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Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A
Suresh K Angurana1, Lalit Takia1, Subhabrata Sarkar2
1Department of Pediatrics, PGIMER, Chandigarh, India.
Insights
Respiratory syncytial virus (RSV) and rhinovirus are common in infants with acute viral bronchiolitis (AVB). Over one-third of infants required pediatric intensive care unit (PICU) admission, with specific clinical signs predicting this need.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Acute viral bronchiolitis (AVB) is a common respiratory infection in infants.
- Understanding the clinico-virological profile and outcomes is crucial for effective management.
- Identifying predictors for intensive care admission can optimize resource allocation.
Purpose of the Study:
- To describe the clinical and virological characteristics of infants with AVB.
- To detail treatment, intensive care unit (ICU) requirements, and outcomes.
- To identify independent predictors for pediatric intensive care unit (PICU) admission.
Main Methods:
- Prospective observational study of 173 infants with AVB admitted to a tertiary care hospital.
- Data collected on clinical features, viral detection (RSV, rhinovirus, etc.), complications, and treatments.
- Multivariate analysis used to determine predictors for PICU admission.
Main Results:
- Respiratory syncytial virus (RSV) and rhinovirus were the most frequent viral isolates.
- Common symptoms included rapid breathing and cough; tachypnea and chest retractions were prominent on examination.
- Complications occurred in 25% of cases; 34% required PICU admission, with mortality at 8.1%.
Conclusions:
- RSV and rhinovirus are predominant in infant AVB.
- Comorbidity, chest retractions, respiratory failure, shock, and mechanical ventilation need predicted PICU admission.
- Viral isolation or coinfection did not correlate with disease severity or outcomes.
Objectives:
The objective of the study was to describe the clinico-virological profile, treatment details, intensive care needs, and outcome of infants with acute viral bronchiolitis (AVB).
Methodology:
In this prospective observational study, 173 infants with AVB admitted to the pediatric emergency room and pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India during November 2019 to February 2020 were enrolled. The data collection included clinical features, viruses detected [respiratory syncytial virus (RSV), rhinovirus, influenza A virus, parainfluenza virus (PIV) 2 and 3, and human metapneumovirus (hMPV)], complications, intensive care needs, treatment, and outcomes. Multivariate analysis was performed to determine independent predictors for PICU admission.
Results:
Most common symptoms were rapid breathing (98.8%), cough (98.3%), and fever (74%). On examination, tachypnea (98.8%), chest retractions (93.6%), respiratory failure (84.4%), wheezing (49.7%), and crepitations (23.1%) were observed. RSV and rhinovirus were the predominant isolates. Complications were noted in 25% of cases as encephalopathy (17.3%), transaminitis (14.3%), shock (13.9%), acute kidney injury (AKI) (7.5%), myocarditis (6.4%), multiple organ dysfunction syndrome (MODS) (5.8%), and acute respiratory distress syndrome (ARDS) (4.6%). More than one-third of cases required PICU admission. The treatment details included nasal cannula oxygen (11%), continuous positive airway pressure (51.4%), high-flow nasal cannula (14.5%), mechanical ventilation (23.1%), nebulization (74%), antibiotics (35.9%), and vasoactive drugs (13.9%). The mortality was 8.1%. Underlying comorbidity, chest retractions, respiratory failure at admission, presence of shock, and need for mechanical ventilation were independent predictors of PICU admission. Isolation of virus or coinfection was not associated with disease severity, intensive care needs, and outcomes.
Conclusion:
Among infants with AVB, RSV and rhinovirus were predominant. One-third infants with AVB needed PICU admission. The presence of comorbidity, chest retractions, respiratory failure, shock, and need for mechanical ventilation independently predicted PICU admission.
How To Cite This Article:
Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, et al. Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study. Indian J Crit Care Med 2021;25(11):1301-1307.
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