The Differences Between RSV and no RSV Acute Bronchiolitis in Hospitalized Infants: A Cross-Sectional Study

Abstract

To identify the differences between the RSV and non-RSV bronchiolitis in hospitalized infants in a Greek tertiary pediatric unit and the possible risk factors related to severe forms of the illness. We performed a retrospective cross-sectional data analysis by reviewing medical records of patients that were hospitalized for acute bronchiolitis from 2012 to 2019. The patients with RSV bronchiolitis were found to require antibiotic treatment, IV fluids, adrenaline, and hypertonic saline inhalations more frequently than the non-RSV patients. They also required prolonged hospitalization, especially those that were admitted to PICU, and received oxygen therapy for longer periods. We searched risk factors for severe forms of the disease according to the need for admission to PICU, the supplemental oxygen and the extended length of hospital stay, concurrently. The patients with RSV bronchiolitis developed more severe illness in comparison with patients with bronchiolitis due to other respiratory viruses.

Clinical course and complications of RSV versus non-RSV bronchiolitis in hospitalised children

“…Analysis of disease severity showed that aetiology may also be associated with prognosis and is therefore of significant value. We observed a more severe of disease course in children with RSV bronchiolitis, which is in line with previously published data (8,9,11) . Apart from the aforementioned apathy and fatigue during feeding, we observed a higher likelihood of oxygen therapy in RSV-positive children (OR = 3.8 in univariate analysis and OR = 4.4 in multivariate analysis); similarly, a higher need for oxygen supplementation in RSV bronchiolitis was reported by García et al in his study of 4.800 children under 2 years of age (8) .…”

“…Our study shows several important differences related to RSV as a specific aetiological factor. RSV was the predominant aetiological factor in acute bronchiolitis (88% of all AB hospitalisations in our series of patients), as might have been expected from published studies, although the percentage of RSV-caused AB is even higher than in previous reports, which found RSV in 60% (11) -62.7% (9) -66% (8) of AB hospitalisations. Furthermore, due to the observed seasonality, RSV was responsible for 86.4% (December) to 94.5-97.7% (January-March) of the hospitalised cases during the peak season of RSV incidence.…”

“…In addition to the epidemiological significance, there are some practical implications of establishing the aetiology. The literature on this topic is rather scarce, but studies comparing RSV and non-RSV bronchiolitis associated RSV with a more severe course of disease, more frequent need for oxygen therapy or respiratory support, transfer to the intensive care unit (ICU) or longer hospital stay (8)(9)(10)(11) . Furthermore, some authors have suggested a higher use of medications, both inhaled therapeutics and antibiotics, in children with RSV AB (11) .…”

“…The literature on this topic is rather scarce, but studies comparing RSV and non-RSV bronchiolitis associated RSV with a more severe course of disease, more frequent need for oxygen therapy or respiratory support, transfer to the intensive care unit (ICU) or longer hospital stay (8)(9)(10)(11) . Furthermore, some authors have suggested a higher use of medications, both inhaled therapeutics and antibiotics, in children with RSV AB (11) . The question of treatment response has also been raised, as a systematic review showed a positive trend towards shorter hospital stays in children with non-RSV AB treated with systematic corticosteroids, although no conclusions can be drawn due to lack of statistical significance (12) .…”

“…Accurate knowledge of the actual epidemiological situation and RSV circulation is needed to guide the use of prophylactic monoclonal antibodies in at-risk groups as precisely as possible; the importance of changing epidemiology was highlighted by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (16) . To date, a relatively stable and repeatable seasonality has been observed in Europe, with increased RSV activity mainly in winter, with the RSV season starting later and lasting longer with increasing northern latitude, peaking between January and March (11,17,18) . The non-pharmacological interventions against the SARS-CoV-2 pandemic rapidly reduced the spread of RSV infection, but as restrictions were relaxed, significant changes in RSV epidemiology were observed, including the presence of RSV outside the previously typical RSV season (16,19) .…”