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Bronchiolitis, Respiratory syncytial virus, risk factors, epidemiology
Background and Aim: Bronchiolitis stands as a prominent reason for hospitalization globally among children under the age of 2 years. Respiratory syncytial virus (RSV) infection is responsible for the onset of the disease, leading to breathing difficulties and, in severe cases, respiratory failure. The present study aimed to determine the epidemiological and risk factors analysis of children with bronchiolitis admitted to NICU.
Patients and Methods: This retrospective study was carried out on 216 children diagnosed of bronchiolitis in the Pediatric Department of Mardan Medical Complex, Mardan from January 2020 to December 2022. Children aged six years or younger who had been diagnosed with bronchiolitis were enrolled. Respiratory viruses were identified using multiplex polymerase chain reaction.
Results: Of the total 216 children, there were 156 (72.2%) male and 60 (27.8%) female. Among all patients, those under 6 months old contributed the most accounted for 56.5% (n=122) of the total, while 38 (17.6%) individuals experienced severe disease. The primary cause for hospital admissions was wheezing, accounting for 146 (67.6%) cases. All patients displayed typical symptoms of acute bronchiolitis, including cough, rapid breathing (tachypnea), and a runny nose. The incidence of bronchiolitis cases rose during the winter-spring season. Every patient revealed bronchiolitis-related abnormalities on chest X-rays, and 76 individuals (35.2%) displayed air trapping in their lungs. Several risk factors, including age (≤6 months), preterm birth, early weaning, low birth weight, and exposure to cigarette smoke, were associated with an increased possibility of developing severe disease.
Conclusion: The study observed that bronchiolitis remains a prominent cause of admission to the Pediatric Intensive Care Unit (PICU). Also, age, exposure to cigarette smoking, preterm birth, low birth weight, undergoing cesarean section, history of mechanical ventilation, breastfeeding <6 months, and substandard living conditions are different risk factors associated with severe bronchiolitis caused by RSV.
2. Nicolai, A.; Ferrara, M.; Schiavariello, C.; Gentile, F.; Grande, M.; Alessandroni, C.; Midulla, F. Viral bronchiolitis in children: A common condition with few therapeutic options. Early Hum. Dev. 2013, 89, S7–S11.
3. Li, Y.; Wang, X.; Blau, D.M.; Caballero, M.T.; Feikin, D.R.; Gill, C.J.; A Madhi, S.; Omer, S.B.; Simões, E.A.F.; Campbell, H.; et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: A systematic analysis. Lancet 2022, 399, 2047–2064.
4. Tsou, P.; Vadivelan, A.; Kovvuri, M.; Garg, N.; Thangavelu, M.; Wang, Y.; Raj, S. Association between multiple respiratory viral infections and pediatric intensive care unit admission among infants with bronchiolitis. Arch. Pediatr. 2020, 27, 39–44.
5. Naja, Z.; Fayad, D.; Khafaja, S.; Chamseddine, S.; Dbaibo, G.; Hanna-Wakim, R. Bronchiolitis admissions in a Lebanese tertiary medical center: A 10 years’ experience. Front. Pediatr. 2019, 7, 189.
6. Praznik, A.; Vinšek, N.; Prodan, A.; Erčulj, V.; Pokorn, M.; Mrvič, T.; Paro, D.; Krivec, U.; Strle, F.; Petrovec, M.; et al. Risk factors for bronchiolitis severity: A retrospective review of patients admitted to the university hospital from central region of Slovenia. Influ. Other Respir. Viruses 2018, 12, 765–771.
7. Najioullah, F.; Bancons, P.; Césaire, R.; Fléchelles, O. Seasonality and coinfection of bronchiolitis: Epidemiological specificity and consequences in terms of prophylaxis in tropical climate. Trop. Med. Int. Health 2020, 25, 1291–1297
8. Alharbi, N.S.; Alnasser, Y.; Alenizi, A.S.; Alanazi, A.S.; Alharbi, A.H.; AlQurashi, F.O.; Nafisah, I.; Yousef, A.A. Did the national lockdown in saudi arabia reduce lower respiratory illnesses in children? Front. Pediatr. 2021, 9, 717739.
9. Alharbi, A.S.; Alzahrani, M.; Alodayani, A.N.; Alhindi, M.Y.; Alharbi, S.; Alnemri, A. Saudi experts’ recommendation for RSV prophylaxis in the era of COVID-19: Consensus from the Saudi Pediatric Pulmonology Association. Saudi Med. J. 2021, 42, 355–362.
10. Greenberg, D.; Dagan, R.; Shany, E.; Ben-Shimol, S.; Givon-Lavi, N. Incidence of respiratory syncytial virus bronchiolitis in hospitalized infants born at 33–36 weeks of gestational age compared with those born at term: A retrospective cohort study. Clin. Microbiol. Infect. 2020, 26, 256.e1–256.e5.
11. Al-Hindi, M.Y.; Alshamrani, Z.M.; Alkhotani, W.A.; Albassam, A.B.; Tashkandi, A.M.A.; AlQurashi, M.A. Utilization of health-care resources of preterm infants during their first 2 years of life after discharge from neonatal intensive care unit. J. Clin. Neonatol. 2021, 10, 37.
12. Fauroux, B.; Hascoët, J.-M.; Jarreau, P.-H.; Magny, J.-F.; Rozé, J.-C.; Saliba, E.; Schwarzinger, M. Risk factors for bronchiolitis hospitalization in infants: A French nationwide retrospective cohort study over four consecutive seasons (2009–2013). PLoS ONE 2020, 15, e0229766.
13. Lee, Y.-I.; Peng, C.-C.; Chiu, N.-C.; Huang, D.T.-N.; Huang, F.-Y.; Chi, H. Risk factors associated with death in patients with severe respiratory syncytial virus infection. J. Microbiol. Immunol. Infect. 2016, 49, 737–742.
14. Mecklin, M.; Heikkilä, P.; Korppi, M. Low age, low birthweight and congenital heart disease are risk factors for intensive care in infants with bronchiolitis. Acta Paediatr. 2017, 106, 2004–2010.
15. Mohammed, M.H.A.; Agouba, R.; EI Obaidy, I.; Alhabshan, F.; Abu-Sulaiman, R. Palivizumab prophylaxis against respiratory syncytial virus infection in patients younger than 2 years of age with congenital heart disease. Ann. Saudi Med. 2021, 41, 31–35.
16. Alejandre, C.; Guitart, C.; Balaguer, M.; Torrús, I.; Bobillo-Perez, S.; Cambra, F.J.; Jordan, I. Use of procalcitonin and C-reactive protein in the diagnosis of bacterial infection in infants with severe bronchiolitis. Eur. J. Pediatr. 2021, 180, 833–842.
17. Al-Hindi, M.Y.; Aljuhani, H.; Alnajjar, A.R.; Alessa, S.; Alqurashi, M.; Faden, Y.A. Examining the association between parental socioeconomic status and preterm birth using multidomain social determinants scale in a tertiary care center in Saudi Arabia. Cureus 2020, 12, e10506.
18. Jartti T, Smits HH, Bønnelykke K, Bircan O, Elenius V, Konradsen JR, Maggina P, Makrinioti H, Stokholm J, Hedlin G, Papadopoulos N. Bronchiolitis needs a revisit: Distinguishing between virus entities and their treatments. Allergy. 2019 Jan;74(1):40-52.
19. Lee, M.; Goh, A. Mortality in children hospitalised with respiratory syncytial virus infection in Singapore. Singap. Med. J. 2021, 62, 642–646.
20. Homaira N, Wiles LK, Gardner C, Molloy CJ, Arnolda G, Ting HP, Hibbert PD, Braithwaite J, Jaffe A. Assessing the quality of health care in the management of bronchiolitis in Australian children: a population-based sample survey. BMJ quality & safety. 2019 Oct 1;28(10):817-25.
21. Ghazaly M, Nadel S. Characteristics of children admitted to intensive care with acute bronchiolitis. European Journal of Pediatrics. 2018 Jun;177:913-20.
22. Tsou P, Vadivelan A, Kovvuri M, Garg N, Thangavelu M, Wang Y, Raj S. Association between multiple respiratory viral infections and pediatric intensive care unit admission among infants with bronchiolitis. Archives de Pédiatrie. 2020 Jan 1;27(1):39-44.
23. Linssen RS, Bem RA, Kapitein B, Rengerink KO, Otten MH, den Hollander B, Bont L, van Woensel JB, PICE Study Group Wösten-van Asperen Roelie M. Klein Richard H. Kneyber Martin CJ Kuiper Jan Willem Verlaat Carin van Heerde Marc Riedijk Maaike A. van Waardenburg Dick A.. Burden of respiratory syncytial virus bronchiolitis on the Dutch pediatric intensive care units. European Journal of Pediatrics. 2021 Oct;180(10):3141-9.
24. Mitting RB, Peshimam N, Lillie J, Donnelly P, Ghazaly M, Nadel S, Ray S, Tibby SM. Invasive mechanical ventilation for acute viral bronchiolitis: retrospective multicenter cohort study. Pediatric Critical Care Medicine. 2021 Mar 1;22(3):231-40.