Hospitalization For Bronchiolitis Research Articles

Modified lung ultrasound score for bronchopulmonary dysplasia predicts late respiratory outcomes in preterm infants.

Lung ultrasound (LUS) is a useful and radiation-free diagnostic tool for predicting bronchopulmonary dysplasia, which is a risk factor for late respiratory disease. However, data on the relationship of LUS with late respiratory disease was scarce. This study aims to determine whether LUS is associated with late respiratory disease during early childhood. This prospective cohort study enrolled preterm infants born before 32 weeks of gestation. LUS was performed at 36 weeks'postmenstrual age. The predictive values of a modified lung ultrasound (mLUS) score based on eight standard sections were assessed to predict late respiratory disease, defined as a physician diagnosis of bronchopulmonary dysplasia deterioration, asthma, reactive airway disease, bronchiolitis, pneumonia, or respiratory-related hospitalization during the first 2 years of life. A total of 94 infants completed follow-up, of whom 74.5% met the late respiratory disease criteria. The mLUS scores were significantly associated with late respiratory disease (adjusted odds ratio: 1.23, CI: 1.10-1.38, p < 0.001). The mLUS scores also well predicted late respiratory disease (AUC = 0.820, 95% CI: 0.733-0.907). These scores were superior to the classic lung ultrasound score (p = 0.02) and as accurate as the modified NICHD-defined bronchopulmonary dysplasia classification (p = 0.91). A mLUS score ≥14 was the optimal cutoff point for predicting late respiratory disease. The modified lung ultrasound score correlates significantly with late respiratory disease and well predicts it in preterm infants during the first 2 years of life.

Hospitalization for bronchiolitis in children aged ≤ 1year, Southern Italy, year 2021: need for new preventive strategies?

BackgroundBronchiolitis is a major cause of hospitalization in infants, particularly in the first six months of life, with approximately 60–80% of admissions due to respiratory syncytial virus (RSV) infection. Currently, no prophylactic options are available for healthy infants. The present study aimed at describing the demographic, clinical, and epidemiological characteristics of infants hospitalized for bronchiolitis in the Apulia region of Italy in 2021.MethodsFrom January to December 2021, data on children aged 0–12 months admitted for bronchiolitis in nine neonatal or pediatric units covering 61% of pediatric beds of hospitals in the Apulia region of Italy were analyzed. Demographic data, comorbidities, need for oxygen support, length of hospital stay, palivizumab administration, and outcomes were collected. For the purpose of the analysis, patients were divided into those aged 0–3 months and > 3 months. A multivariate logistic regression model was used to explore associations between the need for oxygen support and sex, age, comorbidities, history of prematurity, length of hospital stay, and palivizumab administration.ResultsThis study included 349 children aged 0–12 months admitted for bronchiolitis, with a peak of hospitalization in November (7.4 cases/1,000 children). Of these patients, 70.5% were RSV positive, 80.2% were aged 0–3 months, and 73.1% required oxygen support. Moreover, 34.9% required observation in the sub-intensive care unit, and 12.9% in the intensive care unit. Of the infants who required intensive care, 96.9% were aged 0–3 months and 78.8% were born at term. Three patients required mechanical ventilation and one, who required Extra Corporeal Membrane Oxygenation, died. Children aged 0–3 months were more likely to show dyspnea, need oxygen support, and have a longer hospital stay.ConclusionsThe present study showed that almost all of the children who required intensive care support were aged ≤ 3 months and most were born at term. Therefore, this age group remains the highest risk group for severe bronchiolitis. Preventive measures such as single-dose monoclonal antibody immunoprophylaxis, and maternal and childhood vaccination against RSV, may reduce the high public health burden of bronchiolitis.

A Rare Immunodeficiency As a Cause of Inflammatory Bowel Disease; ARPC1B Deficiency

Actin-related protein 2/3 complex subunit 1B (ARPC1B) is involved in the control of actin polymerization. Homozygous loss-of-function mutations in ARPC1B cause immunodeficiency 71 classified as the syndromic combined immunodeficiency with congenital thrombocytopenia. Here we describe two siblings presented with homozygous mutations in the ARPC1B gene. Patient 1, a 12-year-old male, presented with bloody diarrhea, vomiting, fever and eczema starting at the age of five months. GIS endoscopic examination was compatible with Chron’s Disease. He had repeated hospitalizations due to fever, bloody diarrhea, vomiting, pneumonia, asthma, and bronchiolitis. Physical examination was normal except for marked growth retardation. Complete blood count (CBC) revealed thrombocytopenia with normal MPV values, lymphopenia as well as eosinophilia. He had high Ig A, low Ig M, and normal Ig G and Ig E levels. In the lymphocyte subgroup analysis, CD3+, CD8+ T, CD 19+ B cell and RTE percentages were low, and CD21+38+ low B cell percentages were high. Lymphocyte proliferation and Treg cell analysis were normal compared to healthy controls. Patient 2, Patient 1’s three-year-old brother started to complain of vomiting, bloody diarrhea, and eczema when he was four days old. Colonoscopy was revelaed Crohn’s Disease. He had episodes of wheezing and repeated hospitalizations for bronchiolitis. Physical examination revealed growth retardation and severe eczema. CBC was normal except for intermittent leukocytosis and eosinophilia. He had high Ig A and Ig E, low Ig M, and normal Ig G levels. In lymphocyte subgroup analysis, CD3 + T cell, RTE, naive, and CSM B cell percentages were low, CD21+38+ low B and Exhausted Cd8+ T cell percentages were high. T cell proliferative response was significantly lower than that in healthy controls. Treg cell analysis was also found to be significantly lower.Homozygous splicing mutation in the ARPC1B gene was detected in the WGS analysis of the patients. They are preparing for hematopoietic stem cell transplantation.IBD is an important finding of immune dysregulation. Advances in next-generation gene sequencing are revealing the underlying immunodeficiencies of IBDs. ARPC1B identified in our patients is an example of this. Diagnosis of patients reduces mortality and morbidity by providing new treatment options.

Oxygen saturation thresholds for bronchiolitis at high altitudes: a cost-effectiveness analysis

ABSTRACT Background There is evidence suggesting that exaggerated reliance on pulse oximetry (SpO2) and the use of arbitrary/inadequate thresholds of SpO2 might drive unnecessary hospitalizations for viral bronchiolitis, especially among high-altitude residents. The aim of the present study was to compare the cost-effectiveness of two oxygen SpO2 thresholds for deciding whether infants with viral bronchiolitis living at high altitudes need hospital admission or can be discharged home. Methods A cost-effectiveness study was performed to compare the cost and clinical outcomes of two oxygen SpO2 thresholds, adjusted or not, to an altitude above the sea level of Bogota, Colombia (2640 m), for deciding whether infants with viral bronchiolitis need hospitalization or can be discharged home. The principal outcome was avoidance of hospital admission. Results Compared to the use of an SpO2 threshold of 90%, using an SpO2 threshold of 85% in infants with viral bronchiolitis was associated with lower overall costs (US$130.4 vs. US$194.0 average cost per patient) and a higher probability of hospitalization avoided (0.7500 vs. 0.5900), thus leading to dominance. Conclusions The use of an SpO2 threshold below 90% for deciding on hospitalization in infants with viral bronchiolitis living at high altitudes appears to be logical, secure, and cost-effective.

Association between prenatal and neonatal risk factors and development of bronchiolitis in early life.

A questionnaire was administered to the parents of the hospitalized infants with acute bronchiolitis to obtain information regarding patients' medical, family, and prenatal exposure history. Logistic regression with adjustment was performed to evaluate risk factors associated with bronchiolitis in the infants. Among the enrolled patients, 55 (36.7%) were diagnosed as having bronchiolitis, and the majority (89%) of the patients had moderate-to-severe bronchiolitis. The bronchiolitis group had lower C-reactive protein levels than did the control group. Fewer patients in the bronchiolitis group developed fever. However, hospital stays were longer in the bronchiolitis group than in the control group. Respiratory syncytial virus was the most detected virus (23/26, 88.6%) in the bronchiolitis group. Male sex (odds ratio [OR], 5.71; 95% confidence interval [CI], 2.02-16.12; P < 0.001), antibiotic usage during pregnancy (OR, 27.2; 95% CI, 1.12-660.84; P = 0.04), and viral infection (OR, 49.3; 95% CI, 9.01-270.26; P < 0.001) during the postnatal period were significantly associated with hospitalization for acute bronchiolitis in the infants. By contrast, pet exposure during the perinatal period was significantly and negatively associated with acute bronchiolitis (OR = 0.21, 95% CI = 0.07-0.69, P < 0.01). Environmental exposures during pregnancy may affect respiratory health in offspring, and effective strategies should be developed to prevent bronchiolitis in early life.

Clinical epidemiology and disease burden of bronchiolitis in hospitalized children in China: a national cross-sectional study.

Bronchiolitis is a common acute lower respiratory tract infection (ALRTI) and the most frequent cause of hospitalization of infants and young children with ALRTI. Respiratory syncytial virus is the main pathogen that leads to severe bronchiolitis. The disease burden is relatively high. To date, few descriptions of the clinical epidemiology and disease burden of children hospitalized for bronchiolitis are available. This study reports the general clinical epidemiological characteristics and disease burden of bronchiolitis in hospitalized children in China. This study included the face sheet of discharge medical records collected from 27 tertiary children's hospitals from January 2016 to December 2020 that were aggregated into the FUTang Update medical REcords (FUTURE) database. The sociodemographic variables, length of stay (LOS) and disease burden of children with bronchiolitis were analyzed and compared using appropriate statistical tests. In total, 42,928 children aged 0-3years were hospitalized due to bronchiolitis from January 2016 to December 2020, accounting for 1.5% of the total number of hospitalized children of the same age in the database during the period and 5.31% of the hospitalizations for ALRTI. The male to female ratio was 2.01:1. Meanwhile, more boys than girls were observed in different regions, age groups, years, and residences. The 1-2year age group had the greatest number of hospitalizations for bronchiolitis, while the 29days-6months group had the largest proportion of the total inpatients and inpatients with ALRTI in the same age group. In terms of region, the hospitalization rate of bronchiolitis was the highest in East China. Overall, the number of hospitalizations from 2017 to 2020 showed a decreasing trend from that in 2016. Seasonally, the peak hospitalizations for bronchiolitis occurred in winter. Hospitalization rates in North China in autumn and winter were higher than those in South China, while hospitalization rates in South China were higher in spring and summer. Approximately, half of the patients with bronchiolitis had no complications. Among the complications, myocardial injury, abnormal liver function and diarrhea were more common. The median LOS was 6days [interquartile range (IQR) = 5-8], and the median hospitalization cost was 758 United States dollars (IQR = 601.96-1029.53). Bronchiolitis is a common respiratory disease in infants and young children in China, and it accounts for a higher proportion of both total hospitalizations and hospitalizations due to ALRTI in children. Among them, children aged 29days-2years are the main hospitalized population, and the hospitalization rate of boys is significantly higher than that of girls. The peak season for bronchiolitis is winter. Bronchiolitis causes few complications and has a low mortality rate, but the burden of this disease is heavy.

Epidemiology of hospitalization for acute bronchiolitis in children: a systematic review

Bronchiolitis is a sequence of clinical signs and symptoms that include a viral respiratory prodrome followed by wheezing and increased lower respiratory effort. It is the leading cause of hospitalization among infants younger than 2 years of age. Therefore, this paper aimed to assess the epidemiology of hospitalization for acute bronchiolitis in children. Two databases, PubMed and Google Scholar, were searched for studies on bronchiolitis in children published after 2010. Keywords, including epidemiology, children, pediatric, hospitalization, admission, risk factors, and respiratory syncytial virus (RSV), were used in different combinations to obtain the relevant articles. The inclusion criteria for this review were original articles on pediatric bronchiolitis that were written in English, available in full text, and contained clear and complete data. A total of 609 articles were retrieved, of which seven met the inclusion criteria. The included studies involved a total of 4,288 children in 7 countries. The major causative agent for bronchiolitis among hospitalized children was RSV. The main findings analyzed included causative agents, symptoms, hospitalization, management, and complications. Bronchiolitis is mostly caused by RSV. Longer hospital stays were associated with RSV, co-infection, and infants less than 2 months of age.

Temporal-spatial analysis of hospitalizations for bronchiolitis in Brazil: prediction of epidemic regions and periods for immunization against the Respiratory Syncytial Virus.

Due to the high cost and short term of passive immunization against the respiratory syncytial virus, the main virus causing acute viral bronchiolitis, predicting epidemic regions and epidemic months is extremely important. The objective of this study is to identify both the month when the seasonal peak begins and Brazilian regions and states with the highest incidence of monthly hospitalizations due acute viral bronchiolitis. Based on data obtained from DATASUS, monthly hospitalization rates due acute viral bronchiolitis were calculated for every 10,000 live births to children under 12 months of age in all Brazilian states and the Federal District between 2000 and 2019. Seasonal autoregressive integrated moving average models were estimated to forecast monthly hospitalization rates in 2020. A higher incidence of hospitalizations was found for male children, especially under six months of age. As for Brazilian regions, between 2000 and 2019, the South region registered the highest incidence of hospitalizations, followed by the Southeast, Midwest, North and Northeast regions, in this order. Considering the seasonal peak, the period between March and July 2020 comprised the highest expected hospitalization rates. Palivizumab is suggested to be started between February/March and June/July for most Brazilian states, with the exception of Rio Grande do Sul, which, in addition to presenting the highest rates of hospitalizations for acute viral bronchiolitis per 10,000 live births, has the longest seasonal peak between May and September.

Association of Severe Bronchiolitis during Infancy with Childhood Asthma Development: An Analysis of the ECHO Consortium.

Objective: Many studies have shown that severe (hospitalized) bronchiolitis during infancy is a risk factor for developing childhood asthma. However, the population subgroups at the highest risk remain unclear. Using large nationwide pediatric cohort data, namely the NIH Environmental influences on Child Health Outcomes (ECHO) Program, we aimed to quantify the longitudinal relationship of bronchiolitis hospitalization during infancy with asthma in a generalizable dataset and to examine potential heterogeneity in terms of major demographics and clinical factors. Methods: We analyzed data from infants (age <12 months) enrolled in one of the 53 prospective cohort studies in the ECHO Program during 2001−2021. The exposure was bronchiolitis hospitalization during infancy. The outcome was a diagnosis of asthma by a physician by age 12 years. We examined their longitudinal association and determined the potential effect modifications of major demographic factors. Results: The analytic cohort consisted of 11,762 infants, 10% of whom had bronchiolitis hospitalization. Overall, 15% subsequently developed asthma. In the Cox proportional hazards model adjusting for 10 patient-level factors, compared with the no-bronchiolitis hospitalization group, the bronchiolitis hospitalization group had a significantly higher rate of asthma (14% vs. 24%, HR = 2.77, 95%CI = 2.24−3.43, p < 0.001). There was significant heterogeneity by race and ethnicity (Pinteraction = 0.02). The magnitude of the association was greater in non-Hispanic White (HR = 3.77, 95%CI = 2.74−5.18, p < 0.001) and non-Hispanic Black (HR = 2.39, 95%CI = 1.60−3.56; p < 0.001) infants, compared with Hispanic infants (HR = 1.51, 95%CI = 0.77−2.95, p = 0.23). Conclusions: According to the nationwide cohort data, infants hospitalized with bronchiolitis are at a higher risk for asthma, with quantitative heterogeneity in different racial and ethnic groups.

EE472 Use of Health Resources and Micro-Costing Analysis of Hospitalization for Bronchiolitis and Pneumonia in Pediatric Patients: A Retrospective Study From Brazilian Perspective

EE472 Use of Health Resources and Micro-Costing Analysis of Hospitalization for Bronchiolitis and Pneumonia in Pediatric Patients: A Retrospective Study From Brazilian Perspective

66 Trends in bronchiolitis emergency department visits in Ontario, 2004-2018: A population-based cohort study

Abstract Background Bronchiolitis is the most common lower respiratory tract infection in children and places a significant burden on the health care system. There have been few population-based studies describing trends in emergency department (ED) rates over time. Objectives To estimate population-based rates and trends of bronchiolitis ED visits from 2004 to 2018 in Ontario, Canada. Design/Methods We conducted a population-based cohort study of all children less than 2 years of age from April 1, 2004 to March 31, 2018 using linked administrative data. Bronchiolitis hospital encounters were identified using ICD-10 discharge diagnosis codes. The primary outcome was bronchiolitis ED visit rate estimated per 1000 person-years. Secondary outcomes included ED visit rate by subgroups (age, gestational age, birth weight, comorbidity, rurality, and material deprivation), bronchiolitis hospitalizations per 100 bronchiolitis ED visits, bronchiolitis ED 14-day revisit rate (ED revisit or hospitalization per 100 ED visits), and mortality rate (in- and out-of-hospital deaths per 1000 person-years). Annual percent change (APC) was estimated using log-linear regression models to determine trends in outcomes. Results Of the 2,336,446 infants less than 2 years of age during the study period, 93,843 children (4.0%) had 115,116 bronchiolitis ED visits at 208 hospitals. Bronchiolitis accounted for an increasing percentage of all-cause ED visits, from 7,446 (3.4%) of 216,122 in 2004-2005 to 9,702 (4.2%) of 231,693 in 2017-2018 (APC 2.2%; 95% CI [1.2-3.2]). Bronchiolitis ED visits per 1000 person-years increased by 26.7% from 27.0 (95% CI, 26.4-27.7) in 2004-2005 to 34.2 (95% CI, 33.5-34.9) in 2017-18 (APC=2.6%; 95% CI [1.5-3.8], p&amp;lt;0.001). Subgroup specific rates similarly increased over the study period. Hospitalizations per 100 ED visits decreased from 51.8 (95% CI, 50.2-53.4) in 2004-2005 to 37.0 (95% CI, 35.8-38.2) in 2017-2018 (APC -2.6% [95% CI, -3.3 to -1.8], p&amp;lt;0.0001). Revisits after an ED encounter were stable, 14.0 (95% CI, 13.0-15.0) in 2004-2005 and 11.8 (95% CI, 11.1-12.6) per 100 ED visits in 2017-2018 (APC -0.3%, [95% CI, -1.3 to 0.7]; p=0.68), as was the mortality rate (Figure 1). Conclusion In a population-based study from 2004 to 2018, bronchiolitis ED use increased significantly. However, the bronchiolitis hospitalizations declined relative to ED visits, and the ED revisit and mortality rate remained stable, suggesting that illness severity did not increase. These findings indicate an increasing health services burden of bronchiolitis on EDs.

Retrospective observational study of the influence of the COVID-19 outbreak on infants’ hospitalisation for acute bronchiolitis

ObjectivesAcute bronchiolitis is a major public health issue with high number of infants hospitalised worldwide each year. In France, hospitalisations mostly occur between October and March and peak in December....

Socioeconomic position, bronchiolitis and asthma in children: counterfactual disparity measures from a national birth cohort study.

The debated link between severe respiratory syncytial virus (RSV) infection in early life and asthma has yet to be investigated within a social inequity lens. We estimated the magnitude of socioeconomic disparity in childhood asthma which would remain if no child were admitted to hospital for bronchiolitis, commonly due to RSV, during infancy. The cohort, constructed from national administrative health datasets, comprised 83853 children born in Scotland between 1 January 2007 and 31 June 2008. Scottish Index for Multiple Deprivation (SIMD) was used to capture socioeconomic position. Emergency admissions for bronchiolitis before age 1 year were identified from hospital records. Yearly indicators of asthma/wheeze from ages 2 to 9 years were created using dispensing data and hospital admission records. Using latent class growth analysis, we identified four trajectories of asthma/wheeze: early-transient (2.2% of the cohort), early-persistent (2.0%), intermediate-onset (1.8%) and no asthma/wheeze (94.0%). The estimated marginal risks of chronic asthma (combining early-persistent and intermediate-onset groups) varied by SIMD, with risk differences for the medium and high deprivation groups, relative to the low deprivation group, of 7.0% (95% confidence interval: 3.7-10.3) and 13.0% (9.6-16.4), respectively. Using counterfactual disparity measures, we estimated that the elimination of bronchiolitis requiring hospital admission could reduce these risk differences by 21.2% (4.9-37.5) and 17.9% (10.4-25.4), respectively. The majority of disparity in chronic asthma prevalence by deprivation level remains unexplained. Our paper offers a guide to using causal inference methods to study other plausible pathways to inequities in asthma using complex, linked administrative data.

Lessons from SARS-CoV-2 Pandemics: How Restrictive Measures Impacted the Trend of Respiratory Infections in Neonates and Infants up to Three Months of Age.

(1) Background: Massive social efforts to prevent the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have affected the epidemiological features of respiratory infections. (2) Methods: The study aims to describe the trend of hospitalizations for bronchiolitis among newborns and infants up to three months of life in Rome (Italy), in the pre-COVID-19 era and during the pandemic. (3) Results: We observed a marked decrease in the number of neonates and infants with bronchiolitis after national lockdowns in 2020 and the first months of 2021 and a similar trend in the number of bronchiolitis caused by respiratory syncytial virus (RSV). RSV was the leading pathogen responsible for bronchiolitis before the national lockdown in March 2020 (70.0% of cases), while Rhinovirus was the leading pathogen responsible for bronchiolitis (62.5%) during the pandemic while strict restrictions were ongoing. As Italy approached the COVID-19 vaccination target, the national government lifted some COVID-19-related restrictions. A surprising rebound of bronchiolitis (particularly cases caused by RSV) was observed in October 2021. (4) Conclusions: In this study, we describe for the first time the fluctuations over time of RSV bronchiolitis among newborns and young infants in Italy in relation to the restrictive measures containing the spread of the COVID-19 pandemic. Our results are in line with other countries’ reports.

Increased use of high-flow nasal cannulas after the pandemic in bronchiolitis: a more severe disease or a changed physician’s attitude?

After the SARS-CoV-2 pandemic, we noticed a marked increase in high-flow nasal cannula use for bronchiolitis. This study aims to report the percentage of children treated with high-flow nasal cannula (HFNC) in various seasons. The secondary outcomes were admissions for bronchiolitis, virological results, hospital burden, and NICU/PICU need. We conducted a retrospective study in four Italian hospitals, examining the medical records of all infants (< 12 months) hospitalized for bronchiolitis in the last four winter seasons (1 September–31 March 2018–2022). In the 2021–2022 winter season, 66% of admitted children received HFNC versus 23%, 38%, and 35% in the previous 3 years. A total of 876 patients were hospitalized in the study periods. In 2021–2022, 300 infants were hospitalized for bronchiolitis, 22 in 2020–2021, 259 in 2019–2020, and 295 in 2018–2019. The percentage of patients needing intensive care varied from 28.7% to 18%, 22%, and 15% in each of the four considered periods (p < 0.05). Seventy-seven percent of children received oxygen in the 2021–2022 winter; vs 50%, 63%, and 55% (p < 0.01) in the previous 3 years. NIV/CPAP was used in 23%, 9%, 16%, and 12%, respectively. In 2021–2020, 2% of patients were intubated; 0 in 2020–2021, 3% in 2019–2020, and 1% in 2018–2019.Conclusion: This study shows a marked increase in respiratory support and intensive care admissions this last winter. While these severity indexes were all driven by medical choices, more reliable indexes such as intubation rate and length of stay did not change. Therefore, we suggest that there is a more aggressive treatment attitude rather than a more severe disease.What is Known:• COVID-19 pandemic deeply impacted bronchiolitis epidemiology, reducing hospitalizations to onetenth. In the 2021-2022 winter, bronchiolitis resurged to pre-pandemic numbers in Europe.What is New:• Bronchiolitis hospitalization rose much faster in the 2021-2022 winter period, peaking at a higher level. Respiratory supports and high-flow nasal cannula increased significantly compared to the pre-pandemic era.

Is Home Oxygen Therapy an Alternative to Hospitalization for Bronchiolitis?

Bronchiolitis is the leading cause of hospitalization in infants and children younger than age 2 years.1 Although recent data demonstrate that admissions for bronchiolitis are decreasing, the burden on the pediatric health care system remains substantial.2 The most common reasons for admission include hypoxia, increased work of breathing, and dehydration. Treatment remains largely supportive. Home treatment options targeting these areas have the potential to alleviate burden on both the health care system and individual family unit.In this issue of Pediatrics, Lawrence et al present a systematic review of literature relating to home oxygen and home nasogastric feeding for infants and toddlers with bronchiolitis.3 The review identified only 10 studies meeting inclusion criteria, all pertaining to home oxygen therapy (HOT). These studies demonstrated feasibility, acceptability, and safety among the high-altitude population but there are notably fewer data on HOT use at lower elevations. Although there is certainly a need for further research into HOT for bronchiolitis at sea level, it is also worth noting that 6 of these studies report data from growing or sustained HOT programs, with 2 reporting high levels of caregiver comfort and satisfaction, adding support to the acceptability, sustainability, and positive impact of HOT for bronchiolitis.The authors also note a paucity of data on health care cost-savings. A recent study from Rodríguez-Martínez et al used a cost-analysis modeling technique and found a potential significant cost savings in home therapy.4 Even without patient-level data, with the high cost of inpatient care, home care is likely to be less expensive than hospitalization in nearly all instances. It is also important to recognize that there are significant costs associated with hospitalization that are difficult to quantify, including the nonmedical costs to the family such as caregiver workdays missed, the cost of childcare for siblings, and disruption to parenting plans that may be associated with hospitalization of a child.Barriers to implementation and feasibility concerns clearly remain. Interestingly, the pandemic may provide some answers with recent literature describing the use of HOT for hypoxic adults with COVID-19, a process begun during the unprecedented volume of emergency department (ED) and hospitalized patients who accompanied the pandemic.5 This suggests that HOT programs may be implemented safely and quickly, even at sea level. Although some of the HOT literature describes ED-initiated HOT, thereby circumventing hospitalization entirely, short-stay, observation, and inpatient units may be the most feasible starting point for new HOT programs, allowing for more time to coordinate discharge planning and working with primary care providers for follow-up.The authors also suggest a potential role for home management of infants traditionally admitted for observation only, with neither supplemental oxygen nor hydration support. Although this is a cohort that could benefit from recent advances in telehealth capabilities, we would caution against the addition of home pulse oximetry monitoring, which is already overrelied on in decision-making in patients with bronchiolitis, difficult for providers to ignore, and linked to increase in hospitalization and length of stay.6 The use of home pulse oximetry could result in an increase in ED visits and hospitalizations in a system not prepared to provide other home care services such as HOT.Moving forward, the current health care climate of understaffed and overcrowded hospitals will likely necessitate changes in the way that we care for patients. The establishment of home care programs such as HOT may be a worthwhile investment for systems that are experiencing hospital bed shortages and boarding patients in EDs. The current data do demonstrate that HOT can decrease length of stay, and improve family-centered care. In regions where dehydration, more than hypoxia, drives bronchiolitis admissions, trials of home nasogastric hydration may be useful. Sharing of data on the implementation logistics used by successful HOT programs for bronchiolitis could be useful for other interested institutions to move forward with implementation of HOT programs and the research that may reaffirm their benefits.

Increased risk of emergency department presentations for bronchiolitis in infants exposed to air pollution.

Air pollution has been linked to an increased risk of several respiratory diseases in children, especially respiratory tract infections. The present study aims to evaluate the association between pediatric emergency department (PED) presentations for bronchiolitis and air pollution. PED presentations due to bronchiolitis in children aged less than 1 year were retrospectively collected from 2007 to 2018 in Padova, Italy, together with daily environmental data. A conditional logistic regression based on a time-stratified case-crossover design was performed to evaluate the association between PED presentations and exposure to NO2 , PM2.5, and PM10. Models were adjusted for temperature, relative humidity, atmospheric pressure, and public holidays. Delayed effects in time were evaluated using distributed lag non-linear models. Odds ratio for lagged exposure from 0 to 14 days were obtained. Overall, 2251 children presented to the PED for bronchiolitis. Infants' exposure to higher concentrations of PM10 and PM2.5 in the 5 days before the presentation to the PED increased the risk of accessing the PED by more than 10%, whereas high concentrations of NO2 between 2 and 12 days before the PED presentation were associated with an increased risk of up to 30%. The association between pollutants and infants who required hospitalization was even greater. A cumulative effect of NO2 among the 2 weeks preceding the presentation was also observed. In summary, PM and NO2 concentrations are associated with PED presentations and hospitalizations for bronchiolitis. Exposure of infants to air pollution could damage the respiratory tract mucosa, facilitating viral infections and exacerbating symptoms.

Respiratory Syncytial Virus Burden and Healthcare Utilization in United States Infants

BackgroundRespiratory syncytial virus (RSV) is the leading cause of hospitalizations in United States infants aged <1 year, but research has focused on select populations.MethodsNational (Nationwide) Inpatient Sample and National Emergency Department (ED) Sample data (2011–2019) were used to report RSV hospitalization (RSVH), bronchiolitis hospitalization (BH), and ED visit counts, percentage of total hospitalizations/visits, and rates per 1000 live births along with inpatient mortality, mechanical ventilation (MV), and total charges (2020 US dollars).ResultsAverage annual RSVH and RSV ED visits were 56 927 (range, 43 845–66 155) and 131 999 (range, 89 809–177 680), respectively. RSVH rates remained constant over time (P = .5), whereas ED visit rates increased (P = .004). From 2011 through 2019, Medicaid infants had the highest average rates (RSVH: 22.3 [95% confidence interval {CI}, 21.5–23.1] per 1000; ED visits: 55.9 [95% CI, 52.4–59.4] per 1000) compared to infants with private or other/unknown insurance (RSVH: P < .0001; ED visits: P < .0001). From 2011 through 2019, for all races and ethnicities, Medicaid infants had higher average RSVH rates (up to 7 times) compared to infants with private or other/unknown insurance. RSVH mortality remained constant over time (P = .8), whereas MV use (2019: 13% of RSVH, P < .0001) and mean charge during hospitalization (2019: $21 513, P < .0001) increased. Bronchiolitis patterns were similar.ConclusionsThis study highlights the importance of ensuring access to RSV preventive measures for all infants.

A Systematic Literature Review of the Burden of Respiratory Syncytial Virus and Health Care Utilization Among United States Infants Younger Than 1 Year.

BackgroundThe burden and health care utilization (HCU) of respiratory syncytial virus (RSV) in US infants aged <1 year across health care settings are not well characterized.MethodsWe systematically reviewed studies of RSV and bronchiolitis published 2000–2021 (data years, 1979–2020). Outcomes included RSV hospitalization (RSVH)/bronchiolitis hospitalization rates, emergency department (ED)/outpatient (OP) visit rates, and intensive care unit (ICU) admissions or mechanical ventilation (MV) use among RSV-/bronchiolitis-hospitalized infants. Study quality was determined using standard tools.ResultsWe identified 141 good-/fair-quality studies. Five national studies reported annual average RSVH rates (range, 11.6 per 1000 per year among infants aged 6–11 months in 2006 to 50.1 per 1000 per year among infants aged 0–2 months in 1997). Two national studies provided RSVH rates by primary diagnosis for the entire study period (range, 22.0–22.7 per 1000 in 1997–1999 and 1997–2000, respectively). No national ED/OP data were available. Among 11 nonnational studies, RSVH rates varied due to differences in time, populations (eg, prematurity), and locations. One national study reported that RSVH infants with high-risk comorbidities had 5-times more MV use compared to non–high-risk infants in 1997-2012.ConclusionsSubstantial data variability was observed. Nationally representative studies are needed to elucidate RSV burden and HCU.

Changes in Bronchiolitis Incidence During the Last Two Decades in Tampere, Finland: A Retrospective Study.

Background:Bronchiolitis, a lower respiratory tract infection, causes a remarkable number of hospitalizations globally. The epidemiology follows the same pattern as respiratory syncytial virus (RSV), the most common pathogen in bronchiolitis. Epidemics have typically followed a biannual pattern in Nordic countries—first, a small epidemic during spring, followed by a higher peak the next autumn. The aim of this study was to evaluate whether the incidence of bronchiolitis hospitalization has changed during the last 2 decades in Tampere, Finland.Methods:In this retrospective register-based study, data on infants <12 months of age hospitalized with bronchiolitis in 2000–2019 were collected from electronic files of Tampere University Hospital and analyzed by monthly incidences. Additionally, data on RSV incidences were collected from the Finnish National Infectious Diseases Register for children <5 years of age and living in the study area. Poisson’s regression analysis was used to evaluate changes in the incidence rates of bronchiolitis.Results:Of the 1481 infants hospitalized with bronchiolitis, 82.0% had a diagnosis of RSV bronchiolitis. At first, bronchiolitis’ epidemiological pattern followed its typical biannual pattern, then shifted to annual in the middle of the study period, and thereafter occurred biannually again. The highest incidence rate ratios compared to the low-incidence months were between December (22.5), January (25.8) and February (25.5) in 2000–2006, and between February (24.7), March (25.1) and April (21.0) in 2007–2019.Conclusions:The epidemiological pattern of bronchiolitis changed during the study period; incidence peaks were higher and have shifted toward spring in recent years.