Systemic Corticosteroids for Acute Viral Bronchiolitis: A Retrospective Multicenter Cohort Study

The American Academy of Pediatrics (AAP) 2014 clinical practice guidelines for acute viral bronchiolitis caution against systemic corticosteroid administration. We sought to estimate corticosteroid prescribing rates among critically ill children hospitalized for bronchiolitis and characterize clinical features by corticosteroid prescription.

We performed a retrospective, multicenter cohort study using the Pediatric Hospital Information System database that included children aged 1 to 23 months admitted for acute viral bronchiolitis within 48 pediatric intensive care units from 2013 to 2023. Corticosteroid prescription rates were assessed by year, season, and institution. Patient characteristics, treatments, and clinical outcomes were compared using cohorts defined by corticosteroid prescription.

Of 81 376 encounters studied, 30 509 (37.5%) were prescribed corticosteroids. Joinpoint regression of annual prescribing rates yielded a single breakpoint model with prescribing rates decreasing by 2.9% per year before and increasing by 2.1% after 2018. Prescription rates ranged widely by center (17.8%-60.9%). Greater corticosteroid prescription was observed in summer as compared to winter months. Compared to those not prescribed corticosteroids, those prescribed corticosteroids were older (mean age: 10.1 ± 6.3 vs 6.9 ± 5.8 months), had a greater median Pediatric Medical Complexity Algorithm classification (2 [interquartile range, IQR: 1-3] vs 1 [IQR: 1-2]), experienced a longer median length of stay (5 [IQR: 3-10] vs 4 [IQR: 3-6] days), had greater invasive mechanical ventilation rates (33.3% vs 11.8%), and greater albuterol prescription rates (29.6% vs 3.9%; all P < .001).

Corticosteroid use among critically ill children with acute viral bronchiolitis remains modest in lieu of AAP recommendations. Prospective research is needed to delineate clinical efficacy for this indication and offer insight for future guidelines.