Infants under 6 months with bronchiolitis are most likely to need major medical interventions in the 5 days after onset

Abstract

Aim: This study examined the need for, and timing of, major medical interventions (MMIs) in infants under 6 months of age with bronchiolitis. Methods: We reviewed the medical records of 353 children who visited our emergency department with bronchiolitis. MMI was defined as the need for any of the following interventions during admission: supplementary oxygen, intravenous fluids, intravenous antibiotics or admission to the intensive care unit. Results: Altogether 19% of the 353 patients required a MMI and 3% had apnoea. The patients with apnoea were all under 2 months of age, and 90% had a respiratory syncytial virus (RSV) infection and 40% had been born prematurely. The risk of needing a MMI continued for up to 5 days after disease onset. A positive RSV test predicted a MMI with an odds ratio (OR) of 11.5 (95% CI 2.6-50.5), and a fever of over 38°C predicted a MMI with an OR of 3.5 (95% CI 1.4-8.8). Each 1% increase in the initial oxygen saturation value was associated with a decreased risk of MMI (OR 0.7, 95% CI 0.6-0.8). Conclusion: Infants under 6 months of age with bronchiolitis were most likely to need MMIs in the first 5 days after disease onset.