Risk Factors in Children Hospitalized With RSV Bronchiolitis Versus Non–RSV Bronchiolitis

Abstract

BACKGROUND The trends in hospitalization rates and risk factors for severe bronchiolitis have not been recently described, especially after the routine implementation of prophylaxis for respiratory syncytial virus (RSV) infections. OBJECTIVES To define the burden of hospitalizations related to RSV and non-RSV bronchiolitis in a tertiary-care children’s hospital from 2002 to 2007 and to identify the risk factors associated with severe disease. METHODS Medical records of patients hospitalized for bronchiolitis were reviewed for demographic, clinical, microbiologic, and radiologic characteristics as well as the presence of underlying medical conditions. Differences were evaluated between children with RSV and non-RSV bronchiolitis, and multivariable logistic regression analyses were performed to identify independent risk factors for severe disease. RESULTS Bronchiolitis hospitalizations in children younger than 2 years old (n =4800) significantly increased from 536 (3.3%) in 2002 to 1241 (5.5%) in 2007, mainly because of RSV infections. Patients with RSV bronchiolitis (n = 2840 [66%]) were younger at hospitalization and had a lower percentage of underlying medical conditions than children hospitalized with non-RSV bronchiolitis (27 vs 37.5%; P < .001). However, disease severity defined by length of hospitalization and requirement of supplemental oxygen, intensive care, and mechanical ventilation was significantly worse in children with RSV bronchiolitis. RSV infection and prematurity, regardless of the etiology, were identified as independent risk factors for severe bronchiolitis. CONCLUSIONS There was a significant increase in hospitalizations for RSV bronchiolitis from 2002 to 2007. A majority of the children with RSV bronchiolitis were previously healthy, but their disease severity was worse compared with those hospitalized with non-RSV bronchiolitis.

The Epidemiological and Clinical Features of Neonates Hospitalized with Lower Respiratory Tract Viral Infections

“…Tablo II: Viral ASYE nedeniyle yatırılan hastaların demografik özellikleri. RSV ilişkili enfeksiyonların daha ağır klinik seyire neden olduğu bildirilmektedir (4,9,12,13). Viral etken olarak RSV saptanan yenidoğanların, RSV dışı virüs saptananlara göre daha ağır solunum sıkıntısı bulgularının olduğu, oksijen gereksinimi nedeniyle hastaneye yatış oranlarının daha fazla olduğu bildirilmiştir (14).…”

Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis

“…Acute bronchiolitis is the main cause of respiratory illness requiring hospitalization in children under 2 years of age and the trend in hospitalization rate has been increasing in recent years (1). Mainly due to Respiratory Syncytial Virus (RSV) infection, the disease leads to hospitalization in only I% of the children.…”

A systematic review of predictive modeling for bronchiolitis

“…For children with bronchiolitis, García et al [57][58][59] found three predictors of ICU admission: virus species (RSV vs. non-RSV), atelectasis/condensation, and co-infection. For children with RSV infection, Verger et al [60][61][62][63][64][65][66][67][68] identified several risk factors for ICU admission: immature lung development, prematurity, chronic lung disease, congenital heart disease (defined as congestive heart failure, cyanosis, or pulmonary hypertension), neuromuscular impairment, high nasal RSV viral load, surfactant protein A2 polymorphism, age < 6 weeks, neurological disease, cerebral palsy, male gender, lung consolidation, lethargy, grunting, high arterial PaCO 2 , an ED visit in the past week, presence of moderate to severe retractions, inadequate oral intake upon presentation in the ED, and mental retardation.…”

“…For patients hospitalized with bronchiolitis, García et al [57,86,87] identified several predictors of using supplemental oxygen: household tobacco smoking, cyanosis, sternal retraction, intercostal recession, chronic lung disease, trisomy 21, congenital heart disease, virus species, and prematurity. For bronchiolitis patients in the ED and inpatient ward, McCallum et al [88] used a bronchiolitis severity score to predict the use of supplemental oxygen at 12 and 24 hours, with a low AUC of 68% and 75%, respectively.…”