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Hypophosphatemia in infants with severe bronchiolitis and association with length of mechanical ventilation
Alessandra Lusteau1, Frederic Valla2, Etienne Javouhey1
1Hospices Civils de Lyon, Réanimation Pédiatrique, Hôpital Femme Mère Enfant, Bron, France.
Insights
Hypophosphatemia is common in infants with severe bronchiolitis in the pediatric intensive care unit (PICU). This electrolyte disorder is linked to a longer duration of mechanical ventilation (LOMV) for these young patients.
Area of Science:
- Pediatric critical care medicine
- Neonatology
- Pediatric pulmonology
Background:
- Electrolyte imbalances, particularly hypophosphatemia, are frequently observed in pediatric patients diagnosed with bronchiolitis.
- Severe acute bronchiolitis often necessitates admission to a pediatric intensive care unit (PICU) and requires respiratory support, increasing the risk of complications.
Purpose of the Study:
- To determine the incidence of hypophosphatemia in infants hospitalized with severe acute bronchiolitis.
- To investigate the association between hypophosphatemia and the length of mechanical ventilation (LOMV) in these infants.
Main Methods:
- A retrospective cohort study was conducted on infants aged 7 days to 3 months admitted to the PICU with severe acute bronchiolitis.
- Infants with pre-existing conditions that could confound results were excluded. Primary outcomes included the frequency of hypophosphatemia (<1.55 mmol/L) at admission and during the PICU stay.
- Secondary outcomes assessed the relationship between hypophosphatemia and LOMV, controlling for severity scores and weight.
Main Results:
- Out of 319 infants admitted, 178 met the study criteria. Hypophosphatemia was detected in 41% at PICU admission and 46% during the PICU stay.
- Infants with hypophosphatemia at admission experienced significantly longer LOMV (median 109 hours) compared to those without (median 67 hours).
- Multivariable regression analysis confirmed that lower serum phosphate levels at admission were independently associated with prolonged LOMV, even after adjusting for illness severity and patient weight.
Conclusions:
- Hypophosphatemia is a prevalent finding in infants with severe bronchiolitis requiring PICU care.
- The presence of hypophosphatemia at admission is significantly associated with an increased length of mechanical ventilation in infants with severe bronchiolitis.
Objectives:
Electrolyte disorders occurs frequently in children with bronchiolitis. The aim of the present study was to describe the frequency of hypophosphatemia and to evaluate its association with length of mechanical ventilation in infants admitted to a pediatric intensive care unit (PICU) with bronchiolitis.
Methods:
This retrospective cohort study included infants aged between 7 days and 3 months admitted to a PICU between September 2018 and March 2020 and diagnosed with severe acute bronchiolitis requiring respiratory support. Infants with a chronic condition that could potentially be a confounding factor were excluded. The primary outcome was the frequency of hypophosphatemia (<1.55 mmol/L); the secondary outcomes were the frequency of hypophosphatemia during the PICU stay, and the association with length of mechanical ventilation (LOMV).
Results:
Among the 319 infants admitted 178 had at least one phosphatemia value and were included in the study. The frequency of hypophosphatemia was 41% at PICU admission (61/148) and 46% during the PICU stay (80/172). The median [IQR] LOMV was significantly longer in children with hypophosphatemia at admission (109 [65-195] h vs. 67 [43-128] h, p = 0.007), and in multivariable linear regression lower phosphatemia at admission was associated with longer LOMV (p < 0.001) after controlling for severity (PELOD2 score) and weight.
Conclusion:
Hypophosphatemia was frequent in infants with severe bronchiolitis admitted to a PICU and was associated with a longer LOMV.
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