Epidemiology and Risk Factor Analysis of Children with Bronchiolitis Admitted to the Intensive Care Unit at a Tertiary Care Center in Saudi Arabia

Abstract

Bronchiolitis is a leading cause of hospitalization worldwide for children aged ≤2 years. Few studies have compared general ward and pediatric intensive care unit (PICU) admissions, particularly in Saudi Arabia. This retrospective cohort study aimed to compare the demographic and clinical characteristics of children with bronchiolitis admitted to the general ward with those admitted to the PICU. Children (≤6 years) previously diagnosed with bronchiolitis and admitted to the PICU or general ward at a tertiary center in Saudi Arabia between May 2016 and May 2021 were included. Multiplex polymerase chain reaction was used to identify respiratory viruses. Of the 417 patients enrolled, 67 (16.06%) were admitted to the PICU. The PICU group was younger (median, 2 months; interquartile range [IQR], 1–5 months) vs. (6 months; IQR, 2.65–13.25 months). There was a dramatic reduction in bronchiolitis admissions during the COVID-19 pandemic. The most common causative virus was respiratory syncytial virus (RSV) (54.9%). In the multivariate regression analysis, hypoxia, hyperinflation on X-ray, and non-RSV bronchiolitis were independently associated with PICU admission. However, a higher chronological age and cough were protective. Children with Down syndrome, immunodeficiency, or neuromuscular disorders, and intermediate preterm infants (29–33 weeks of gestation) are at a high risk of PICU admission (adjusted odds ratio: 2.4, 7.1, 2.9, and 2.9; p = 0.037, 0.046, 0.033, and 0.029, respectively). Bronchiolitis is still one of the leading causes of PICU admission. Particular attention should be paid to preventive measures, especially in the post-COVID-19 era, targeting high-risk groups.

Respiratory Syncytial Virus (RSV) Burden in Infants in the Kingdom of Saudi Arabia and the Impact of All-Infant RSV Protection: A Modeling Study

“…Seasonality was based on Osman et al [ 2 ], a retrospective cohort study conducted between 2016 and 2021 in a tertiary hospital in the KSA, that defined RSV seasonality in the KSA as the period from October to February. The model also considered low levels of RSV circulation beyond the RSV specific season (between March and September).…”

“…Risks of inpatient hospitalization in preterm and term infants were informed by Spanish retrospective studies Muñoz-Quiles 2016 [ 16 ] and Heppe Montero 2022 [ 17 ], respectively. The risk of PICU admissions was derived from a local retrospective study Osman 2023 [ 2 ] that reported PICU admission among children hospitalized with bronchiolitis in a KSA tertiary hospital between 2016 and 2021, while the risk of MV among those hospitalized was informed by a retrospective study of outcomes in children with bronchiolitis in Spain [ 18 ]. As more granular data were not available, risks of PICU admission and MV among hospitalized infants were assumed to be constant over the first year of infants’ lives.…”

“…RSV is a seasonal virus, and its transmission and seasonality are driven by geographical location and climate. In the Kingdom of Saudi Arabia (KSA), the circulation of the RSV virus is mostly confined to the winter season (from September to March) with a peak in December and January [ 2 ]. From 2001 to 2015, approximately 23% of acute respiratory illnesses in the pediatric population in the KSA were attributable to RSV infection, with children aged < 1 year representing the majority of cases [ 3 ].…”

“…Although the risk of severe illness is the highest among infants born prematurely and in those with underlying conditions [ 6 ], most infants hospitalized for RSV infection were born full-term and/or are otherwise healthy [ 2 ]. Therefore, the implementation of an immunoprophylaxis strategy aiming to protect all infants during their first RSV season is being considered in the KSA.…”