Materials and methods:
This prospective study was conducted in Pediatric emergency room (ER) and Pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India during the season of AVB for the year 2019-20 (November 2019 to February 2020). The study was approved by the Institute Ethics Committee and patients were enrolled after written informed consent from the parents or legal guardians. All infants admitted to ER and PICU with AVB were included. The AVB was defined as the first episode of wheezing in a child younger than 12-24 months who has findings of a viral respiratory infection on examination and absence of pneumonia or atopy3,4. Patients were managed following the protocol for AVB in ER and PICU.
In Pediatric ER, there are 20-30 admissions per day. The ER is manned 24X7 by 6-8 junior residents (undergoing MD Pediatrics training), 2-3 senior residents (undergoing Pediatric critical care fellowship), and one Pediatric critical care consultant. The 15-bedded PICU is manned 24X7 by 4-5 junior residents, 2-3 Pediatric critical care senior residents, and one Pediatric critical care consultant. For management of AVB, there are facilities for administration of heated humidified oxygen, continuous positive airway pressure, high flow nasal cannula, nebulization, and multipara monitors in ER and PICU; and non-invasive and invasive ventilation in PICU.
The data was collected on a pre-designed study proforma regarding demographic variables like age, sex, presenting complaints, duration of illness, gestation and birth weight, pre-referral treatment details, underlying illness or comorbidity (congenital cardiac disease, chronic lung disease, neurological disease, neuromuscular disorder, etc.), and clinical findings. The chest radiograph findings, extra-pulmonary manifestations or complications [(myocarditis, encephalitis/encephalopathy, transaminitis, shock, acute respiratory distress syndrome, (ARDS), acute kidney injury (AKI), and multiple organ dysfcuntion syndrome (MODS), pulmonary artery hypertension (PAH)], treatment details [oxygen support, mechanical ventilation, nebulization, antibiotics, steroids, vasoactive agents, intravenous immunoglobulin (IVIG)], and outcome (duration of PICU and hospital admission, and mortality) were noted.