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Long-lasting effects of COVID-19 pandemic on hospitalizations and severity of bronchiolitis
Gregorio Paolo Milani1,2, Andrea Ronchi3, Carlo Agostoni1,2
1Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Insights
The COVID-19 pandemic indirectly increased the burden of infant bronchiolitis hospitalizations. Disease severity rose in later pandemic years, even after accounting for risk factors, suggesting increased infant vulnerability.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Bronchiolitis is a leading cause of infant hospitalization.
- The pandemic's impact on infant respiratory disease epidemiology is under investigation.
- Data on bronchiolitis severity and risk factors pre- and during the pandemic are limited.
Purpose of the Study:
- To investigate changes in hospitalized infant bronchiolitis prevalence and clinical severity during the COVID-19 pandemic.
- To identify risk factors associated with bronchiolitis severity before and during the pandemic.
- To assess the pandemic's indirect effects on infant bronchiolitis burden.
Main Methods:
- A retrospective study analyzed data from 5330 infants hospitalized for bronchiolitis across 27 Italian hospitals.
- Data were collected for four periods: pre-pandemic (2018-19) and three pandemic years (2020-21, 2021-22, 2022-23).
- Clinical severity indicators included oxygen supplementation, non-invasive ventilation, and hospital stay duration.
Main Results:
- Hospitalizations decreased significantly in 2020-21 but gradually increased in 2021-22 and 2022-23 compared to pre-pandemic levels.
- Disease severity, indicated by oxygen use, ventilation needs, and hospital stay, was higher in 2021-22 and particularly in 2022-23.
- Increased severity persisted even after adjusting for known bronchiolitis risk factors.
Conclusions:
- The COVID-19 pandemic indirectly increased the burden of bronchiolitis among hospitalized infants.
- Higher disease severity in recent pandemic years suggests increased infant vulnerability, not explained by traditional risk factors.
- Further research is needed on the interplay of viruses, preventive measures, and infant health.
Abstract:
Bronchiolitis is a common cause of hospitalization in infants. The long-lasting impact of hygiene and social behavior changes during the pandemic on this disease is debated. We investigated the prevalence of hospitalized cases, clinical severity, and underlying risk factors before and during pandemic. The study was conducted in 27 hospitals in Italy and included infants hospitalized for bronchiolitis during the following four periods: July 2018-March 2019, July 2020-March 2021, July 2021-March 2022, and July 2022-March 2023. Data on demographics, neonatal gestational age, breastfeeding history, underlying chronic diseases, presence of older siblings, etiologic agents, clinical course and outcome were collected. A total of 5330 patients were included in the study. Compared to 2018-19 (n = 1618), the number of hospitalizations decreased in 2020-21 (n = 121). A gradual increase was observed in 2021-22 (n = 1577) and 2022-23 (n = 2014). A higher disease severity (need and length of O2-supplementation, need for non-invasive ventilation, hospital stay) occurred in the 2021-22 and, especially, the 2022-23 periods compared to 2018-19. This tendency persisted after adjusting for risk factors associated with bronchiolitis severity. Conclusions: Compared to adults, COVID-19 in infants is often asymptomatic or mildly symptomatic and rarely results in hospitalization. This study indicates that the pandemic has indirectly induced an increased burden of bronchiolitis among hospitalized infants. This shift, which is not explained by the recognized risk factors, suggests the existence of higher infant vulnerability during the last two seasons. What is known: • The pandemic led to a change in epidemiology of respiratory diseases • Large data on severity of bronchiolitis and underlying risk factors before and during COVID-19 pandemic are scarce What is new: • Compared to pre-pandemic period, hospitalizations for bronchiolitis decreased in 2020-21 and gradually increased in 2021-22 and 2022-23 • Compared to pre-pandemic period, higher disease burden occurred in 2021-22 and, especially, in 2022-23. This tendency persisted after adjusting for risk factors associated with bronchiolitis severity • The interplay among viruses, preventive measures, and the infant health deserves to be further investigated.
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