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Evaluation of hospitalized infants and young children with bronchiolitis - a multi centre study
Insights
This study on pediatric bronchiolitis in Bangladesh found common risk factors like young age and socioeconomic status. Most infants recovered, but highlighted variations in diagnosis and treatment outside major cities.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Understanding risk factors and clinical presentation is crucial for effective management.
- Limited data exists on bronchiolitis in resource-limited settings like Bangladesh.
Purpose of the Study:
- To evaluate the risk factors, clinical profile, management, and outcomes of hospitalized young children with bronchiolitis in Bangladesh.
- To investigate the association of respiratory syncytial virus (RSV) with bronchiolitis in this population.
- To identify potential disparities in diagnosis and treatment across different healthcare facilities.
Main Methods:
- A consecutive series of 429 young children with bronchiolitis were evaluated; 348 were studied in detail.
- Data collected included risk factors, clinical symptoms, management, and outcomes via structured questionnaires and hospital records.
- Respiratory syncytial virus (RSV) IgM and IgG antibody status was assessed using ELISA in a subset of patients and controls.
Main Results:
- The majority of affected children were male (66%), under 6 months old (82.7%), and from rural, socioeconomically disadvantaged backgrounds.
- Common clinical features included cough (99%), respiratory distress (97%), and wheeze (100%).
- RSV IgM antibodies were detected in 43.6% of cases. Treatment commonly involved antibiotics (99%) and oxygen therapy (83%), with a 2% mortality rate. Significant differences in diagnosis and treatment (ceftriaxone, parenteral steroids) were noted in hospitals outside Dhaka.
Conclusions:
- Young age, male sex, and lower socioeconomic status are significant risk factors for severe bronchiolitis in Bangladeshi children.
- While most children recover, variations in diagnostic practices and treatment protocols, particularly outside major urban centers, warrant attention.
- Further research is needed to optimize bronchiolitis management strategies in resource-limited settings and address potential RSV seasonality.
Abstract:
Four hundred and twenty nine young children with bronchiolitis admitted consecutively in different hospitals of Bangladesh were evaluated. Three hundred and forty eight children studied for their putative risk factors, clinical profile, management and the outcome. Both cases and controls were examined for respiratory syncytial virus (RSV) antibody status. The diagnosis of bronchiolitis was made on the basis of first attack of wheeze in previously healthy children below two years of age. Detailed history including the possible risk factors, the management and daily follow-up on the ward and the outcome at discharge were documented through a structured questionnaire. Chest x-ray was done in each case to find out the radiological changes. Blood of 266 patients and 30 controls were studied for RSV IgM and IgG antibody by ELISA. There were 66% male and 34% female children. The median age of the children was 3.0 months and 82.7% were below 6 months of age. Most of the babies were born term (88%), with ABW (73%), by normal vaginal delivery (88%). Exclusive or predominant breast-feeding were given in 72% cases. The location of the patient was rural in 55% cases. Around half of the parents were illiterate or slightly educated (up to 5 years schooling) fathers 46.5% and mothers 56% and majority of the parents were poor (74%). In 52% cases the number of family members in one room were four or more. Half of the parents (52%) were smokes and there was atopy in 26.5% families. The clinical features of bronchiolitis were mostly cough (99%), respiratory distress (97%), feeding difficulty (93%) and fast breathing (96%) (median RR 68/min). Fever (1000F or more) was in only 33% cases, though parents complained in 90% cases. All children (100%) had wheeze and crackles in lungs in 96% cases. Liver could be palpable in 83% and spleen in 42% cases. Important radiological features were increased translucency (96%), increased interstitial markings (87%), hyperinflation (75%) and streaky densities (61%). In 69.6% cases TLC was 12,000 or less and only 15% with a neutrophil fraction greater than 60%. Children were positive for IgM antibody in 43.6% cases and both IgM and IgG in 5.3% cases. The main modalities of treatment were antibiotics (99%) (Ampicillin, 76%), oxygen therapy (83%), nebulised salbutamol (76%) and intravenous fluid (51%). The median duration of hospital stay was 4 days. Most of the children were discharged with improvement (96%) with 2% mortality. Not a single case was diagnosed as bronchiolitis in hospitals outside Dhaka. Cefrtiaxone (72.5%) and parenteral steroids (70.5%) were the mainstay of therapy there.