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Clinical Features of Patients With Bronchiolitis Prior to the Initiation of Noninvasive Respiratory Support
Lindsey L Scheller1, Coral N Crandall1, Kristen E Carlin2,3
1Ms. Scheller, Crandall, Lein, and Mr. DiBlasi are affiliated with Seattle Children's Hospital, Seattle, Washington, USA.
Insights
Clinical factors like respiratory score, retractions, and nasopharyngeal suctioning predict respiratory deterioration in infants with bronchiolitis. Positive affect and behavior may indicate a lower risk of severe illness.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Informatics
Background:
- Effective management of infant bronchiolitis relies on accurate severity assessment.
- Limited research exists on clinical and physiological predictors of respiratory deterioration.
- Identifying these factors is crucial for timely intervention.
Purpose of the Study:
- To identify clinical and physiological variables associated with respiratory deterioration in hospitalized infants with bronchiolitis.
- To inform the development of predictive algorithms for early detection of severe cases.
- To improve patient outcomes through proactive clinical management.
Main Methods:
- Retrospective cohort study of infants under 2 years hospitalized for bronchiolitis.
- Primary outcome: respiratory deterioration requiring respiratory support within 48 hours.
- Multivariable logistic regression analysis of clinical and physiological parameters.
Main Results:
- 26% of patients (154/584) experienced deterioration.
- Significant predictors included higher respiratory score, more retractions, lower S/F ratio, higher pulse rate, and nasopharyngeal suctioning.
- Positive affect and behavior were associated with a lower risk of deterioration.
Conclusions:
- Specific clinical variables can predict respiratory deterioration in infants with bronchiolitis.
- These findings support the development of predictive algorithms for clinical decision support.
- Early identification of at-risk infants can lead to timely interventions and improved care.
Abstract:
Background: Effective management of infants hospitalized with bronchiolitis depends on clinician assessment of disease severity. Although environmental and demographic risk factors help identify severe cases, there is limited research on specific clinical and physiological characteristics associated with respiratory deterioration. This study aimed to identify physiologic variables and clinical parameters associated with respiratory deterioration in hospitalized infants with bronchiolitis. Methods: A single-center retrospective cohort study included previously healthy infants <2 years of age hospitalized for bronchiolitis. The primary outcome measure, deterioration, was defined as respiratory distress requiring noninvasive (including high-flow nasal cannula) or invasive respiratory support within 48 h of admission. A multivariable logistic regression analysis with preselected factors was used to assess the odds of deterioration. Variables included sex, age, affect and behavior, nasopharyngeal suctioning, number, location of retractions, SpO2/FIO2 (S/F ratio), breathing frequency, pulse rate, and respiratory severity score. A secondary analysis assessed retraction locations. Results: Of the 584 eligible patients, 154 (26%) experienced a deterioration event and required noninvasive or invasive respiratory support. Respiratory score (odds ratio [OR] 1.9 [95% CI 1.5-2.4]), total number of retractions (OR: 2.5 [95% CI 1.6-3.8]), S/F ratio (OR: 1.0 [95% CI 0.99-0.998), pulse rate (OR: 1.0 [95% CI 1.0-1.1]), nasopharyngeal suctioning (OR: 5.5 [95% CI 2.6-11.7]), and positive affect and behavior descriptors (OR: 0.3 [95% CI 0.1-0.7]) were associated with deterioration. Age, sex, negative affect and behavior descriptors, and breathing frequency were not statistically significant. Conclusions: These variables may be used to design predictive algorithms that alert clinicians of impending respiratory deterioration in infants with bronchiolitis.
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