Abstract | Objectives: The purpose of this study was to evaluate differences in the severity of
bronchiolitis in children younger than one year of age before and after the lockdown caused by
the covid-19 pandemic.
Materials and methods: This retrospective study examined children up to 365 days of
age hospitalized for bronchiolitis in two periods, classified by before and after the lockdown:
from 1st of April, 2018 until 31st of March, 2020 and from 1st of May, 2021 until 30th of April,
2023. Focus was placed on the influence of the lockdown on the severity of bronchiolitis in
children younger than one year of age. We analyzed the following parameters: general
information of the studied children (hospitalization rate of bronchiolitis, virus, coinfection,
monthly admission, length of stay in hospital), socio-demographic data (sex, age) and the
severity of bronchiolitis (bacterial infection, oxygen therapy, mechanical ventilation/respiratory
support, intensive care unit).
Results: Our survey consisted of 323 children comprising 163 before and 160 children
after the lockdown. After screening for the diagnosis of bronchiolitis, our study included only
247 children who were used for the further major examinations. 128 children of them belonged
to the period before the lockdown, the remaining 119 children participated in the period after
the lockdown. RSV was the most common detectable viral agent in both phases with an increase
in the post-lockdown period (72.7 % vs. 84.0 %; P = 0.021). Seasonal occurrence of
bronchiolitis, specifically RSV-bronchiolitis, shifted due to the lockdown (P < 0.001). First
cases were documented in the summer and early fall months with peak in November (0.0 % vs.
38.7 %). Few cases were recorded in January and February (21.1 % vs. 4.2 %, 39.8 % vs.
1.7 %). More boys were affected in both periods, but with a decreasing trend in the postlockdown
phase (63.3 % vs. 55.5 %, P = 0.211). On average, studied children were younger
after the lockdown (120 ± 87 days vs. 105 days ± 81 days, P = 0.249), with an increase in
children younger than 29 days (10.2 % vs. 16.0 %). During both eras, the majority of patients
studied were 29 days to less than three months of age (39.8 % vs. 37.0 %, P = 0.060). Bacterial
superinfections were detected more frequently before the lockdown (7.0 % vs. 4.2 %,
P = 0.337).The necessity of oxygen therapy was more apparent in the children after the
lockdown (38.3 % vs. 48.7 %), even though without statistical significance (P = 0.097). The
latter two parameters were independent of lockdown, sex and age of the patient. The occurrence
of mechanical ventilation/respiratory support was more often after the lockdown (1.6 % vs.
6.7 %) and significantly associated with age (P = 0.010), but again without statistical significance (P = 0.053). Following the lockdown, more children required intensive care and
treatment (6.2 % vs. 16.0 %, P = 0.014), significantly influenced by lockdown and age
(P = 0.040, P = 0.003). Our study achieved no difference in the case of coinfection (1.6 % vs.
1.7 %) and length of hospital stay (two days most frequently, 4 days ± 2 days and 4 days ±
3 days on average).
Conclusion: The introduction and subsequent enactment of the lockdown with its
associated NPIs have an impact on the severity of bronchiolitis in pediatric patients. Upward
trends concerning oxygen therapy, mechanical ventilation/respiratory support, and intensive
care could be demonstrated. However, further studies are needed to investigate the severity of
bronchiolitis in children under the influence of the lockdown in more detail, with greater
precision and in a larger population. |
Abstract (croatian) | Ciljevi: Svrha ovog istraživanja bila je procijeniti razlike u težini bronhiolitisa u djece
mlađe od godinu dana prije i nakon zaključavanja uzrokovanog pandemijom covid-19.
Materijali i metode: Ova retrospektivna studija ispitivala je djecu do 365 dana starosti
hospitaliziranu zbog bronhiolitisa u dva razdoblja, klasificirana prije i nakon zaključavanja: od
1. travnja 2018. do 31. ožujka 2020. i od 1. svibnja 2021. do 30. travnja 2023. Fokus je stavljen
na utjecaj zaključavanja na ozbiljnost bronhiolitisa u djece mlađe od godinu dana. Analizirali
smo sljedeće parametre: opće podatke ispitivane djece (stopa hospitalizacije bronhiolitisa,
virusa, koinfekcije, mjesečni prijem, duljina boravka u bolnici), sociodemografske podatke
(spol, dob) i težinu bronhiolitisa (bakterijska infekcija, terapija kisikom, mehanička
ventilacija/respiratorna podrška, jedinica intenzivne njege).
Rezultati: Istraživanje se sastojalo od 323 djece koja su se sastojala od 163 djece prije
i 160 djece nakon zaključavanja. Nakon probira za dijagnozu bronhiolitisa, naša studija je
uključila samo 247 djece koja su korištena za daljnje velike preglede. Njih 128 djece pripadalo
je razdoblju prije zaključavanja, preostalih 119 djece sudjelovalo je u razdoblju nakon
zaključavanja. RSV je bio najčešći virusni agens koji se može otkriti u obje faze s povećanjem
razdoblja nakon zaključavanja (72,7 % naspram 84,0 %; P = 0,021). Sezonska pojava
bronhiolitisa, posebno RSV-bronhiolitisa, pomaknuta je zbog zaključavanja (p < 0,001). Prvi
slučajevi zabilježeni su u ljetnim i ranim jesenskim mjesecima, a vrhunac je zabilježen u
studenome (0,0 % naspram 38,7 %). U siječnju i veljači zabilježeno je nekoliko slučajeva
(21,1 % naspram 4,2 %, 39,8 % naspram 1,7 %). U oba su razdoblja oboljeli više dječaka, ali s
trendom smanjenja u fazi nakon zatvaranja (63,3 % u odnosu na 55,5 %, P = 0,211). U prosjeku,
ispitivana djeca bila su mlađa nakon zaključavanja (120 ± 87 dana u odnosu na 105 dana ± 81
dan, P = 0,249), s povećanjem broja djece mlađe od 29 dana (10,2 % naspram 16,0 %). Tijekom
oba razdoblja, većina ispitanih pacijenata bila je u dobi od 29 dana do manje od tri mjeseca
(39,8 % naspram 37,0 %, P = 0,060). Bakterijske superinfekcije otkrivene su češće prije
zaključavanja (7,0 % naspram 4,2 %, P = 0,337). Potreba za terapijom kisikom bila je očitija u
djece nakon zatvaranja (38,3 % naspram 48,7 %), iako bez statističke značajnosti (P = 0,097).
Potonja dva parametra bila su neovisna o zaključavanju, spolu i dobi pacijenta. Pojava
mehaničke ventilacije/respiratorne potpore bila je češća nakon zaključavanja (1,6 % naspram 6,7 %) i značajno povezana s dobi (p = 0,010), ali opet bez statističke značajnosti (P = 0,053).
Nakon zatvaranja više djece zahtijevalo je intenzivnu njegu i liječenje (6,2 % u odnosu na
16,0 %, P = 0,014), pod znatnim utjecajem ograničenja kretanja i dobi (P = 0,040, P = 0,003).
U ovom istraživanju nije postignuta razlika u slučaju koinfekcije (1,6 % naspram 1,7 %) i
duljini boravka u bolnici (dva dana najčešće, 4 dana ± 2 dana i 4 dana ± 3 dana u prosjeku).
Zaključci: Uvođenje i naknadno donošenje zaključavanja s povezanim NPI-ima utječe
na ozbiljnost bronhiolitisa u pedijatrijskih bolesnika. Mogli bi se pokazati uzlazni trendovi u
vezi s terapijom kisikom, mehaničkom ventilacijom / respiratornom podrškom i intenzivnom
njegom. Međutim, potrebna su daljnja istraživanja kako bi se detaljnije istražila ozbiljnost
bronhiolitisa u djece pod utjecajem zaključavanja, s većom preciznošću i u većoj populaciji. |