102 - Changes in critical bronchiolitis after COVID-19 lockdown

Poster Number: 102
Publication Number: 102.307

Jose M. Cardenas, University of Florida College of Medicine, Gainesville, FL, United States; Charlene Pringle, University of Florida College of Medicine, Gainesville, FL, United States; Kathleen Ryan, University of Florida College of Medicine, Gainesville, FL, United States; K. Leslie Avery, University of Florida College of Medicine, Gainesville, FL, United States

Background: In response to the COVID-19 pandemic, state and local governments implemented mitigation strategies, including lockdowns (LD), thereby averting the typical fall/winter 2020 bronchiolitis season, and reducing the incidence of respiratory viruses, such as Respiratory Syncytial Virus (RSV). Florida implemented a strict LD from April 1, 2020, to April 30, 2020, followed by an atypical bronchiolitis out of season surge in April 2021. Anecdotally, this surge appeared to be associated with both increased poly-viral coinfections and disease severity.

Objective: Determine if the bronchiolitis out of season surge differed from historical seasonal case patterns.

Design/Methods: Single-center retrospective cohort study of admissions to the Pediatric Intensive Care Unit (PICU) with ICD-10 codes of bronchiolitis, from December 9, 2019, to February 29, 2020 (12 weeks, pre-lockdown group or PreLD), compared to March 29 to June19, 2021 (12 weeks, post-lockdown group or PostLD). Comparing gender, ethnicity, age, viral coinfections, viruses detected, PICU length of stay, hospital length stay, mortality, maximum respiratory support needed, mechanical ventilation days, ECMO days and severity of disease measured by Pediatric Logistic Organ Dysfunction-2 (PELOD2) and Pediatric Sequential Organ Failure Assessment (pSOFA). Categorical data was analyzed using CHISQ test and t-test for continuous variables. A 2-sided p < 0.05 was considered significant.

Results: 135 subjects were analyzed from the two cohorts. More patients were admitted during the PostLD phase (87 v. 48). The PostLD group had a higher age at admission (11.2±12.3 v. 6.6±7.5, p 0.0075), but no differences in gender or Race/Ethnicity. The PostLD group also exhibited a higher proportion of RSV infections (73 v. 16 p < 0.0001) and poly viral coinfections (p < 0.0001). Higher Coronavirus OC43 (9 v. 0 p 0.0263) and Parainfluenza types 1-4 (HPIV) (19 v. 1 p 0.0017) coinfections, yet fewer Human Metapneumovirus (HMPV) coinfections (0 v. 4 p 0.0147) were observed PostLD. No differences were found in hospital length of stay, PICU length of stay, mortality, mechanical ventilation days, ECMO days, or severity of illness scores based on PELOD-2 or pSOFA scores.Conclusion(s): In the bronchiolitis out of season surge, there was an increased number of admissions to the PICU. Those patients were older, and more likely to have RSV, as well as a coinfection with Coronavirus OC43 or HPIV, yet less likely to have HMPV. No difference in length of stay or disease severity was demonstrated.
Demographics
Viruses