SARS-CoV-2-related bronchiolitis: a multicentre international study

Cozzi, Giorgio; Sovtić, Aleksandar; Garelli, Davide; Krivec, Uroš; Silvagni, Davide; Corsini, Ilaria; Colombo, Marco; Giangreco, Manuela; Giannattasio, Antonietta; Milani, Gregorio P.; Minute, Marta; Marchetti, Federico; Gatto, Antonio; Debbia, Carla; Gortan, Anna Jolanda; Massaro, Marta; Hatziagorou, Elpis; Ravidà, Domenico; Diamand, Raz; Jones, Elizabeth; Visekruna, Jelena; Zago, Alessandro; Barbi, Egidio; Amaddeo, Alessandro; Wiel, Luisa Cortellazzo

doi:10.1136/archdischild-2023-325448

Cited by 6 publications

(5 citation statements)

References 26 publications

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“…Compared to adults, COVID-19 in infants is often asymptomatic or mildly symptomatic and rarely results in hospitalization [ 28 , 29 ]. The IRIDE study indicates that the pandemic has indirectly induced an increased prevalence and severity of bronchiolitis requiring hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Long-lasting effects of COVID-19 pandemic on hospitalizations and severity of bronchiolitis

Milani,

Ronchi,

Agostoni

et al. 2024

Eur J Pediatr

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Bronchiolitis is a common cause of hospitalization in infants. The long-lasting impact of hygiene and social behavior changes during the pandemic on this disease is debated. We investigated the prevalence of hospitalized cases, clinical severity, and underlying risk factors before and during pandemic. The study was conducted in 27 hospitals in Italy and included infants hospitalized for bronchiolitis during the following four periods: July 2018-March 2019, July 2020-March 2021, July 2021-March 2022, and July 2022-March 2023. Data on demographics, neonatal gestational age, breastfeeding history, underlying chronic diseases, presence of older siblings, etiologic agents, clinical course and outcome were collected. A total of 5330 patients were included in the study. Compared to 2018–19 (n = 1618), the number of hospitalizations decreased in 2020–21 (n = 121). A gradual increase was observed in 2021–22 (n = 1577) and 2022–23 (n = 2014). A higher disease severity (need and length of O2-supplementation, need for non-invasive ventilation, hospital stay) occurred in the 2021–22 and, especially, the 2022–23 periods compared to 2018–19. This tendency persisted after adjusting for risk factors associated with bronchiolitis severity. Conclusions: Compared to adults, COVID-19 in infants is often asymptomatic or mildly symptomatic and rarely results in hospitalization. This study indicates that the pandemic has indirectly induced an increased burden of bronchiolitis among hospitalized infants. This shift, which is not explained by the recognized risk factors, suggests the existence of higher infant vulnerability during the last two seasons. What is known:• The pandemic led to a change in epidemiology of respiratory diseases• Large data on severity of bronchiolitis and underlying risk factors before and during COVID-19 pandemic are scarce What is new:• Compared to pre-pandemic period, hospitalizations for bronchiolitis decreased in 2020–21 and gradually increased in 2021–22 and 2022–23• Compared to pre-pandemic period, higher disease burden occurred in 2021–22 and, especially, in 2022–23. This tendency persisted after adjusting for risk factors associated with bronchiolitis severity• The interplay among viruses, preventive measures, and the infant health deserves to be further investigated

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Section: Discussionmentioning

confidence: 99%

Long-lasting effects of COVID-19 pandemic on hospitalizations and severity of bronchiolitis

Milani,

Ronchi,

Agostoni

et al. 2024

Eur J Pediatr

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“…Five infants presented a coinfection with RSV and required oxygen supplementation, and one patient developed acute bronchiolitis with respiratory distress, requiring respiratory support with HFNC. This highlights the importance of considering alternative diagnoses beyond COVID-19, especially in cases of respiratory failure or the need for respiratory support, and the possibility of coinfections with more aggressive respiratory viruses [ 19 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway

Bellini,

Brisca,

Orfanos

et al. 2024

Healthcare

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Aim: To provide a comprehensive description of the clinical features, biochemical characteristics, and outcomes of infants up to 90 days old with COVID-19. Moreover, to assess the severity of the disease and propose an effective management pathway. Methods: Retrospective single-center study spanning three years. Patient data includes age, sex, symptoms, comorbidities, blood and urine test results, cultures, admission, length of stay, therapies, intensive care unit admission, and mortality. Results: A total of 274 patients were enrolled in the study, comprising 55% males. Among them, 60 patients (22%) were under the age of 29 days, while 214 (78%) fell within the 29 to 90 days age range. The overall incidence of SARS-CoV-2 infections was 0.28 per 10,000 Pediatric Emergency Department admissions. Blood inflammatory markers showed no significant abnormalities, and there were no recorded instances of positive blood cultures. Less than 1% of infants showed urinary tract infections with positive urine cultures, and 1.5% of patients had a concurrent RSV infection. Hospitalization rates were 83% for neonates and 67% for infants, with a median length of stay (LOS) of 48 h for both age groups. None of the patients required admission to the Pediatric or Neonatal Intensive Care Unit, and only one required High Flow Nasal Cannula (HFNC). No secondary serious bacterial infections were observed, and all hospitalized patients were discharged without short-term sequelae. No deaths were reported. Discussion and Conclusions: Infants with COVID-19 generally exhibit milder or asymptomatic forms of the disease, making home management a viable option in most cases. Blood tests, indicative of a mild inflammatory response, are recommended primarily for children showing symptoms of illness. Hospitalization precautions for infants without apparent illness or comorbidities are deemed unnecessary. Given the evolving nature of experiences with COVID-19 in infants, maintaining a high level of clinical suspicion remains imperative.

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“…Bronchiolitis is one of the most common viral infections in infants and the respiratory syncytial virus has been the most frequently associated pathogen with this disease 1 . The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, which causes COVID‐19, typically presents with respiratory symptoms 2 . Although SARS‐CoV‐2 has been reported to be a possible rare cause of bronchiolitis, 2 further research is needed to understand this relationship.…”

Section: Unadjusted Analysesa Total Sample Cases Controls Pmentioning

confidence: 99%

“…The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, which causes COVID‐19, typically presents with respiratory symptoms 2 . Although SARS‐CoV‐2 has been reported to be a possible rare cause of bronchiolitis, 2 further research is needed to understand this relationship. The aim of this study was to explore the hypothesis that SARS‐CoV‐2 was one of the respiratory viruses that caused bronchiolitis in Italy.…”

Section: Unadjusted Analysesa Total Sample Cases Controls Pmentioning

confidence: 99%

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Multi‐centre study concluded that the severe acute respiratory syndrome coronavirus 2 was not a primary cause of bronchiolitis in infants

Milani,

Marchisio,

Agostoni

et al. 2024

Acta Paediatrica

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Bronchiolitis is one of the most common viral infections in infants and the respiratory syncytial virus has been the most frequently associated pathogen with this disease. 1 The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which causes COVID-19, typically presents with respiratory symptoms. 2Although SARS-CoV-2 has been reported to be a possible rare cause of bronchiolitis, 2 further research is needed to understand this relationship. The aim of this study was to explore the hypothesis that SARS-CoV-2 was one of the respiratory viruses that caused bronchiolitis in Italy.This multi-centre case-control study included all infants up to 1 year of age that fulfilled the inclusion criteria between 1 October 2021 and 31 March 2023 when they presented to the paediatric

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SARS-CoV-2-related bronchiolitis: a multicentre international study

Cited by 6 publications

References 26 publications

Long-lasting effects of COVID-19 pandemic on hospitalizations and severity of bronchiolitis

Long-lasting effects of COVID-19 pandemic on hospitalizations and severity of bronchiolitis

Clinical Course, Laboratory Findings, and Prognosis of SARS-CoV-2 Infection in Infants up to 90 Days of Age: A Single-Center Experience and a Proposal for a Management Pathway

Multi‐centre study concluded that the severe acute respiratory syndrome coronavirus 2 was not a primary cause of bronchiolitis in infants

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