RISK FACTORS ASSOCIATED WITH PROLONGED LENGTH OF STAY IN CHILDREN HOSPITALIZED FOR ACUTE BRONCHIOLITIS

Aya Alkousa*, Souad Sakkour and Intesar Naser

ABSTRACT

Acute bronchiolitis is the most common respiratory disease in infants and young children. 1-3% of children with bronchiolitis require hospitalization, particularly during the winter months. A quarter of patients admitted for acute bronchiolitis may undergo prolonged hospital length of stay (LOS). Because prolonged LOS is directly associated with treatment costs, and because it puts the child at greater risk of developing complications such as hospital-acquired infections, there is a need to identify other risk factors associated with prolonged hospital LOS for acute bronchiolitis (such as parental smoking and a family history of atopy). This will allow for prevention, where possible, and to improve provided healthcare. We conducted a prospective cohort study of 76 children hospitalized for acute bronchiolitis in Lattakia University Hospital. Objective: Main objective: To identify risk factors associated with prolonged hospital length of stay in children admitted with acute bronchiolitis at Lattakia University Hospital. Study method: Design: Analytic Cohort Study (Prospective) - Sample: 76 children admitted to the pediatric department with acute bronchiolitis, aged two years or younger, excluding those with chronic diseases such as congenital heart defects, bronchopulmonary dysplasia, and multiple hospitalizations.- Statistical Analysis: the following statistics were used:
1- Descriptive Statistics: Frequencies and percentages to represent qualitative variables, measures of central tendency and dispersion to represent quantitative variables.
2- Inferential Statistics: Chi-square or Fisher's exact test to study relationships between qualitative variables. Independent Student's t test to compare mean differences between two independent groups.
All variables were tested using univariate regression. The variables with statistical significance were entered into the Multivariate analysis equation, the relative risk (RR) was measured, confidence intervals were found, and values were considered starting from 2 and above. The results were considered statistically significant with a p-value of 5%. The IBM SPSS statistics (V25) program was used to calculate the statistical coefficients and analyze the results. Results: The average length of stay was 4.63±2.5 days, with a percentage of 31.6%. 64.5% of the children were males, with male-to-female ratio 1:1.8. The mean age was 6.41±5.8 months, and the mean birth weight was 2846.05±377.1 g. Prematurity represented 5.3% of the study sample, and none of the above variables were associated with LOS (p=0.4, p=0.8, p=0.6, p=0.1), respectively. 44.7% of the infants were exclusively breastfed, and the mean consultation time was 5.18±3.9 days. Parental smoking was present in 44.7% of the study sample. The above variables did not constitute statistically significant differences (p=0.2, p=0.9, p=0.8), respectively. The mean oxygen saturation was 95.55±4.2. Supplemental oxygen and respiratory distress score at admission were significant risk factors for prolonged hospital LOS in both the univariate model (p=0.01) and the multivariate model (p=0.0001, p=0.002), respectively. 21.1% of the infants had a family history of atopy, and deep suctioning was performed in 59.2% of cases, with a statistically significant association with prolonged LOS (p=0.04, p=0.001) in both the univariate model and the multivariate model (p=0.04, p=0.0001). Conclusion: There are a number of clinical parameters that can be identified at admission and are associated with prolonged hospital length of stay for acute bronchiolitis: initial oxygen saturation, supplemental oxygen, and respiratory distress at admission, in addition to a family history of atopy. Deep suctioning is associated with longer length of stay. Further studies are needed to clarify the relationship between various variables and hospital length of stay.

Keywords: Bronchiolitis, length of stay, risk factors, breastfeeding, family history of atopy, deep suctioning.