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

Area of Science:

• Pediatric critical care medicine
• Pharmacology and therapeutics
• Infectious diseases

Background:

• The American Academy of Pediatrics (AAP) 2014 guidelines recommend against systemic corticosteroid use for acute viral bronchiolitis.
• Despite recommendations, corticosteroid prescribing patterns in critically ill children with bronchiolitis require investigation.

Purpose of the Study:

• To determine corticosteroid prescribing rates in critically ill children hospitalized for acute viral bronchiolitis.
• To analyze trends in prescribing rates over time and by institution.
• To compare clinical characteristics and outcomes between children who received corticosteroids and those who did not.

Main Methods:

• Retrospective, multicenter cohort study utilizing the Pediatric Hospital Information System database.
• Inclusion of children aged 1-23 months admitted to pediatric intensive care units for acute viral bronchiolitis (2013-2023).
• Assessment of corticosteroid prescription rates by year, season, and institution, with comparative analysis of patient features and outcomes.

Main Results:

• 37.5% of 81,376 encounters involved corticosteroid prescriptions.
• Annual prescribing rates decreased by 2.9% pre-2018 and increased by 2.1% post-2018.
• Corticosteroid use was higher in older children, those with greater medical complexity, longer hospital stays, and increased rates of mechanical ventilation and albuterol use.

Conclusions:

• Corticosteroid use in critically ill children with acute viral bronchiolitis is modest, despite AAP recommendations.
• Significant variation in prescribing rates exists across institutions and seasons.
• Further prospective research is necessary to clarify the clinical efficacy of corticosteroids for this condition and inform future guidelines.