Prospective multicenter study of children with bronchiolitis requiring mechanical ventilation

Pediatrics. 2012 Sep;130(3):e492-500. doi: 10.1542/peds.2012-0444. Epub 2012 Aug 6.


Objective: To identify factors associated with continuous positive airway pressure (CPAP) and/or intubation for children with bronchiolitis.

Methods: We performed a 16-center, prospective cohort study of hospitalized children aged <2 years with bronchiolitis. For 3 consecutive years from November 1 until March 31, beginning in 2007, researchers collected clinical data and a nasopharyngeal aspirate from study participants. We oversampled children from the ICU. Samples of nasopharyngeal aspirate were tested by polymerase chain reaction for 18 pathogens.

Results: There were 161 children who required CPAP and/or intubation. The median age of the overall cohort was 4 months; 59% were male; 61% white, 24% black, and 36% Hispanic. In the multivariable model predicting CPAP/intubation, the significant factors were: age <2 months (odds ratio [OR] 4.3; 95% confidence interval [CI] 1.7-11.5), maternal smoking during pregnancy (OR 1.4; 95% CI 1.1-1.9), birth weight <5 pounds (OR 1.7; 95% CI 1.0-2.6), breathing difficulty began <1 day before admission (OR 1.6; 95% CI 1.2-2.1), presence of apnea (OR 4.8; 95% CI 2.5-8.5), inadequate oral intake (OR 2.5; 95% CI 1.3-4.3), severe retractions (OR 11.1; 95% CI 2.4-33.0), and room air oxygen saturation <85% (OR 3.3; 95% CI 2.0-4.8). The optimism-corrected c-statistic for the final model was 0.80.

Conclusions: In this multicenter study of children hospitalized with bronchiolitis, we identified several demographic, historical, and clinical factors that predicted the use of CPAP and/or intubation, including children born to mothers who smoked during pregnancy. We also identified a novel subgroup of children who required mechanical respiratory support <1 day after respiratory symptoms began.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Bronchiolitis, Viral / physiopathology
  • Bronchiolitis, Viral / therapy*
  • Bronchiolitis, Viral / virology
  • Continuous Positive Airway Pressure*
  • Female
  • Humans
  • Infant
  • Intubation, Intratracheal*
  • Male
  • Polymerase Chain Reaction
  • Pregnancy
  • Prenatal Exposure Delayed Effects
  • Smoking / adverse effects