Identification of bronchiolitis profiles in Italian children through the application of latent class analysis
Giuliana Ferrante1, Carmela Fondacaro2, Giovanna Cilluffo3
1Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialities, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy. giuliana.ferrante@unipa.it.
Insights
This study identified three distinct clinical profiles of bronchiolitis in Italian children, revealing significant heterogeneity in this common lower respiratory tract infection. These findings enhance understanding of bronchiolitis variability and aid future research.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Bronchiolitis is a leading lower respiratory tract infection in infants and young children.
- Clinical presentation of bronchiolitis exhibits significant heterogeneity, challenging its classification as a single entity.
- No prior studies have identified distinct bronchiolitis profiles within the Italian pediatric population.
Purpose of the Study:
- To identify discrete clinical profiles of hospitalized Italian children with bronchiolitis.
- To compare identified profiles with those from international cohorts using a clustering approach.
- To investigate the phenotypic variability of bronchiolitis in a specific European population.
Main Methods:
- Retrospective single-center study of 401 children aged ≤2 years hospitalized with bronchiolitis.
- Latent class analysis was employed to classify children based on clinical features and viral etiology.
- Data collected included age at hospitalization, respiratory symptoms (distress, apnea, cough), and viral diagnosis (RSV).
Main Results:
- Three distinct bronchiolitis profiles were identified: Class 1 (49%, infants ≤6 months, high RSV, respiratory distress, no cough), Class 2 (77%, older infants, RSV, cough predominant), and Class 3 (19%, older infants, predominantly male, cough predominant, no apnea).
- Class 1 infants were more likely born near the epidemic season (p=0.028).
- Class 3 infants exhibited significantly longer breastfeeding duration (p=0.004).
Conclusions:
- A clustering approach successfully identified three distinct clinical profiles of bronchiolitis in hospitalized Italian children.
- These profiles show similarities to those identified in international studies, suggesting common underlying patterns.
- The findings highlight the phenotypic variability of bronchiolitis, crucial for targeted research and potential clinical management strategies.
Background:
Bronchiolitis is the primary infection of the lower respiratory tract in children under 2 years of age. Although it is generally considered a single nosological entity, recent studies suggested remarkable clinical heterogeneity. To date, no studies have identified classes of children with bronchiolitis within the Italian population. This study aimed to identify discrete profiles of Italian children hospitalized with bronchiolitis using a clustering approach and to compare findings with those obtained in international cohorts.
Methods:
This was a retrospective single-centre study conducted on children aged ≤2 years hospitalised with bronchiolitis (n = 401) at the Department of Infectious Diseases and the University Department of General Pediatrics in "Giovanni Di Cristina" Pediatric Hospital of Palermo, Italy, between November 2012 and May 2019. Bronchiolitis profiles were determined by latent class analysis, classifying children based on clinical characteristics at admission and viral aetiology.
Results:
Three profiles were identified. Class 1 (49%) was composed of 45% male children; all children were aged ≤6 months at hospitalization; 77% were infected with RSV; 100% had respiratory distress, 11% had apnea and none had cough. Class 2 (77%) was mainly composed of male subjects (51%); 19% were aged > 6 months at admission; 37% were infected with RSV; 12% had respiratory distress, 5% had apnea and 90% had cough. Class 3 (19%) included the largest proportion of male subjects (94%) and was mostly composed of children aged > 6 months at the time of admission (68%); 70% had cough, 12% showed respiratory distress and none presented with apnoea. Children in Class 1 were more frequently born near the epidemic season (p = 0.028); breastfeeding duration was significantly longer for children in Class 3 (p = 0.004).
Conclusions:
The study identified distinct clinical profiles of bronchiolitis by a clustering approach in a single-centre study of children hospitalised for bronchiolitis in Italy. The three bronchiolitis profiles share some similarities with those identified in international studies using the same statistical approach. These findings may help to increase the understanding of the phenotypic variability that typically characterizes bronchiolitis, with relevant implications for future research.
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