Characteristics of children admitted to intensive care with acute bronchiolitis

Marwa Ghazaly,Simon Nadel

doi:10.1007/s00431-018-3138-6

Abstract

To assess factors associated with outcome in children admitted to paediatric intensive care (PIC) with bronchiolitis. A retrospective study of children admitted to the PICU at St Mary’s Hospital, London with bronchiolitis over a 6-year period (2011–2016). All bronchiolitis admissions < 2 years were included. Data collected particularly noted risk factors for severity, demographics, microbiology and outcome. We compared respiratory syncytial virus (RSV) with non-RSV status. Multivariate analysis was performed. Two hundred seventy-four patients were identified. Median age was 60 days (IQR 28–150 days), 63% were male, 90% were invasively ventilated and 42% were previously healthy. Pre-existing co-morbidities were present in 38%. The most frequently isolated pathogens were RSV (60%) and rhinovirus (26%). Co-infection was present in 45%, most commonly with RSV, rhinovirus and bacterial pathogens. Median length of stay (LOS) was 6 days (IQR 4.75–10). Younger age, prematurity, RSV, co-infection and co-morbidity were identified as significant risk factors for prolonged LOS. Six children died. Five of these had documented co-morbidities.Conclusion: RSV causes more severe bronchiolitis than other viruses. Nearly half of children admitted to PICU with RSV were previously healthy. Current guidelines for immunoprophylaxis of RSV bronchiolitis should be re-considered.What is Known:• Bronchiolitis is one of the most common reasons for unplanned PICU admission. The most common virus causing bronchiolitis is RSV• Bronchiolitis severe enough to require admission to PICU is associated with frequent morbidity but has low mortality.What is New:• RSV causes more severe bronchiolitis than other viruses.• Nearly half of all children admitted to PICU with RSV were previously healthy.

Highlights

Acute bronchiolitis is a leading cause of hospitalization in young children
Our study presents a comprehensive review of the characteristics and clinical outcomes of children admitted to a single paediatric intensive care unit (PICU) in London, UK, with a clinical diagnosis of acute bronchiolitis
Bronchiolitis is a significant cause of PICU admission in the developed world

Summary

Introduction

Acute bronchiolitis is a leading cause of hospitalization in young children. children with bronchiolitis do not usually require hospitalization, approximately 3% of affected children are admitted to hospital [7, 30].In the developed world, infants aged < 1 year with bronchiolitis account forEur J Pediatr (2018) 177:913–92018% of all paediatric hospital admissions [13]. Acute bronchiolitis is a leading cause of hospitalization in young children. In December 2011 in England, there were 30,451 hospital admissions for bronchiolitis [6]. Bronchiolitis admission rates in infants under 1 year have previously been estimated to be 24.2 to 31.2 per 1000 in the UK and USA, respectively [4, 12, 21]. Most children hospitalized due to acute bronchiolitis have an uneventful course [3, 15]; approximately 2–6% requires admission to a paediatric intensive care unit (PICU), with 2–3% of hospitalizations requiring invasive mechanical ventilation [13]. Acute bronchiolitis accounts for around 13% of PICU admissions in the UK [9], being a significant burden on PICU beds, with a Bwinter surge^ in activity occurring predictably each November to February [7, 11, 12, 29]

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