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.