Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study

Abstract

Objectives The objective of the study was to describe the clinico-virological profile, treatment details, intensive care needs, and outcome of infants with acute viral bronchiolitis (AVB). Methodology In this prospective observational study, 173 infants with AVB admitted to the pediatric emergency room and pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India during November 2019 to February 2020 were enrolled. The data collection included clinical features, viruses detected [respiratory syncytial virus (RSV), rhinovirus, influenza A virus, parainfluenza virus (PIV) 2 and 3, and human metapneumovirus (hMPV)], complications, intensive care needs, treatment, and outcomes. Multivariate analysis was performed to determine independent predictors for PICU admission. Results Most common symptoms were rapid breathing (98.8%), cough (98.3%), and fever (74%). On examination, tachypnea (98.8%), chest retractions (93.6%), respiratory failure (84.4%), wheezing (49.7%), and crepitations (23.1%) were observed. RSV and rhinovirus were the predominant isolates. Complications were noted in 25% of cases as encephalopathy (17.3%), transaminitis (14.3%), shock (13.9%), acute kidney injury (AKI) (7.5%), myocarditis (6.4%), multiple organ dysfunction syndrome (MODS) (5.8%), and acute respiratory distress syndrome (ARDS) (4.6%). More than one-third of cases required PICU admission. The treatment details included nasal cannula oxygen (11%), continuous positive airway pressure (51.4%), high-flow nasal cannula (14.5%), mechanical ventilation (23.1%), nebulization (74%), antibiotics (35.9%), and vasoactive drugs (13.9%). The mortality was 8.1%. Underlying comorbidity, chest retractions, respiratory failure at admission, presence of shock, and need for mechanical ventilation were independent predictors of PICU admission. Isolation of virus or coinfection was not associated with disease severity, intensive care needs, and outcomes. Conclusion Among infants with AVB, RSV and rhinovirus were predominant. One-third infants with AVB needed PICU admission. The presence of comorbidity, chest retractions, respiratory failure, shock, and need for mechanical ventilation independently predicted PICU admission. How to cite this article Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, et al . Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study. Indian J Crit Care Med 2021;25(11):1301–1307.

Acute kidney injury in infants hospitalized for viral bronchiolitis

“…During the hospitalization, none of our patients was diagnosed with AKI. This, in addition to the presence of only one report describing an association between AKI and bronchiolitis [ 8 ], further confirms our meaning that AKI, especially in its milder forms, is often under-recognized in children [ 4 – 7 ].…”

“…Despite the non-PICU setting of the study, our data confirmed that a considerable percentage (about 11%) of patients with viral bronchiolitis may develop AKI. This prevalence is higher than the one (7.5%) reported by Angurana et al [ 8 ], which —unlikely— did not provide the methods to diagnose AKI nor the different stages of the disease. Probably, only the more severe AKI cases were accounted in such paper [ 8 ].…”

“…This prevalence is higher than the one (7.5%) reported by Angurana et al [ 8 ], which —unlikely— did not provide the methods to diagnose AKI nor the different stages of the disease. Probably, only the more severe AKI cases were accounted in such paper [ 8 ].…”

“…A previous study reported an AKI prevalence of 4.5% in infants affected by viral bronchiolitis in a non-PICU setting [ 8 ]. Considering this prevalence and the one of our study (10.8% in the 139 subjects with viral bronchiolitis), the post hoc power, with an alpha of 0.05, was of 86.1%.…”

“…In the current literature, only one study shows that 7.5% of infants with viral bronchiolitis develop AKI as complication of the respiratory disease [ 8 ]. More specifically, AKI develops in 12.7% of the infants with viral bronchiolitis admitted and in 4.5% of those not admitted to pediatric intensive care unit (PICU) [ 8 ]. Factors associated with AKI in infants affected by viral bronchiolitis, however, have never been investigated.…”