Acute bronchiolitis: hospitalization, complications and therapeutic management in children less than two years old at a high complexity institution during 2017-2018: A descriptive study
DOI:
https://doi.org/10.17533/udea.iatreia.173Keywords:
Bronchiolitis, Complications, Hospitalization, InfantAbstract
Introduction: Acute bronchiolitis is defined as the first broncho-obstructive episode in children under two years of age, preceded by signs of upper respiratory tract infection. Its significance lies in its high prevalence, as it is the leading cause of hospitalization in children under one year in Colombia. While it is a disease with low fatality, there are patient groups that may develop severe complications.
Objective: This study aimed to describe the frequency of hospitalization and complications, as well as the treatment, of children under two years of age with acute bronchiolitis in a high complexity institution.
Methods: A retrospective descriptive observational study was conducted. The study population consisted of infants diagnosed with bronchiolitis who were admitted to the institution during 2017 and 2018. The information was recorded in a database and analyzed with SPSS-24.0.
Results: A total of 427 patients were included, of whom 266 were females (62.3%). The median age was 2 months (1-5 months). Retractions were present in 242 infants (56.7%). Hospitalization was required for 268 patients (62.8%), with a median length of stay of 4 days (2-7 days). Among the hospitalized patients, 32 (11.9%) were admitted to the Intensive Care Unit (ICU). Nasal lavage was the most commonly used therapy, applied to 365 patients
(85.5%). Viral panel testing was performed in 259 patients (60.6%), with respiratory syncytial virus (RSV) being the primary agent detected.
Conclusions: Although more than half of the patients required hospitalization, the majority had a benign course. While management approaches varied, symptomatic treatment was predominant.
Downloads
References
(1) Asociación Colombiana de Neumología Pediátrica. Guía de práctica clínica para bronquiolitis (diagnóstico, tratamiento y prevención) [Internet]. [citado el 15 de agosto de 2021]. Disponible en: https://portal.neumopediatriacolombia.com/guia-bronquiolitis/
(2) García RA, Córdoba-Gamero JF, Muñoz-Zara P, Barrios I. Bronquiolitis [Internet]. Neumosur [citado el 15 de agosto de 2021]. Disponible en: https://www.neumosur.net/files/publicaciones/ebook/41-BRONQUIOLITIS-Neumologia-3_ed.pdf
(3) Bennett JE, Dolin R, Blaser MJ, eds. Enfermedades infecciosas. Principios y práctica. 9a ed. Elsevier; 2020. p. 847–52.
(4) Jartti T, Smits HH, Bønnelykke K, Bircan O, Elenius V, Konradsen JR, et al. Bronchiolitis needs a revisit: Distinguishing between virus entities and their treatments. Allergy [Internet]. 2019;74(1):40–52. DOI 10.1111/all.13624.
(5) Comité Nacional de Neumonología, Comité Nacional de Infectología, Comité de Medicina Interna Pediátrica, Comité de Pediatría Ambulatoria y Colaboradores. Recomendaciones para el manejo de las infecciones respiratorias agudas bajas en menores de 2 años. Arch Argent Pediatr [Internet]. 2015;113(4):373–4. DOI 10.5546/aap.2021.S171.
(6) Meissner HC. Viral bronchiolitis in children. N Engl J Med [Internet]. 2016;374(1):62–72. DOI 10.1056/NEJMra1413456.
(7) Hasegawa K, Mansbach JM, Teach SJ, Fisher ES, Hershey D, Koh JY, et al. Multicenter study of viral etiology and relapse in hospitalized children with bronchiolitis. Pediatr Infect Dis J [Internet]. 2014;33(8):809–13. DOI 10.1097/INF.0000000000000293.
(8) Mansbach JM, Piedra PA, Teach SJ, Sullivan AF, Forgey T, Clark S, et al. Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Arch Pediatr Adolesc Med [Internet]. 2012;166(8):700–6. DOI 10.1001/archpediatrics.2011.1669.
(9) Rivera-Sepulveda A, Garcia-Rivera EJ. Epidemiology of bronchiolitis: a description of emergency department visits and hospitalizations in Puerto Rico, 2010-2014. Trop Med Health [Internet]. 2017;45:24. DOI 10.1186/s41182-017-0064-7.
(10) Alvarez AE, Marson FA de L, Bertuzzo CS, Arns CW, Ribeiro JD. Epidemiological and genetic characteristics associated with the severity of acute viral bronchiolitis by respiratory syncytial virus. J Pediatr (Rio J) [Internet]. 2013;89(6):531–43. DOI 10.1016/j.jped.2013.02.022.
(11) Caballero MT, Polack FP, Stein RT. Viral bronchiolitis in young infants: new perspectives for management and treatment. J Pediatr (Rio J) [Internet]. 2017;93(1):75–83. DOI 10.1016/j.jped.2017.07.003.
(12) Camargo-Crespo CE. Validación de una escala de severidad en bronquiolitis viral aguda en una población de lactantes atendidos en el Hospital de la Misericordia [Internet]. [citado el 15 de agosto de 2021]. Disponible en: https://repositorio.unal.edu.co/bitstream/handle/unal/21500/5599350.2014.pdf?sequence=1&isAllowed=y
(13) Villatoro P. Indicadores no monetarios de pobreza: avances y desafíos para su medición. Memorias del seminario regional realizado en Santiago, los días 16 y 17 de mayo de 2017 [Internet]. Santiago: Naciones Unidas; 2017 [citado el 15 de agosto de 2021]. Disponible en: https://repositorio.cepal.org/bitstream/handle/11362/43140/1/S1701175_es.pdf
(14) Stollar F, Glangetas A, Luterbacher F, Gervaix A, Barazzone-Argiroffo C, Galetto-Lacour A. Frequency, timing, risk factors, and outcomes of desaturation in infants with acute bronchiolitis and initially normal oxygen saturation. JAMA Netw Open [Internet]. 2020;3(12): e2030905. DOI 10.1001/jamanetworkopen.2020.30905.
(15) Piñero Fernández JA, Alfayate Migueléz S, Menasalvas Ruiz A, Salvador García C, Moreno Docón A, Sánchez-Solís de Querol M. Características epidemiológicas, clínicas y terapéuticas de lactantes hospitalizados por bronquiolitis. An Pediatr (Barc) [Internet]. 2012;77(6):391–6. DOI 10.1016/j.anpedi.2012.05.007.
(16) Ramos-Fernández JM, Pedrero-Segura E, Gutiérrez-Bedmar M, Delgado-Martín B, Cordón-Martínez AM, Moreno-Pérez D, et al. Epidemiología de los ingresos por bronquiolitis en el sur de Europa: análisis de las epidemias 2010-2015. An Pediatr (Barc) [Internet]. 2017;87(5):260–8. DOI 10.1016/j.anpedi.2016.10.002.
(17) Preciado H, Castillo MA, Díaz TF, Rodríguez JD. Bronquiolitis: factores de riesgo en menores de dos años. Hospital de San José de Bogotá D.C. Colombia. 2013-2014. Rev repert med cir [Internet]. 2015;24(3):194–200. DOI 10.31260/RepertMedCir.v24.n3.2015.615.
(18) Cerdán-Rojas S. Factores asociados con hospitalización prolongada en lactantes con bronquiolitis moderada. Rev Cubana Pediatr [Internet]. 2022;94(1)e1797. Disponible en: http://www.revpediatria.sld.cu/index.php/ped/article/view/1797/944
(19) Rodríguez-Martínez CE, Sossa-Briceño MP, Nino G. Predictors of prolonged length of hospital stay for infants with bronchiolitis. J Investig Med [Internet]. 2018;66(6):986–991. DOI 10.1136/jim-2018-000708.
(20) Buendía JA, Patiño DG. Risk factors for severe bronchiolitis in Colombia. Trop Doct [Internet]. 2021 Jul;51(3):434–437. DOI 10.1177/00494755211002032.
(21) Rodríguez DA, Rodríguez-Martínez CE, Cárdenas AC, Quilaguy IE, Mayorga LY, Falla LM, et al. Predictors of severity and mortality in children hospitalized with respiratory syncytial virus infection in a tropical region. Pediatric pulmonology [Internet]. 2014;49(3):269–276. DOI 10.1002/ppul.22781.
(22) Ochoa-Sangrador C, González de Dios J. Conferencia de Consenso sobre bronquiolitis aguda (II): epidemiología de la bronquiolitis aguda. Revisión de la evidencia científica. An Pediatr (Barc) [Internet]. 2010;72(3): 222.e1-222.e26. DOI 10.1016/j.anpedi.2009.11.019.
(23) Ghazaly M, Nadel S. Characteristics of children admitted to intensive care with acute bronchiolitis. Eur J Pediatr [Internet]. 2018;177(6):913–20. DOI 10.1007/s00431-018-3138-6.
(24) Márquez-Aguirre AC, Bolaños-Macías J, Moreno J, Buitrago J. Caracterización de una cohorte durante cinco años después de un episodio de bronquiolitis que requiere hospitalización en una clínica de tercer nivel de Bogotá, Colombia. Infectio [Internet]. 2019;23(3):234. DOI 10.22354/in.v23i3.786.
(25) Lozano JM. Bronchiolitis. BMJ Clin Evid [Internet]. 2007 Oct 10;2007:0308. PMID: 19450362; PMCID: PMC2943823.
(26) Carroll KN, Gebretsadik T, Griffin MR, Wu P, Dupont WD, Mitchel EF, et al. Increasing burden and risk factors for bronchiolitis-related medical visits in infants enrolled in a state health care insurance plan. Pediatrics [Internet]. 2008;122(1):58–64. DOI 10.1542/peds.2007-2087.
(27) Megalaa R, Perez GF, Kilaikode-Cheruveettara S, Kotwal N, Rodriguez-Martinez CE, Nino G. Clinical definition of respiratory viral infections in young children and potential bronchiolitis misclassification. J Investig Med [Internet]. 2018;66(1):46–51. DOI 10.1136/jim-2017-000491.
(28) Dumas O, Mansbach JM, Jartti T, Hasegawa K, Sullivan AF, Piedra PA, et al. A clustering approach to identify severe bronchiolitis profiles in children. Thorax [Internet]. 2016;71(8):712–8. DOI 10.1136/thoraxjnl-2016-208535.
(29) Arroyo M, Salka K, Perez GF, Rodríguez-Martínez CE, Castro-Rodriguez JA, Gutierrez MJ, et al. Phenotypical sub-setting of the first episode of severe viral respiratory infection based on clinical assessment and underlying airway disease: A pilot study. Front Pediatr [Internet]. 2020;8:121. DOI 10.3389/fped.2020.00121.
(30) Rodriguez-Martinez CE, Nino G, Castro-Rodriguez JA, Acuña-Cordero R, Sossa-Briceño MP, Midulla F. For which infants with viral bronchiolitis could it be deemed appropriate to use albuterol, at least on a therapeutic trial basis? Allergol Immunopathol (Madr) [Internet]. 2021;49(1):153–8. DOI 10.15586/aei.v49i1.12.
(31) Serra JA, González-Dambrauskas S, Vásquez-Hoyos P, Carvajal C, Donoso A, Cruces P, et al. Therapeutic variability in infants admitted to Latin-American pediatric intensive units due to acute bronchiolitis. Rev Chil Pediatr [Internet]. 2020;91(2):216–25. DOI 10.32641/rchped.v91i2.1156.
(32) Arraut-Collazos P, Lesmes-Agudelo A. Caracterización de la población con bronquiolitis en la clínica infantil Colsubsidio en el año 2013 [Internet]. 2015 [citado el 15 de agosto de 2021]. Disponible en: https://repository.urosario.edu.co/bitstream/handle/10336/10515/53106146-2015.pdf?sequence=1
(33) Angoulvant F, Bellêttre X, Milcent K, Teglas J-P, Claudet I, Le Guen CG, et al. Effect of nebulized Hypertonic Saline treatment in emergency departments on the hospitalization rate for acute bronchiolitis: A randomized clinical trial. JAMA Pediatr [Internet]. 2017;171(8):e171333. DOI 10.1001/jamapediatrics.2017.1333.
(34) Brooks CG, Harrison WN, Ralston SL. Association between hypertonic saline and hospital length of stay in acute viral bronchiolitis: A reanalysis of 2 meta-analyses. JAMA Pediatr [Internet]. 2016;170(6):577–84. DOI 10.1001/jamapediatrics.2016.0079.
(35) Mussman GM, Parker MW, Statile A, Sucharew H, Brady PW. Suctioning and Length of Stay in Infants Hospitalized With Bronchiolitis. JAMA Pediatr [Internet]. 2013;167(5):414–421. DOI 10.1001/jamapediatrics.2013.36.
(36) Montejo-Fernández M, Benito-Manrique I, Montiel-Eguía A, Benito-Fernández J. Una iniciativa para reducir el uso de medicación innecesaria en lactantes con bronquiolitis en atención primaria. An Pediatr (Engl Ed) [Internet]. 2019;90(1):19–25. DOI 10.1016/j.anpedi.2018.02.016.
(37) Rueda-Villabona J. Características poblacionales de los pacientes con bronquiolitis de la Subred Sur Occidente de Salud Unidad de Kennedy de mayo del 2015 a mayo del 2016 y factores asociados a complicaciones y mortalidad [Internet]. 2017 [citado el 15 de agosto de 2021]. Disponible en: https://repository.unimilitar.edu.co/handle/10654/16961
(38) Moreel L, Proesmans M. High flow nasal cannula as respiratory support in treating infant bronchiolitis: a systematic review. Eur J Pediatr [Internet]. 2020;179(5):711–8. DOI 10.1007/s00431-020-03637-0.
(39) Arredondo-Escalante J, Cabezas-Canoles H. Caracterización de la severidad de la bronquiolitis en menores de dos años [Internet]. 2017 [Citado el 15 de agosto de 2021]. Disponible en: https://repository.unilibre.edu.co/bitstream/handle/10901/10722/73.198.153%20.pdf?sequence=1
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Iatreia
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Papers published in the journal are available for use under the Creative Commons license, specifically Attribution-NonCommercial-ShareAlike 4.0 International.
The papers must be unpublished and sent exclusively to the Journal Iatreia; the author uploading the contribution is required to submit two fully completed formats: article submission and authorship responsibility.
