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Predictors of Intensive Care Admission in Hypoxemic Bronchiolitis Infants, Secondary Analysis of a Randomized Trial
Donna Franklin1, Franz E Babl2, Jocelyn Neutze3
1Gold Coast University Hospital, Children's Emergency and Critical Care Collaborative Research Group, Southport, Australia; Gold Coast University Hospital, Children's Critical Care, Southport, Australia; Menzies Health Institute Queensland, Griffith University, Australia; The University of Queensland, Faculty of Medicine, Brisbane, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.
Insights
Young infants with bronchiolitis requiring oxygen may need intensive care unit (ICU) admission. Key predictors include age, heart rate, oxygen saturation, prior ICU admission, and illness onset time, regardless of oxygen therapy type.
Area of Science:
- Pediatrics
- Critical Care Medicine
- Respiratory Illness
Background:
- Bronchiolitis is a common respiratory infection in infants.
- Intensive care unit (ICU) admission is a significant outcome for infants with severe bronchiolitis.
- Identifying predictors of ICU admission can aid in clinical decision-making and resource allocation.
Purpose of the Study:
- To identify predictors of ICU admission in infants with bronchiolitis.
- To determine if these predictors are consistent across different oxygenation methods (high-flow vs. standard oxygen).
Main Methods:
- Secondary analysis of a multicenter randomized controlled trial involving 1472 infants (<12 months) with bronchiolitis.
- Evaluation of baseline characteristics, physiological data, and medical history as predictors of ICU admission.
- Multivariate analysis to assess the significance of identified predictors.
Main Results:
- 146 out of 1472 infants were admitted to the ICU.
- Key predictors of ICU admission included younger age (weeks), pre-enrolment heart rate >160/min, lower pre-enrolment SpO2 (%), previous ICU admission, and shorter time from illness onset to hospital presentation.
- These predictors demonstrated similar robustness for infants receiving high-flow nasal cannula therapy and standard-oxygen therapy.
Conclusions:
- Infants with bronchiolitis presenting with specific clinical factors are at higher risk for ICU admission.
- Factors such as age <2 months, heart rate >160/min, SpO2 <87%, prior ICU admission, and rapid symptom onset (≤2 days) predict ICU admission.
- These predictive factors are independent of the oxygenation method used, highlighting their universal applicability in managing bronchiolitis.
Objectives:
To evaluate in a preplanned secondary analysis of our parent randomized controlled trial predictors of intensive care unit (ICU) admission in infants with bronchiolitis and analyze if these predictors are equally robust for children receiving high-flow or standard-oxygen.
Study Design:
A secondary analysis of a multicenter, randomized trial of infants aged <12 months with bronchiolitis and an oxygen requirement was performed using admission and outcome data of all 1472 enrolled infants. The primary outcome was ICU admission. The predictors evaluated were baseline characteristics including physiological data and medical history.
Results:
Of the 1472 enrolled infants, 146 were admitted to intensive care. Multivariate predictors of ICU admission were age (weeks) (OR: 0.98 [95% CI: 0.96-0.99]), pre-enrolment heart rate >160/min (OR: 1.80 [95% CI: 1.23-2.63]), pre-enrolment SpO2 (transcutaneous oxygen saturation) (%) (OR: 0.91 [95% CI: 0.86-0.95]), previous ICU admission (OR: 2.16 [95% CI: 1.07-4.40]), and time of onset of illness to hospital presentation (OR: 0.78 [95% CI: 0.65-0.94]). The predictors were equally robust for infants on high-flow nasal cannula therapy or standard-oxygen therapy.
Conclusion:
Age <2 months, pre-enrolment heart rate >160/min, pre-enrolment SpO2 of <87%, previous ICU admission and time of onset of ≤2 days to presentation are predictive of an ICU admission during the current hospital admission of infants with bronchiolitis independent of oxygenation method used.
Trial Registration:
ACTRN12613000388718.
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