Background
It remains unclear whether hyponatremia independently predicts a higher severity in children with bronchiolitis.
Objective
To investigate the association between hyponatremia and bronchiolitis severity in children hospitalized to the intensive care unit (ICU) for bronchiolitis.
Methods
We conducted a 16-center, prospective cohort study of hospitalized children age <2 years with bronchiolitis during the winters of 2007 to 2010. We classified patients into two groups: normonatremia (135–145 mEq/L) and hyponatremia (<135 mEq/L) based on the first-measured serum sodium concentration on the day of hospitalization. Outcomes were use of mechanical ventilation and ICU length-of-stay (LOS). To examine the association of sodium status with outcomes, we fit logistic and linear regression models with propensity score adjustment.
Results
Of 231 children hospitalized to the ICU for bronchiolitis, 193 patients (84%) were categorized into the normonatremia group, and 38 children (16%) into hyponatremia group. Compared to children with normonatremia, those with hyponatremia had higher risks of mechanical ventilation use (40% vs. 58%; P=0.04) and longer ICU LOS (median, 3 days vs. 6 days; P=0.007). Likewise, in the adjusted analyses, children with hyponatremia had significantly higher risks of mechanical ventilation use (OR, 2.14; 95%CI, 1.03–4.48; P=0.04) and longer ICU LOS (β-coefficient 2.21 days; 95%CI, 0.68–3.73 days; P=0.003).
Conclusions
In this prospective, multicenter study of children hospitalized for bronchiolitis, hyponatremia on the day of hospitalization was associated with a higher severity. Our data support hyponatremia as a prognostic factor that might improve the ability of clinicians to predict the disease course of children with severe bronchiolitis.