Last season’s bronchiolitis hospitalizations higher than pre-pandemic rates
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Key takeaways:
- There was a 75.3% rise in bronchiolitis admissions in 2022 to 2023 compared with the median before COVID-19.
- Peak seasons prior to COVID-19 differed from the peak seasons observed during the pandemic.
Compared with the median bronchiolitis admission rate before the COVID-19 pandemic, hospitalizations among children increased during the 2022 to 2023 season, according to results published in JAMA Network Open.
“At the bedside, this means that clinicians at children’s hospitals, and particularly those who work in the ICU, can expect to continue to see disproportionate numbers of bronchiolitis admissions,” Jonathan H. Pelletier, MD, assistant professor of pediatrics at Northeast Ohio Medical University and pediatric intensivist at Akron Children’s Hospital, told Healio. “Without changes to the health care system or clinical workflows, there is a meaningful chance that this will result in recurrent pediatric bed shortages in the fall and winter, similar to what we saw in 2022.”
In a retrospective cross-sectional study of 41 U.S. children’s hospitals, Pelletier and colleagues evaluated 400,801 admissions for bronchiolitis (n = 349,609; median age, 6 months; 58.7% boys; 43.7% white) in children aged younger than 2 years between July 2010 and June 2023, to find out how admissions have changed from before the COVID-19 pandemic (2010-2011, 2019-2020) to during the pandemic (2020-2021, 2022-2023).
Prior to COVID-19, the median number of yearly bronchiolitis hospitalizations was 29,309.
Compared with this number, admissions for bronchiolitis dropped by 69.2% (n = 9,030) between 2020 and 2021, whereas the 2022 to 2023 season showed a 75.3% (n = 51,397) rise in admissions.
“This wasn't a masking study, but it's really worth noting that masking and social distancing in 2020 were remarkably effective in nearly eliminating bronchiolitis in 2020,” Pelletier told Healio. “The cost of that was increased admissions this past year, as a larger-than-normal volume of previously unexposed children contracted these viruses.”
During 2022 to 2023, researchers observed an increase in hospital days by 47.1%, ICU days by 45.2% and inflation-adjusted hospitalization costs by $375.6 million compared with medians before the pandemic.
Further, researchers found several significant differences between patients hospitalized before vs. during the pandemic, including age (6 months vs. 7 months), the number of patients admitted to the ICU (32.2% vs. 36.7%), the number of patients receiving noninvasive ventilation (6.8% vs. 9.4%), the number of patients receiving invasive mechanical ventilation (6.8% vs. 5.3%) and inflation-adjusted costs per admission (median, $9,439 vs. $9,760).
Using forecasts based on monthly admission counts from before the pandemic, researchers found differences in seasonality of admissions during the pandemic.
Before COVID-19, bronchiolitis admissions peaked in December through February, but peak seasons during the pandemic were August and November. The forecast predicted 943 admissions during August 2021, but the actual number of admissions was 5,036. Similarly, more hospitalizations for bronchiolitis occurred in November 2022 than what was forecasted (10,120 vs. 5,268).
Even after factoring out children with complex chronic conditions and repeat admissions in two sensitivity analyses, researchers continued to observe the same results outlined above.
Notably, among those aged younger than 5 years, admissions for bronchiolitis and viral pneumonia increased from 35,623 before the pandemic to 66,767 in the 2022 to 2023 season. Based on age, the group with the largest increase in admissions was 24- to 59-month-olds, with 5,169 admissions before COVID-19 and 13,973 during the pandemic.
“While I had expected the incidence of bronchiolitis to increase transiently due to decreased herd immunity from masking, the magnitude of the change was larger than I expected,” Pelletier told Healio. “This difference was especially profound in the sensitivity analysis including toddlers aged 2 to 5 years. Admissions in this group increased by more than 50%, which really reinforces the herd immunity hypothesis.
“Historically, we haven’t included these children as ‘having bronchiolitis,’ though it’s clinically debatable whether an RSV infection in a 3-year-old is meaningfully different than RSV infection in a 1-year-old,” he added.
Pelletier told Healio future studies should evaluate how these trends impact other factors.
“This study continues to ‘sound the alarm’ that ICU admissions for bronchiolitis are rising and are contributing to critical pediatric bed shortages,” Pelletier said. “My hope would be that future studies will examine whether these trends are related to changes in viral respiratory illness, care practices or both. I also hope to see studies of broader applications of RSV vaccines in infants and pregnant women to reduce the burden of hospitalization.”