TOP 68 - Post COVID-19 pandemic trends in disease severity and management of RSV and HRV bronchiolitis

Publication Number: 1827.TOP 68

Mary R. Loftus, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Ioni Kokodis, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Arnab Sengupta, Promedica Ebeid Children’s Hospital, Toledo, OH, Sylvania, OH, United States; Ashley Wolf, Comer Children's Hospital at University of Chicago Medical Center, CHICAGO, IL, United States; Hannah Murphy, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Courtney Sniffen, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Nancy Ghanayem, University of Chicago Division of the Biological Sciences The Pritzker School of Medicine, DOWNERS GROVE, IL, United States

Background: Viral bronchiolitis is the leading cause of hospitalization for children younger than two years and is most often caused by respiratory syncytial virus (RSV) and human rhinovirus (HRV). Patients with RSV are often younger with fewer comorbidities but higher bronchiolitis severity scores. Those with HRV are often older and predisposed to atopy and future asthma diagnoses. Since the COVID-19 pandemic, bronchiolitis has been associated with increased hospitalizations and intensive care services with a rise in viral co-infections.

Objective: The objective of this study is to investigate predictors of illness severity and differences in management practices and outcomes in patients with RSV, HRV, and combined RSV/HRV bronchiolitis in the post-COVID-19 era.

Design/Methods: Institutional review board approval was obtained for this single institution retrospective review of hospitalized patients aged 0-24 months from 07/2021 to 06/2024 with bronchiolitis due to RSV and/or HRV. ICD-10 codes identified potential encounters which were confirmed by chart review. Patient data collected for the eligible cohort included demographics, birth gestational age, prior bronchiolitis, comorbid conditions, respiratory viral panel (RVP) results, admitting unit, respiratory support, prescribed medications, and length of stay (LOS). Patients were excluded if RVP screening was not performed or if other viruses were detected. Additional exclusion criteria included prior diagnosis of asthma, tracheostomy, or cyanotic or unrepaired congenital heart disease. Stata (College Station, TX) was used to perform univariable logistic regression analyses. Odds ratios, 95% confidence intervals, and p-values were calculated, with a p < 0.05 considered significant.

Preliminary

Results: ICD-10 codes identified 2260 encounters of which 649 (29%) met inclusion criteria. The cohort includes 306 (47%) patients with HRV, 253 (39%) with RSV and 90 (14%) with both viruses. Nearly two thirds (409/649) of the cohort received care in the PICU (Table 1). Patients with HRV had higher odds of steroid (OR 2.55, p < 0.001, 95% CI 1.70-3.83) and albuterol (OR 1.76, p = 0.001, 95% CI 1.25-2.47) prescription, lower odds of superimposed bacterial infection (OR 0.45, p = 0.002, 95% CI 0.27-0.75) and shorter hospital LOS (OR 0.09, p = 0.001, 95% CI 0.02-0.40) compared to those with RSV. Coinfected patients had higher odds of ICU care (OR 1.74, p = 0.027, 95% CI 1.06-2.84), longer hospital LOS (OR 2.77, p = 0.02, 95% CI 1.18-6.54), and higher levels of respiratory support (OR 2.64, p = 0.001, 95% CI 1.52-4.58) than single virus infection alone.

Table 1: Patient Characteristics


Table 2: Clinical Characteristics