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. 2023 Oct 2;6(10):e2339884.
doi: 10.1001/jamanetworkopen.2023.39884.

Admissions for Bronchiolitis at Children's Hospitals Before and During the COVID-19 Pandemic

Kailey A Remien  1 , Justin Z Amarin  2 , Christopher M Horvat  3 , Ryan A Nofziger  4   5 , Christopher K Page-Goertz  4   5 , James B Besunder  4   5 , Brittany K Potts  5   6 , Michael L Forbes  4   5   7 , Natasha Halasa  2 , Jonathan H Pelletier  4   5
Affiliations

Admissions for Bronchiolitis at Children's Hospitals Before and During the COVID-19 Pandemic

Kailey A Remien et al. JAMA Netw Open. .

Abstract

Importance: The COVID-19 pandemic has been associated with a transient decrease in bronchiolitis hospitalizations compared with prepandemic patterns, but current effects remain unknown.

Objective: To analyze changes in patterns of bronchiolitis admissions at US children's hospitals during the 2020-2023 bronchiolitis seasons compared with the 2010-2019 seasons.

Design, setting, and participants: This retrospective cross-sectional study used data from 41 US children's hospitals in the Pediatric Health Information System database. Bronchiolitis has winter-predominant seasonality, so hospitalizations were grouped according to bronchiolitis season (from July through June). This study included all patients aged younger than 2 years admitted with a diagnosis of bronchiolitis between July 1, 2010, and June 30, 2023. Bronchiolitis seasons from July through June between 2010-2011 and 2019-2020 were classified as the prepandemic era, and seasons between 2020-2021 and 2022-2023 were classified as the pandemic era. Data analysis was performed from July 1, 2010, through June 30, 2023.

Exposures: Admission date.

Main outcomes and measures: The primary outcome was number of hospitalizations for bronchiolitis by season and month. Monthly admission counts from the prepandemic era were transformed into time series and used to train seasonal ensemble forecasting models. Forecasts were compared to monthly admissions during the pandemic era.

Results: In this study, there were 400 801 bronchiolitis admissions among 349 609 patients between July 1, 2010, and June 30, 2023. The median patient age was 6 (IQR, 2-12) months; 58.7% were boys and 43.7% were White. Hospitalizations increased gradually during the prepandemic era (median, 29 309 [IQR, 26 196-34 157]), decreased 69.2% (n = 9030) in the 2020-2021 season, and increased 75.3% (n = 51 397) in the 2022-2023 season. Patients in the pandemic era were older than those in the prepandemic era (median, 7 [IQR, 3-14] vs 6 [2-12] months; P < .001). Intensive care unit (ICU) admissions increased from 32.2% (96 245 of 298 535) in the prepandemic era to 36.7% (37 516 of 102 266) in the pandemic era (P < .001). The seasonality of bronchiolitis admissions changed during the pandemic era. Admissions peaked in August 2021 (actual 5036 vs 943 [95% CI, 0-2491] forecasted) and November 2022 (actual 10 120 vs 5268 [95% CI, 3425-7419] forecasted). These findings were unchanged in sensitivity analyses excluding children with complex chronic conditions and excluding repeat admissions. In a sensitivity analysis including all viral lower respiratory tract infections in children aged younger than 5 years, there were 66 767 admissions in 2022-2023 vs 35 623 (31 301-41 002) in the prepandemic era, with the largest increase in children aged 24 to 59 months.

Conclusions and relevance: The findings of this cross-sectional study suggest that bronchiolitis hospitalizations decreased transiently and then increased markedly during the COVID-19 pandemic era. Patients admitted during the pandemic era were older and were more likely to be admitted to an ICU. These findings suggest that bronchiolitis seasonality has not yet returned to prepandemic patterns, and US hospitals should prepare for the possibility of atypical timing again in 2023.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Horvat reported receiving grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) during the conduct of the study. Dr Nofziger reported receiving funding from the US Centers for Disease Control and Prevention (paid to Akron Children’s Hospital) for involvement in bronchiolitis research and other virus (COVID-19 and influenza) research outside the submitted work. Dr Halasa reported receiving grants from Sanofi, Quidel, and Merck outside the submitted work. Dr Pelletier reported receiving grants from the NICHD outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Hospital Admissions, Bed Utilization, and Cost by Bronchiolitis Season
A to D, Number of hospital admissions (A), intensive care unit (ICU) admissions (B), hospital days (C), and inflation-adjusted cost (D). The bar height represents the value for each panel. In the x-axis for each facet, bronchiolitis season is considered July through June of the first and second year, respectively, of each year range. Each facet has a different y-axis scale to show trends.
Figure 2.
Figure 2.. Annual Bronchiolitis Admissions by Age Group
In the x-axis, bronchiolitis season is considered July through June of the first and second year, respectively, of each year range.
Figure 3.
Figure 3.. Severity of Illness by Season
In the x-axis, bronchiolitis season is considered July through June of the first and second year, respectively, of each year range. ICU indicates intensive care unit; IMV, invasive mechanical ventilation; NIV, noninvasive ventilation.
Figure 4.
Figure 4.. Seasonality of Bronchiolitis Admissions Between the 2020-2021 and 2022-2023 Seasons
The blue line represents the forecasted monthly admission count. The dotted orange line indicates the actual number of monthly admissions. The dark blue and light blue shaded regions represent the model 80% and 95% CIs, respectively. Model weighting was performed with an optimized autoregessive integrated moving average of 51.0% and a neural network of 49.0%. Vertical lines separate the bronchiolitis seasons.
See this image and copyright information in PMC

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