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

Abstract

Introduction and objective: Bronchiolitis in young children often requires hospitalisation. It is mostly caused by respiratory syncytial virus (RSV) and aetiological factors may be associated with clinical presentation and prognosis. We aimed to compare the epidemiology, clinical features, severity and management of RSV and non-RSV bronchiolitis. Materials and methods: This cross-sectional retrospective study included hospitalised children under 2 years of age. Children with a positive rapid antigen diagnostic test and/or molecular study were included in the RSV group, while those with a negative result were classified as non-RSV bronchiolitis. We compared patient history, clinical presentation, disease severity including passive oxygen therapy, intensive care unit transfer, death, length of hospital stay, presence of complications, oxygen saturation <92%, acidosis, hypercapnia and treatment used. Results: The study included 524 patients (median age 2 months): 462 (88%) RSV and 62 (12%) non-RSV cases. A 7-fold increase in the number of cases was observed between 2010–2011 and 2017–2018. A univariate regression model showed lower odds of family history of atopy (odds ratio, OR = 0.46), higher odds of cough (OR = 4.74), apathy (OR = 2.61), feeding difficulties (OR = 2.03) and vomiting (OR = 3.34) in the RSV group. RSV patients required oxygen therapy (OR = 3.78) and antibiotics (OR = 2.82) more frequently, received inhaled steroid therapy for longer (9 vs. 8 days) and had a higher likelihood of complications (OR = 4.24). A multivariate model showed statistical significance for cough (OR = 6.22), oxygen therapy (OR = 4.43) and complications (OR = 15.95). Conclusions: We observed an increasing trend in bronchiolitis hospitalisations, including RSV bronchiolitis, which was associated with a more severe disease course. No significant clinical features were identified to replace laboratory tests.