Evaluation of Infants Hospitalized in Intensive Care Unit Due to Acute Severe Bronchiolitis in Terms of Recurrent Wheezing or Asthma Development

Abstract

Objective: Bronchiolitis stands out as the most prevalent lower respiratory tract infection among young children. Severe bronchiolitis, or bronchiolitis requiring admission to the hospital, affects 2-3% of all infants. The aim of this study was to evaluate individuals who were followed up in the pediatric intensive care unit (PICU) due to severe bronchiolitis in terms of asthma development. Material and Methods: Patients who were admitted Ankara Bilkent City Hospital PICU between January 2013 and December 2022, who were diagnosed with severe bronchiolitis and who had no additional systemic disease were included in the study. Demographic and clinical characteristics of patients, intensive care support treatments, duration of hospital stays, atopic conditions, and respiratory viral panel cultures was documented. The current clinical condition of the patients was documented through hospital records and telephone interviews conducted with their caregivers. The existence of asthma symptoms and the utilization of treatments within the last 12 months were evaluated according to the guidelines of the Global Initiative for Asthma (GINA) and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Results: The mean age of the 60 patients admitted to the intensive care unit who met the study criteria was 13.5±7.2 months. The mean age of the children at the time of the study was 42.5 months. Male gender was more predominant (n=39, 65%). The mean number of days that respiratory support was received in intensive care was 4.9 (±3.5) days and the mean number of days of systemic steroid therapy was 3.8 (±1.7) days. In the viral respiratory tract, Respiratory Syncytial Virus (RSV) was isolated at the highest frequency in 27 patients, accounting for 45%, followed by rhinovirus (n=6, 10%) and Bocavirus (n=5, 8.3%). The number of patients receiving current asthma treatment was (n=33, 55%). Upon assessing the current status, it was found that there had been 25 (41.6%) patients with asthma attacks over the past 12 months. Conclusion: This study revealed that over half of the patients who experienced severe bronchiolitis subsequently developed asthma, with some not being referred to an allergy clinic. Furthermore, it was observed that certain patients, despite presenting with asthma symptoms, were unaware that these symptoms were attributable to asthma. We recommend that patients admitted to the PICU with a diagnosis of severe bronchiolitis be closely monitored for the potential development of asthma and that families be thoroughly informed at the time of discharge.

Keywords

• infants
• pediatric intensive care
• severe bronchiolitis
• asthma
• wheezing

Yoğun Bakım Ünitesinde Akut Şiddetli Bronşiolit Nedeniyle Yatırılan İnfantların Tekrarlayan Hışıltı veya Astım Gelişimi Açısından Değerlendirilmesi

Abstract

Amaç: Bronşiolit, çocuklar arasında en yaygın alt solunum yolu enfeksiyonu olarak öne çıkmaktadır. Hastaneye yatış gerektiren ağır bronşiolit, tüm infantların yaklaşık %2-3’ünü etkilemektedir. Bu çalışmanın amacı, ağır bronşiolit nedeniyle çocuk yoğun bakım ünitesinde (ÇYBÜ) takip edilmiş olan bireyleri astım gelişimi açısından değerlendirmektir. Gereç ve Yöntemler: Ocak 2013 ile Aralık 2022 tarihleri arasında Ankara Bilkent Şehir Hastanesi ÇYBÜ’ye kabul edilen, ağır bronşiolit tanısı almış ve ek sistemik hastalığı olmayan hastalar çalışmaya dahil edilmiştir. Hastaların demografik ve klinik özellikleri, aldıkları yoğun bakım destek tedavileri, hastanede kalış süreleri, atopi durumları ve solunum yolundan izole edilen viral panel sonuçları değerlendirilmiştir. Hastaların mevcut klinik durumu, hastane kayıtları ve bakım verenler ile yapılan telefon görüşmelerinden elde edildi. Astım semptomlarının varlığı ve son 12 ay içinde tedavi kullanımı, GINA ve Uluslararası Çocukluk Çağı Astım ve Alerjileri Çalışması (ISAAC) anketine göre değerlendirildi. Bulgular: Çalışma kriterlerini karşılayan 60 hastanın, yoğun bakımda yatışı yaş ortalaması 13.5 (±7.2) aydı. Çalışma sırasında çocukların ortalama yaşı 42.5 aydı.ekleyelim. Erkek cinsiyet daha baskındı (n=39, %65). Mevcut astım tedavisi alan hasta sayısı 33 (%55) olarak belirlendi. Mevcut durum sorgulandığında, son 12 ayda astım atağı geçirmiş olanların sayısı 25 (%41.6) olarak tespit edildi. Sonuç: Bu çalışmada, şiddetli bronşiolit geçiren hastaların yarısından fazlasında astım geliştiği ve bazı hastaların alerji polikliniğine yönlendirilmediği görülmüştür. Ayrıca, bazı hastaların astım semptomları olmasına rağmen, bu semptomların astımdan kaynaklandığının farkında olmadıkları belirlenmiştir. Ağır bronşiolit tanısı ile ÇYBÜ’ye yatırılan hastaların, astım gelişimi açısından yakından izlenmesi ve taburculuk sırasında ailelerin bilgilendirilmesi gerektiğini öneriyoruz.

Keywords

• astım
• çocuk yoğun bakım
• Ağır bronşiolit
• Bebek

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