.jpg "Charlene Pringle, CPNP, FCCM (she/her/hers) photo")
Charlene Pringle, CPNP, FCCM (she/her/hers)
Pediatric Critical Care Nurse Practitioner
University of Florida
Gainesville, Florida
Disclosure information not submitted.
Leslie Avery, MD, JD, MBA
Chief and Clinical Associate Professor, Department of Pediatrics, Critical Care Medicine
University of Florida, United States
Disclosure information not submitted.
Title: Trend of critical bronchiolitis following easing of SARS-CoV-2 precautions
Introduction: Public health measures implemented to slow the spread of the SARS-CoV-2 pandemic resulted in a marked decrease in the overall incidence of viral infections and Pediatric Intensive Care Unit (PICU) admissions nationwide. Following the easing of local restrictions in Gainesville, FL in March 2021, a significant uptick in patients were admitted to UF Health Shands Children’s Hospital with a diagnosis of bronchiolitis presenting with multiple viral co-infections and an increased disease severity, requiring more interventions compared to previous years. The objective was to determine if more patients with bronchiolitis required PICU admission during the typical “off-season” of critical bronchiolitis compared with pre-pandemic numbers.
Methods: We conducted a retrospective chart review of PICU admissions with ICD-10 codes capturing the diagnosis of bronchiolitis from March 29 through June 19, 2021 (post precautions) and compared them with historical cohorts for the same pre-pandemic weeks in 2017, 2018 and 2019.
Results: 120 children were admitted with critical bronchiolitis from March 29 through June 19; 25% of those (n =78) were RSV positive. A combination of 10 other viruses were detected in the non-RSV critical bronchiolitis patients. Comparing the same time span for the three years prior to the pandemic, the number of children admitted with critical bronchiolitis was 27 (2017), 36 (2018) and 23 (2019). When the cohort from 2021 is compared with the same 12 week cohorts from 2017, 2018, and 2019, the odds of being admitted to the PICU were substantially higher than the three years prior to the pandemic: 2017 OR = 5.8 (95% CI 3.7,9.1 p< 0.0001), 2018 OR = 4.4 (95% CI 2.9,6.6 p< 0.0001), 2019 OR = 6.7 (95% CI 4.1,10.9 p < 0.0001).
Conclusions: A significant increase in bronchiolitis cases requiring PICU admission occurred following easing of local SARS-CoV-2 restrictions. One possible explanation is the lack of immunity developed against common respiratory viruses that cause bronchiolitis during the time frame of social distancing and mandatory mask usage. Further study is currently underway investigating whether these post-precautions’ cohort has increased morbidity (measured by severity of illness, respiratory support, and length of stay), and the possible impact of additional viral co-infections.