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Prospective multicenter study of children with bronchiolitis requiring mechanical ventilation
Jonathan M Mansbach1, Pedro A Piedra, Michelle D Stevenson
1Department of Medicine, Children’s Hospital Boston, Harvard Medical School, Boston, , MA 02115, USA. jonathan.mansbach@childrens.harvard.edu
Pediatrics
|August 8, 2012
Summary
Infants hospitalized with bronchiolitis needing respiratory support were younger, had apnea, or severe breathing difficulty. Maternal smoking during pregnancy also increased the need for continuous positive airway pressure (CPAP) and/or intubation.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Infectious Diseases
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Severe cases may require mechanical respiratory support.
- Identifying risk factors for severe bronchiolitis is crucial for timely intervention.
Purpose of the Study:
- To identify demographic, historical, and clinical factors predicting the need for continuous positive airway pressure (CPAP) and/or intubation in hospitalized children with bronchiolitis.
Main Methods:
- A 16-center, prospective cohort study of hospitalized children aged <2 years with bronchiolitis.
- Clinical data and nasopharyngeal aspirates were collected over three consecutive winter seasons.
- Nasopharyngeal aspirates were tested for 18 pathogens using polymerase chain reaction.
Main Results:
- 161 children required CPAP and/or intubation.
- Predictive factors included younger age (<2 months), maternal smoking during pregnancy, low birth weight, rapid onset of breathing difficulty, apnea, inadequate oral intake, severe retractions, and low oxygen saturation (<85%).
- The multivariable model achieved an optimism-corrected c-statistic of 0.80.
Conclusions:
- Several factors predict the need for mechanical respiratory support in infants with bronchiolitis.
- Maternal smoking during pregnancy is a significant risk factor.
- A subgroup requiring support within one day of symptom onset was identified.
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