Predictors of Intensive Care Admission in Hypoxemic Bronchiolitis Infants, Secondary Analysis of a Randomized Trial

Donna Franklin; Franz E Babl; Jocelyn Neutze; Simon Craig; Ed Oakley; Jeremy Furyk; Chris M Frampton; Nadia Hasan; Trang Mt Pham; Letitia Miller; John F Fraser; Stuart R Dalziel; Andreas Schibler; A Pediatric Acute Respiratory Intervention Study (PARIS) on behalf of PREDICT

doi:10.1016/j.jpeds.2022.12.006

Predictors of Intensive Care Admission in Hypoxemic Bronchiolitis Infants, Secondary Analysis of a Randomized Trial

J Pediatr. 2023 May:256:92-97.e1. doi: 10.1016/j.jpeds.2022.12.006. Epub 2022 Dec 14.

Affiliations

¹ Gold Coast University Hospital, Children's Emergency and Critical Care Collaborative Research Group, Southport, Australia; Gold Coast University Hospital, Children's Critical Care, Southport, Australia; Menzies Health Institute Queensland, Griffith University, Australia; The University of Queensland, Faculty of Medicine, Brisbane, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia. Electronic address: donna.franklin@health.qld.gov.au.
² Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia; Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
³ Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia; Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand; KidzFirst Middlemore Hospital, Auckland, New Zealand.
⁴ Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia; Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Emergency Department, Monash Medical Centre, Melbourne, Australia.
⁵ Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia; Emergency Department, University Hospital Geelong, Victoria, Australia.
⁶ Department of Medicine, University of Otago Christchurch, New Zealand.
⁷ The University of Queensland, Faculty of Medicine, Brisbane, Australia; Queensland Children's Hospital, South Brisbane, Australia.
⁸ The University of Queensland, Faculty of Medicine, Brisbane, Australia.
⁹ Queensland Children's Hospital, South Brisbane, Australia.
¹⁰ St Andrew's War Memorial Hospital, Brisbane, Australia; Critical Care Research Group, St Andrew's War Memorial Hospital, Brisbane, Australia; Wesley Medical Research, Auchenflower, Queensland, Australia.
¹¹ Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
¹² Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia; St Andrew's War Memorial Hospital, Brisbane, Australia; Critical Care Research Group, St Andrew's War Memorial Hospital, Brisbane, Australia; Wesley Medical Research, Auchenflower, Queensland, Australia.

PMID: 36528052
DOI: 10.1016/j.jpeds.2022.12.006

Abstract

Objectives: To evaluate in a preplanned secondary analysis of our parent randomized controlled trial predictors of intensive care unit (ICU) admission in infants with bronchiolitis and analyze if these predictors are equally robust for children receiving high-flow or standard-oxygen.

Study design: A secondary analysis of a multicenter, randomized trial of infants aged <12 months with bronchiolitis and an oxygen requirement was performed using admission and outcome data of all 1472 enrolled infants. The primary outcome was ICU admission. The predictors evaluated were baseline characteristics including physiological data and medical history.

Results: Of the 1472 enrolled infants, 146 were admitted to intensive care. Multivariate predictors of ICU admission were age (weeks) (OR: 0.98 [95% CI: 0.96-0.99]), pre-enrolment heart rate >160/min (OR: 1.80 [95% CI: 1.23-2.63]), pre-enrolment SpO₂ (transcutaneous oxygen saturation) (%) (OR: 0.91 [95% CI: 0.86-0.95]), previous ICU admission (OR: 2.16 [95% CI: 1.07-4.40]), and time of onset of illness to hospital presentation (OR: 0.78 [95% CI: 0.65-0.94]). The predictors were equally robust for infants on high-flow nasal cannula therapy or standard-oxygen therapy.

Conclusion: Age <2 months, pre-enrolment heart rate >160/min, pre-enrolment SpO₂ of <87%, previous ICU admission and time of onset of ≤2 days to presentation are predictive of an ICU admission during the current hospital admission of infants with bronchiolitis independent of oxygenation method used.

Trial registration: ACTRN12613000388718.

Keywords: intensive care admission; predictors in bronchiolitis.

Publication types

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

MeSH terms

Bronchiolitis* / therapy
Child
Critical Care
Hospitalization*
Humans
Infant
Oxygen / therapeutic use
Oxygen Inhalation Therapy / methods

Substances

Oxygen

Associated data

ANZCTR/ACTRN12613000388718