Independent risk factors that effect the hospitalization of acute bronchiolitis

Acute bronchiolitis is an acute lower respiratory tract disease characterized by cough, tachypnea, prolonged expiration, wheezing and retractions, often caused by viral infection in infants under two years of age especially 3-6 months of age. It is accompanied by inflammation of the small airways (bronchiole) and inflammatory obstruction. Acute bronchiolitis, which varies according to seasonal frequency, is most prevalent in the winter and spring. It occurs in 10-20% of children under two years of age especially in boys. RSV bronchiolitis is the most common cause of hospitalization and lower respiratory tract infections in infants. 90% of children are infected with RSV in the first two years of life, and 40% of these children are suffering from lower respiratory tract infections. Cochrane data and many guidelines recommend a few treatments for acute bronchiolitis. The main purpose of treatment is providing adequate fluid balance in acute disease and maintaining normal oxygen saturation level. The patients who were hospitalized as acute bronchiolitis with moderate to severe attacks in the Pediatric Emergency and Intensive Care Unit of the Turgut Özal medical center between October 2016 and June 2017 were included in this study. All of the patients were < 2 years old. The patients were randomly included in the study. Informed concents were taken from the parents or caregivers. A total of 95 (61 male, 34 female) patients were included in the study; 59 were moderate attacks and 36 were severe attacks. The median age of both groups was 7 months. Patients were divided into four groups. Inhale β 2 agonist, inhale epinephrine, inhale 3% hypertonic saline and systemic steroid treatment were given to each group of patients. In our study, the duration of hospitalization, the duration of oxygen therapy, the number of complaints at the end of the first week and first month of discharge, and the continuing or repetition of wheezing or cough at the end of the first month of discharge were recorded. When evaluated with logistic regression analysis of factors affecting the duration of acute bronchiolitis (history of CHD, premature birth history, apnea or cyanosis, tachypnea, retraction and wheezing); premature birth history tachypnea, breastfeeding less than 2 moths or no breastfeeding were related with length of hospitalization. There was a 3.16 times more risk duration of hospitalization (95% CI: 0,11-0,89 ,p = 0,03) in non-breastfeeding or breastfeeding < 2 months compared to in the first six months only breastfeeding infants. There was a 6.57 times increased the risk duration of hospitalization (95% CI: 1.44-29.8, p = 0.015) in infants who had premature birth history. The patients who had tachypnea in admission had 14,49 times increased duration of hospitalization (95% CI, 0.01-0.29, p=0,001). And also, there was no significiant difference in duration of hospitalization, duration of oxygen therapy, the number of complaints at the end of first week and first month of discharge repatation of complaints between inhale β₂ agonist, inhale epinefrin, inhale hypertonic saline and systemic steroid taken groups moderate or severe attacks. Our study is one of the studies evaluating the efficacy of different treatment options and factors affecting the duration of hospitalization in acute bronchiolitis. The basic treatment of bronchiolitis is hydration and oxygenation however there are many treatment options with costeffectivenes and efficacy. Patients with high risk factors and espected long duration of hospitalization should be referred to tertiary centers for intensive care follow up.