largely comparable in the 33 (15.8%) RSV-negative versus the 176 (84.2%) RSV-positive children; also, no difference was observed in medical therapy provided: duration of oxygen therapy, administration of steroid, and duration of hospital stay. Systemic steroids, inhalation, or antibiotic therapy were given to 34.6%, 79.4%, and 49.1% of children respectively. Of the 214 patients with bronchiolitis, only 19 (8.8%) were admitted to ICU. Conclusion : Our data suggest that, irrespective of treatments provided, RSV-positive and RSV-negative children had a similar clinical course. The results of our retrospective study further underline the need to improve adherence to existing guidelines on bronchiolitis treatment. What is Known: • Bronchiolitis is a common diseases with seasonal peak. The outcome is usually favorable but hospitalization and even ICU admission is not exceptional. What is New: • Children with RSV associated bronchiolitis do not have a different course and outcome. The analysis of the 2021-2022 cohort, following COVID pandemic peaking, did not show a different course and outcome. • Adherence to literature recommendation, i.e. to focus on oxygen and hydration therapy while avoiding unnecessary systemic therapy with steroid and antibiotics, should be improved.

Respiratory viral infections before the COVID-19 in Portugal: A single center study

“…These rates were higher than those described for the 2018/2019 Portuguese winter season (14 % in children ≤4 yr) [ 5 ] and the 2019/2020 season in Parma (overall MVI rate of 19.8 %) [ 9 ]. The impact of MVI on severe viral respiratory disease remains uncertain [ [18] , [19] , [20] , [21] ]. Recent research even suggests that MVI may be protective against severe disease in some cases, unlike viral-bacterial infections, which most likely contribute to worse outcomes [ [20] , [21] , [22] ].…”

Nasal CPAP in the Pediatric Ward to Reduce PICU Admissions for Severe Bronchiolitis?

“…The bronchiolitis epidemics after SARS-CoV-2 pandemic were characterized by an anticipation of the usual autumn–winter spread and by increased numbers of ED admissions and a high burden of hospitalization in pediatric departments [ 25 ]. In the autumn and winter seasons of 2021–2022 and 2022–2023, an anticipation of the epidemic peaks of infection and an increased case number were observed, probably secondary to the “immunological debt” due to the public health measures aimed to control the spread of SARS-CoV-2 [ 3 , 4 , 5 , 6 , 7 , 8 , 32 , 33 , 34 ]. The perspective, reiterated by media and scientific societies, of an uncontrolled increase in admissions for bronchiolitis in PICUs led us to implement, when needed, respiratory support with nCPAP in the general pediatric ward [ 9 , 10 , 11 ].…”

“…The COVID-19 pandemic disrupted RSV seasonality, and recent, post-pandemic epidemics of bronchiolitis have raised serious clinical and organizational problems in many regions of the world [ 2 ]. In the autumn and winter seasons of 2021–2022 and 2022–2023, an anticipation of the epidemic peaks of infection and an increased case number have been observed, probably secondary to the “immunological debt” due to public health measures aimed at controlling the spread of SARS-CoV-2 [ 3 , 4 , 5 , 6 , 7 , 8 ].…”

“…If HFNC is nowadays frequently used outside PICUs, CPAP remains a prerogative of intensive areas, and the decision to use it often involves infant referral from pediatric wards to PICUs [ 15 , 23 ]. Recent studies suggest that about 5% to 25% of children with bronchiolitis may require hospitalization in a PICU to receive respiratory support, mainly CPAP [ 5 , 6 , 24 , 25 ].…”

Trattare la bronchiolite con nCPAP nelle Pediatrie per “proteggere” le Terapie Intensive pediatriche?

“…Recenti casistiche italiane riportano che il 5-25% dei bambini con bronchiolite possono richiedere il ricovero in TIP per ricevere un supporto respiratorio. Il costo di un ricovero per bronchiolite in TIP risulta essere oltre il 60% più elevato della degenza in un reparto di pediatria [18][19][20][21] . Nei periodi epidemici di bronchiolite il carico assistenziale per le TIP può essere molto impegnativo e, d'altra parte, sono ancora relativamente poco numerose le esperienze di impiego della CPAP nei reparti di Pediatria generale [22][23][24][25][26] .…”