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Original research
SARS-CoV-2-related bronchiolitis: a multicentre international study
  1. Giorgio Cozzi1,
  2. Aleksandar Sovtic2,3,
  3. Davide Garelli4,
  4. Uros Krivec5,6,
  5. Davide Silvagni7,
  6. Ilaria Corsini8,
  7. Marco Colombo9,
  8. Manuela Giangreco10,
  9. Antonietta Giannattasio11,
  10. Gregorio Paolo Milani12,13,
  11. Marta Minute14,
  12. Federico Marchetti15,
  13. Antonio Gatto16,
  14. Carla Debbia17,
  15. Anna Jolanda Gortan18,
  16. Marta Massaro19,
  17. Elpis Hatziagorou20,
  18. Domenico Ravidà21,
  19. Raz Diamand22,
  20. Elizabeth Jones23,
  21. Jelena Visekruna2,
  22. Alessandro Zago24,
  23. Egidio Barbi1,24,
  24. Alessandro Amaddeo1,
  25. Luisa Cortellazzo Wiel23
  26. the SARS-CoV-2 bronchiolitis study group
    1. 1 Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
    2. 2 Institute for Health Protection of Mother and Child of Serbia 'Dr Vukan Cupic', Beograd, Serbia
    3. 3 University of Belgrade Faculty of Medicine, Beograd, Serbia
    4. 4 Regina Margherita Children's Hospital, Turin, Italy
    5. 5 Department of Pediatric Pulmology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
    6. 6 Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
    7. 7 Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
    8. 8 IRCCS Policlinico Ospedaliero Universitario di Bologna, Bologna, Italy
    9. 9 Pediatric Emergency Deparment, Ospedale Filippo del Ponte, ASST Sette Laghi, Varese, Italy
    10. 10 Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
    11. 11 Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
    12. 12 Paediatric Emergency Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
    13. 13 Department of Clinical Science and Community Health, University of Milan, Milan, Italy
    14. 14 Ospedale Regionale Ca Foncello Treviso, Treviso, Italy
    15. 15 Department Of Pediatrics, Ospedale S. Maria delle Croci, Ravenna, Italy
    16. 16 Department of Pediatrics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
    17. 17 Emergency Departement, IRCCS Istituto Giannina Gaslini, Genova, Italy
    18. 18 Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
    19. 19 Ospedale Santa Maria degli Angeli di Pordenone, Pordenone, Italy
    20. 20 Pediatric Pulmonology Unit, 3rd Pediatric Dept, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
    21. 21 Institute of Pediatrics of Southern Switzerland, EOC, Bellinzona, Switzerland
    22. 22 Ruth Rappaport Children’s Hospital, Haifa, Israel
    23. 23 Bradford Royal Infirmary, Bradford, UK
    24. 24 University of Trieste, Trieste, Italy
    25. 1 Institute for Health Protection of Mother and Child of Serbia, Beograd, Serbia
    26. 2 Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
    27. 3 IRCCS Policlinico Ospedaliero Universitario di Bologna, Bologna, Italy
    28. 4 Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
    29. 5 Department of Pediatrics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
    30. 6 Azienda sanitaria universitaria Friuli Centrale, Udine, Italy
    31. 7 Pediatric Pulmonology Unit, 3rd Pediatric Dept, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
    32. 8 Institute of Pediatrics of Southern Switzerland, EOC, Bellinzona, Switzerland
    33. 9 Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
    34. 10 Ruth Rappaport Children’s Hospital, Haifa, Israel
    35. 11 Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
    36. 12 Department of Pediatrics, Ospedale S. Maria delle Croci, Ravenna, Italy
    37. 13 Regina Margherita Children’s Hospital, Turin, Italy
    38. 14 Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
    1. Correspondence to Dr Giorgio Cozzi, Emergency Department, IRCCS Materno Infantile Burlo Garofolo, Trieste, Friuli-Venezia Giulia, Italy; giorgio.cozzi{at}burlo.trieste.it

    Abstract

    Background Bronchiolitis is the main acute lower respiratory tract infection in infants. Data regarding SARS-CoV-2-related bronchiolitis are limited.

    Objective To describe the main clinical characteristics of infants with SARS-CoV-2-related bronchiolitis in comparison with infants with bronchiolitis associated with other viruses.

    Setting, patients, interventions A multicentre retrospective study was conducted in 22 paediatric emergency departments (PED) in Europe and Israel. Infants diagnosed with bronchiolitis, who had a test for SARS-CoV-2 and were kept in clinical observation in the PED or admitted to hospital from 1 May 2021 to 28 February 2022 were considered eligible for participation. Demographic and clinical data, diagnostic tests, treatments and outcomes were collected.

    Main outcome measures The main outcome was the need for respiratory support in infants testing positive for SARS-CoV-2 compared with infants testing negative.

    Results 2004 infants with bronchiolitis were enrolled. Of these, 95 (4.7%) tested positive for SARS-CoV-2. Median age, gender, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative infants. Human metapneumovirus and respiratory syncytial virus were the viruses most frequently detected in the group of infants negative for SARS-CoV-2.

    Infants testing positive for SARS-CoV-2 received oxygen supplementation less frequently compared with SARS-CoV-2-negative patients, 37 (39%) vs 1076 (56.4%), p=0.001, OR 0.49 (95% CI 0.32 to 0.75). They received less ventilatory support: 12 (12.6%) high flow nasal cannulae vs 468 (24.5%), p=0.01; 1 (1.0%) continuous positive airway pressure vs 125 (6.6%), p=0.03, OR 0.48 (95% CI 0.27 to 0.85).

    Conclusions SARS-CoV-2 rarely causes bronchiolitis in infants. SARS-CoV-2-related bronchiolitis mostly has a mild clinical course.

    • Covid-19
    • emergency care
    • infant welfare
    • paediatric emergency medicine

    Data availability statement

    Data are available on reasonable request.

    This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

    https://bmj.com/coronavirus/usage

    https://doi.org/10.1136/archdischild-2023-325448

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      Data availability statement

      Data are available on reasonable request.

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      Footnotes

      • Twitter @ElpisHatziagoro

      • Collaborators Bojana Gojšina, Institute for Health Protection of Mother and Child of Serbia “Dr Vukan Cupic”, Beograd, Serbia; Tijana Grba, Institute for Health Protection of Mother and Child of Serbia “Dr Vukan Cupic”, Beograd, Serbia; Mihail Basa, Institute for Health Protection of Mother and Child of Serbia “Dr Vukan Cupic”, Beograd, Serbia; Silvia Carlassara, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy; Marcello Lanari, IRCCS Policlinico Ospedaliero Universitario di Bologna, Italy; Antonia Pascarella, Pediatric Emergency Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy; Antonietta Curatola, Department of Pediatrics, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy; Sara Pedicini, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy; Petrina Vantsi, Pediatric Pulmonology Unit, 3rd Pediatric Department, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece; Federica Vanoni, Institute of Pediatrics of Southern Switzerland, EOC, Bellinzona, Switzerland and Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland; Nitai Levy, Ruth Rappaport Children’s Hospital, Haifa, Israel, Sergio Ghirardo, Institute for Maternal and Child Health IRCCS Burlo Garofolo of Trieste, Trieste, Italy. Angela Troisi, Ospedale Santa Maria delle Croci, Ravenna, Italy; Alessandra Iacono, Ospedale Santa Maria delle Croci, Ravenna, Italy; Claudia Bondone, Regina Margherita Children’s Hospital, Turin, Italy; Samantha Bosis, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.

      • Contributors GC and AA conceived and supervised the work. AS, DG, UK, DS, IC, MC, AGi, GPM, MMi, FM, AGa, CD, AJG, MMa, EH, DR, RD, EJ, JV, LCW and AZ collected the data. MG performed the statistical analysis. GC, AS, EB and AA wrote the draft of the manuscript. LCW edited the final version of the manuscript. GC is guarantor

      • Funding This work was supported by the Ministry of Health, Rome, Italy, in collaboration with the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.