Clinical Profile of Acute Bronchiolitis and Risk Factors for Severe Disease and Mortality in Children 31 Days to 24 Months of Age Admitted in a District Hospital

Background:Acute bronchiolitis, an acute infectious illness of the lower respiratory tract.It is predominantly a viral respiratory disease. An infant with bronchiolitis typically presents with illness during the winter months. General supportive measures are the mainstay of management. Most of these children begin to improve within one or two weeks. But it can lead to severe disease and mortality in some children. Objective:To describe the clinical profile and risk factors for severity and mortality in children 31 days to 24 months of age presenting with acute bronchiolitis at district hospital. Subjects and methods: This Descriptive study / Nested case control study was done at Government District Headquarters Hospital, Namakkal betweenJanuary 2017 and December 2018. 215 children between the age group of 31 days to 24 months who meet the case definition for acute bronchiolitis were included in this study. All cases of severe disease and those who have died were taken as cases and those who had mild and moderate disease were taken as controls in a ratio of 1: 2 and various environmental, demographic and clinical factors were compared between these groups. Statistical analysis was done using SPSS software with 17.0 version. Proportions and mean with standard deviation of outcome measures will be arrived at as applicable and to compare the risk factors among cases and controls, Odds ratio with 95% Confidence Interval will be calculated. To adjust for confounding factors, adjusted OR with 95% Confidence Interval will be arrived by multivariate analysis. Results: Totally 215 children were included in this study. The male to female ratio was 1.7:1. 92 (42.8%) children were between 3 and 6 months of age with a mean age 4.6 months. Most of these cases (83.3%) were reported between the months of October and January. Mean duration of hospital stay was 3.52 days. All children in our study had upper respiratory illness followed by breathlessness. Fever was documented in 69.8% children. Chest x ray showed bilateral hyperinflation in 182(84.65%) children and it was normal in 33(15.35%) children. 97(45.10%) children in our study population, required intravenous hydration. Treatment with adrenaline, salbutamol and hypertonic saline aerosol therapy were given in 123(57.20%), 84(39.10%) and 8(3.70%) children respectively. infants with fever, caesarean delivery, mechanical ventilation in the newborn period and upper respiratory illness in the family were independently associated with increased risk of developing severe disease. Conclusion: If a child with acute bronchiolitis with risk factors, severity should be anticipated and the child should be monitored closely for signs of clinical deterioration. Proper antenatal and neonatal care and creating awareness to the public regarding the separation of family members having upper respiratory illness from young infants will reduce severity of bronchiolitis.