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Factors associated with mild bronchiolitis in young infants
Son H McLaren1, Ying Shelly Qi2, Janice A Espinola2
1Department of Emergency Medicine Columbia University Vagelos College of Physicians and Surgeons New York New York USA.
Insights
Infants under 90 days with mild bronchiolitis were older, had adequate oral intake, and higher oxygen saturation. These factors can help identify infants who may not need hospitalization for bronchiolitis.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Epidemiology
Background:
- Bronchiolitis in early infancy (first 3 months) is a risk factor for severe illness.
- Identifying mild cases in infants under 90 days is crucial for appropriate care and resource allocation.
Purpose of the Study:
- To identify clinical characteristics associated with mild bronchiolitis in infants 90 days or younger presenting to the emergency department (ED).
Main Methods:
- Secondary analysis of a prospective cohort study involving infants 90 days or younger with clinically diagnosed bronchiolitis.
- Mild bronchiolitis defined by discharge from ED without subsequent hospitalization or brief (<24 hours) inpatient stay.
- Multivariable logistic regression used to determine factors associated with mild illness.
Main Results:
- Of 333 eligible infants (≤90 days), 47% experienced mild bronchiolitis; none required mechanical ventilation.
- Older age (61-90 days vs. 0-60 days) was associated with mild bronchiolitis (OR 2.72).
- Adequate oral intake (OR 4.48) and lowest ED oxygen saturation ≥94% (OR 3.12) were also significantly associated with mild illness.
Conclusions:
- Approximately half of infants aged 90 days or younger presenting to the ED with bronchiolitis had a mild course.
- Older age, adequate oral intake, and higher oxygen saturation are key predictors of mild bronchiolitis in this age group.
- These findings can inform strategies to reduce unnecessary hospitalizations for young infants with bronchiolitis.
Objective:
Bronchiolitis within the first 3 months of life is a risk factor for more severe illness. We aimed to identify characteristics associated with mild bronchiolitis in infants ≤90 days old presenting to the emergency department (ED).
Methods:
We conducted a secondary analysis of infants ≤90 days old with clinically diagnosed bronchiolitis using data from the 25th Multicenter Airway Research Collaboration prospective cohort study. We excluded infants with direct intensive care unit admissions. Mild bronchiolitis was defined as (1) sent home after the index ED visit and did not have a return ED visit or had a return ED visit without hospitalization, or (2) were hospitalized from the index ED visit to the inpatient floor for <24 hours. Multivariable logistic regression, adjusting for potential clustering by hospital site, was used to identify factors associated with mild bronchiolitis.
Results:
Of 373 infants aged ≤90 days, 333 were eligible for analysis. Of these, 155 (47%) infants had mild bronchiolitis, and none required mechanical ventilation. Adjusting for infant characteristics, clinical factors associated with mild bronchiolitis included older age (61-90 days vs 0-60 days) (odds ratio [OR] 2.72, 95% confidence interval [CI] 1.52-4.87), adequate oral intake (OR 4.48, 95% CI 2.08-9.66), and lowest ED oxygen saturation ≥94% (OR 3.12, 95% CI 1.55-6.30).
Conclusions:
Among infants aged ≤90 days presenting to the ED with bronchiolitis, about half had mild bronchiolitis. Mild illness was associated with older age (61-90 days), adequate oral intake, and oxygen saturation ≥94%. These predictors may help in the development of strategies to limit unnecessary hospitalization in young infants with bronchiolitis.
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