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Outcomes and Risk Factor Analysis of Plastic Bronchitis Among 321 Children with Influenza Pneumonia After

Qian Hu¹, Jianle Wu¹, Chengqian Wang¹

¹Department of Respiratory Diseases, Shenzhen Children's Hospital, Shenzhen, People's Republic of China.

Infection and Drug Resistance

|June 27, 2023

Insights

Plastic bronchitis (PB) in children with influenza pneumonia is linked to severe outcomes. Early detection via bronchoscopy and identifying risk factors like mediastinal emphysema can improve prognosis for pediatric patients.

Area of Science:

Pediatric Pulmonology
Infectious Diseases
Critical Care Medicine

Background:

Plastic bronchitis (PB) is a rare, severe lung disease.
Influenza virus infection is a common pediatric respiratory illness that can trigger PB.
Understanding PB outcomes and risk factors in children with influenza is crucial.

Purpose of the Study:

To assess the outcomes of pediatric patients with influenza virus pneumonia and PB.
To identify risk factors associated with PB development in this population.
To evaluate the role of bronchoscopy in PB management.

Main Methods:

Retrospective analysis of 321 children with influenza virus pneumonia who underwent bronchoscopy.
Comparison of clinical characteristics, treatment, and outcomes between PB and non-PB patients.
Multivariate analysis to identify risk factors for PB development.

Main Results:

11.2% of patients developed PB, associated with longer fever duration and increased risk of severe conditions (respiratory failure, ARDS, air-leak syndrome).
PB patients required more anti-inflammatory treatment and ventilator support.
Radiographic findings (mediastinal emphysema, lung consolidation) and elevated neutrophils, AST, and LDH were identified as risk factors for PB.

Conclusions:

Influenza virus infection is a significant risk factor for PB in children.
Early identification of PB through bronchoscopy and risk factor assessment can improve patient outcomes.
Despite requiring intensive care, children with PB associated with influenza pneumonia can achieve full recovery.

Read full analysis

Abstract

Background:

Plastic bronchitis (PB) is a rare and severe lung disease. It can be triggered by influenza virus infection, which is a common respiratory infection in children. Bronchoscopy can aid in the early detection and treatment of PB. However, the outcomes and risk for PB development in pediatric patients with influenza virus infection are not fully understood.

Methods:

Data from 321 children diagnosed with influenza virus pneumonia who underwent bronchoscopy examinations between 1st January, 2009 and 31st December, 2020 were retrospectively analyzed to assess the outcomes and risk factors associated with PB development.

Results:

This study included 97 girls and 224 boys with influenza virus pneumonia with a median age of 42 months. Among them, 36 patients (11.2%) were categorized as having PB based on bronchoscopy findings. PB patients had significantly longer fever durations (p=0.010) and higher risks of developing severe conditions including respiratory failure (p<0.001), acute respiratory distress syndrome (p<0.001), and air-leak syndrome (p<0.001) compared to non-PB patients. Conventional treatment including the use of neuraminidase inhibitors and antibiotics did not differ between the PB and non-PB patients, but PB patients required more anti-inflammatory treatment (p=0.019) and ventilator support (p<0.001). Combined univariate and multivariate analyses suggested that radiographic findings, including mediastinal emphysema (p=0.012) and lung consolidation (p=0.012), as well as increased levels of neutrophils (p=0.026), aspartate aminotransferase (p=0.004), and lactate dehydrogenase (p<0.001), were identified as risk factors for PB development in patients with influenza virus pneumonia. Although PB patients required more intensive care and had longer hospital stays, they all recovered well after treatment.

Conclusion:

Influenza virus infection is linked to PB development in children. Identifying risk factors and early intervention such as bronchoscopy can improve the prognosis of children with PB.

Keywords:

bronchoscopy influenza virus pediatric plastic bronchitis pneumonia

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