SARS-CoV-2-related bronchiolitis: a multicentre international study

Giorgio Cozzi; Aleksandar Sovtic; Davide Garelli; Uros Krivec; Davide Silvagni; Ilaria Corsini; Marco Colombo; Manuela Giangreco; Antonietta Giannattasio; Gregorio Paolo Milani; Marta Minute; Federico Marchetti; Antonio Gatto; Carla Debbia; Anna Jolanda Gortan; Marta Massaro; Elpis Hatziagorou; Domenico Ravidà; Raz Diamand; Elizabeth Jones; Jelena Visekruna; Alessandro Zago; Egidio Barbi; Alessandro Amaddeo; Luisa Cortellazzo Wiel; SARS-CoV-2 bronchiolitis study group

doi:10.1136/archdischild-2023-325448

SARS-CoV-2-related bronchiolitis: a multicentre international study

Arch Dis Child. 2023 Sep;108(9):e15. doi: 10.1136/archdischild-2023-325448. Epub 2023 May 2.

Authors

Giorgio Cozzi¹, Aleksandar Sovtic^{2

3}, Davide Garelli⁴, Uros Krivec^{5

6}, Davide Silvagni⁷, Ilaria Corsini⁸, Marco Colombo⁹, Manuela Giangreco¹⁰, Antonietta Giannattasio¹¹, Gregorio Paolo Milani^{12

13}, Marta Minute¹⁴, Federico Marchetti¹⁵, Antonio Gatto¹⁶, Carla Debbia¹⁷, Anna Jolanda Gortan¹⁸, Marta Massaro¹⁹, Elpis Hatziagorou²⁰, Domenico Ravidà²¹, Raz Diamand²², Elizabeth Jones²³, Jelena Visekruna², Alessandro Zago²⁴, Egidio Barbi^{25

24}, Alessandro Amaddeo²⁵, Luisa Cortellazzo Wiel²³; SARS-CoV-2 bronchiolitis study group

Collaborators

SARS-CoV-2 bronchiolitis study group:
Bojana Gojšina, Tijana Grba, Mihail Basa, Silvia Carlassara, Marcello Lanari, Antonia Pascarella, Antonietta Curatola, Sara Pedicini, Petrina Vantsi, Federica Vanoni, Nitai Levy, Sergio Ghirardo, Angela Troisi, Alessandra Iacono, Claudia Bondone, Samantha Bosis

Affiliations

¹ Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy giorgio.cozzi@burlo.trieste.it.
² Institute for Health Protection of Mother and Child of Serbia 'Dr Vukan Cupic', Beograd, Serbia.
³ University of Belgrade Faculty of Medicine, Beograd, Serbia.
⁴ Regina Margherita Children's Hospital, Turin, Italy.
⁵ Department of Pediatric Pulmology, University Children's Hospital Ljubljana, Ljubljana, Slovenia.
⁶ Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
⁷ Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
⁸ IRCCS Policlinico Ospedaliero Universitario di Bologna, Bologna, Italy.
⁹ Pediatric Emergency Deparment, Ospedale Filippo del Ponte, ASST Sette Laghi, Varese, Italy.
¹⁰ Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
¹¹ Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
¹² Paediatric Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
¹³ Department of Clinical Science and Community Health, University of Milan, Milan, Italy.
¹⁴ Ospedale Regionale Ca Foncello Treviso, Treviso, Italy.
¹⁵ Department Of Pediatrics, Ospedale S. Maria delle Croci, Ravenna, Italy.
¹⁶ Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
¹⁷ Emergency Departement, IRCCS Istituto Giannina Gaslini, Genova, Italy.
¹⁸ Azienda sanitaria universitaria Friuli Centrale, Udine, Italy.
¹⁹ Ospedale Santa Maria degli Angeli di Pordenone, Pordenone, Italy.
²⁰ Pediatric Pulmonology Unit, 3rd Pediatric Dept, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece.
²¹ Institute of Pediatrics of Southern Switzerland, EOC, Bellinzona, Switzerland.
²² Ruth Rappaport Children's Hospital, Haifa, Israel.
²³ Bradford Royal Infirmary, Bradford, UK.
²⁴ University of Trieste, Trieste, Italy.
²⁵ Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.

PMID: 37130726
DOI: 10.1136/archdischild-2023-325448

Abstract

Background: Bronchiolitis is the main acute lower respiratory tract infection in infants. Data regarding SARS-CoV-2-related bronchiolitis are limited.

Objective: To describe the main clinical characteristics of infants with SARS-CoV-2-related bronchiolitis in comparison with infants with bronchiolitis associated with other viruses.

Setting, patients, interventions: A multicentre retrospective study was conducted in 22 paediatric emergency departments (PED) in Europe and Israel. Infants diagnosed with bronchiolitis, who had a test for SARS-CoV-2 and were kept in clinical observation in the PED or admitted to hospital from 1 May 2021 to 28 February 2022 were considered eligible for participation. Demographic and clinical data, diagnostic tests, treatments and outcomes were collected.

Main outcome measures: The main outcome was the need for respiratory support in infants testing positive for SARS-CoV-2 compared with infants testing negative.

Results: 2004 infants with bronchiolitis were enrolled. Of these, 95 (4.7%) tested positive for SARS-CoV-2. Median age, gender, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative infants. Human metapneumovirus and respiratory syncytial virus were the viruses most frequently detected in the group of infants negative for SARS-CoV-2.Infants testing positive for SARS-CoV-2 received oxygen supplementation less frequently compared with SARS-CoV-2-negative patients, 37 (39%) vs 1076 (56.4%), p=0.001, OR 0.49 (95% CI 0.32 to 0.75). They received less ventilatory support: 12 (12.6%) high flow nasal cannulae vs 468 (24.5%), p=0.01; 1 (1.0%) continuous positive airway pressure vs 125 (6.6%), p=0.03, OR 0.48 (95% CI 0.27 to 0.85).

Conclusions: SARS-CoV-2 rarely causes bronchiolitis in infants. SARS-CoV-2-related bronchiolitis mostly has a mild clinical course.

Keywords: Covid-19; emergency care; infant welfare; paediatric emergency medicine.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Bronchiolitis* / diagnosis
Bronchiolitis* / epidemiology
Bronchiolitis* / therapy
COVID-19* / complications
COVID-19* / epidemiology
Child
Hospitalization
Humans
Infant
Retrospective Studies
SARS-CoV-2