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Management of Hospitalized Respiratory Syncytial Virus Bronchiolitis in the Pediatric Ward in Spain: Assessing the Impact of a New Clinical Practice Protocol

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Abstract

Background

Bronchiolitis caused by the respiratory syncytial virus (RSV) is the main reason for hospitalization in infants. Supportive care is the mainstay of treatment, and tests are restricted to a few indications. During 2015, our hospital bronchiolitis protocol (2015 HBP) was updated according to the latest practice guidelines.

Objective

The objective of this study was to assess implementation of the 2015 HBP and the clinical outcome of children aged ≤ 24 months with RSV bronchiolitis admitted to a pediatric ward.

Methods

We compared the use of treatments and tests, hospital length of stay (LOS), and oxygen requirements before implementation of the 2015 HBP (2014–2015 and 2015–2016 seasons) and after implementation (2016–2017 and 2017–2018 seasons).

Results

The study population comprised 251 children (44.90%) in the first period and 308 (55.10%) in the second (median age 99 days, interquartile range 44–233). After implementation of the 2015 HBP, a statistically significant reduction was found in the percentage of patients undergoing the following treatments or diagnostic tests: salbutamol, from 57.77 to 31.17% (p < 0.001); epinephrine, from 61.75 to 1.30% (p < 0.001); 3% hypertonic saline, from 70.12 to 6.82% (p < 0.001); antibiotics, from 33.07 to 23.05% (p = 0.008); and chest X-ray, from 43.82 to 31.17% (p = 0.001). No statistically significant reductions were observed in the use of corticosteroids and blood tests. Hospital LOS and oxygen requirements were similar in each period.

Conclusions

Appropriate implementation of the 2015 HBP in the pediatric ward improves the use of medication and chest X-ray without modifying clinical outcomes. However, further efforts are needed to reduce the use of salbutamol, corticosteroids, and blood tests.

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Authors and Affiliations

  1. Pediatric Hospitalization Unit, Department of Pediatrics, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Jorgina Vila

  2. Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, 08193, Barcelona, Spain

    Jorgina Vila, Esther Lera & Carlos Rodrigo

  3. Pediatric Emergency Unit, Department of Pediatrics, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Esther Lera

  4. Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Paula Peremiquel-Trillas & José Ángel Rodrigo-Pendás

  5. Research Unit Infections and Cancer, Institut Català d’Oncologia, Avinguda de la Gran Via de l’Hospitalet, 199-203, L’Hospitalet de Llobregat, 08908, Barcelona, Spain

    Paula Peremiquel-Trillas

  6. Department of Pediatrics. Hospital, Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Laia Martínez & Irene Barceló

  7. Respiratory Viruses Unit, Virology Section, Microbiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Cristina Andrés & Andrés Antón

  8. Department of Pediatrics. Hospital, Universitari Germans Trias i Pujol, Carretera de Canyet, s/n, Badalona, 08916, Barcelona, Spain

    Carlos Rodrigo

  9. Germans Trias i Pujol Research Institute, Carretera de Can Ruti, Camí de les Escoles, s/n, Badalona, 08916, Barcelona, Spain

    Carlos Rodrigo

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  1. Jorgina Vila
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  2. Esther Lera
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Corresponding author

Correspondence to Jorgina Vila.

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Funding

This work was partially supported by national R + D + I Plan 2008–2011 and by the Carlos III Health Institute, Subdirectorate-General of Networks and Cooperative Research Centers, Spanish Ministry of Economy and Competitiveness, and Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003). It was also supported by the Health Research Fund, Spanish Ministry of Economy and Competitiveness (Grants FIS PI14/01838 and PI18/00685), and by the European Regional Development Fund (ERDF).

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the local institutional research committee and with the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards. The study was approved by the Vall d’Hebron Hospital Clinical Research Ethics Committee [PR(AG)78/2014].

Consent to participate

Informed consent was waived by the Hospital Clinical Research Ethics Committee because of the retrospective nature of the study and because all the procedures were performed as part of routine care.

Consent for publication

Not applicable.

Availability of data and material

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Author contributions

All authors contributed to the study conception and design and to interpretation of data. Material was prepared and data collected by JV, EL, LM, and IB. The microbiological analysis was performed by AA and CA. Data were analyzed by PP-T and JÁR-P. The first draft of the manuscript was written by JV, EL, and PP-T, and all authors commented on previous versions of the manuscript. All authors read and approved the final version of the manuscript.

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Vila, J., Lera, E., Peremiquel-Trillas, P. et al. Management of Hospitalized Respiratory Syncytial Virus Bronchiolitis in the Pediatric Ward in Spain: Assessing the Impact of a New Clinical Practice Protocol. Pediatr Drugs 24, 63–71 (2022). https://doi.org/10.1007/s40272-021-00488-6

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