Expected Clinical Trajectory of Severe Bronchiolitis Doesn't Pass Muster in New Study

By Reuters Staff

October 23, 2020

NEW YORK (Reuters Health) - A new study challenges the notion that bronchiolitis symptoms peak on days three to five of illness in hospitalized infants.

"Severe bronchiolitis is a heterogeneous condition with an unpredictable clinical course. Practitioners should exercise caution when making clinical decisions or providing anticipatory guidance on the basis of symptom duration," Dr. Alan Schroeder of Stanford University in California and colleagues say in a paper in Pediatrics.

Bronchiolitis makes up roughly 18% of all hospitalizations in infants and young children. It's been described as having an "expected clinical trajectory" with symptom severity peaking between three and five days. But Dr. Schroeder and colleagues found no association between day of illness at admission and clinically important outcomes in bronchiolitis hospitalizations.

Their findings are based on data from two multicenter prospective studies involving 746 children under 2 years of age admitted to the hospital for bronchiolitis. The median day of illness at admission was four (range, two to five days).

Day of illness at admission was not associated with length of stay, positive-pressure ventilation or duration of cough. There was also no significant difference in day of illness at discharge in children readmitted versus not readmitted to the hospital.

Following discharge, cough lasted for a median of six days; in 65 (14.3%) children, the cough lingered for 14+ days.

One limitation of the study is the reliance on admission notes to gauge onset of illness, which is subject to caregiver recall and may not reflect the true trajectory of the disease.

"Our findings should help inform the anticipatory guidance provided to families during bronchiolitis hospitalizations and might discourage practitioners from using day of illness to influence clinical decision-making," the researchers say.

"Rather than using the day of illness to anchor clinical management and anticipatory guidance, day-to-day progress may be a more reliable predictor of the disease trajectory," they suggest.

Dr. Schroeder did not respond to a request for comments by press time.

SOURCE: https://bit.ly/3dPrQdP Pediatrics, online October 22, 2020.

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