Astudillo Patricio, Rodriguez-Fernandez Maria, Castro-Rodríguez José A, López-Lastra Marcelo
Laboratorio de Virología Molecular, Instituto Milenio de Inmunología e Inmunoterapia, Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Institute for Biological and Medical Engineering, Schools of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile.
Pediatr Res. 2025 May 3. doi: 10.1038/s41390-025-04096-9.
Supervised clustering of bronchiolitis patients, according to their clinical characteristics at hospital admission, helps predict short-term hospital outcomes and the risk of developing childhood respiratory illness. Thus, we evaluated the use of wheezing status for stratifying bronchiolitis patients.
A prospective cohort study was conducted involving 668 previously healthy, full-term Chilean infants ( < 2 years old) hospitalized with bronchiolitis. Patients categorized based on their wheezing status at hospital admission were monitored during hospitalization and followed for 4 years after discharge.
Wheezing children presented a more severe illness requiring more oxygen during their hospital stay. Upon discharge, they were more likely to develop preschool wheezing at 12 months and asthma at 4 years of age. Among the non-wheezing, those with RSV had more severe disease. Risk factors exclusively associated with persistent asthma development for the wheezing were clinical bacterial coinfection, parental asthma history, and having had a severe bronchiolitis episode. Risk factors exclusive for non-wheezing were maternal smoking during pregnancy and severe retractions.
Bronchiolitis patients can be categorized based on their wheezing status at hospital admission, helping predict short-term clinical outcomes and identify infants at risk of developing severe short- and long-term respiratory illnesses.
Stratifying viral bronchiolitis patients using a simple bedside strategy based on their wheezing status at hospitalization can help improve individual-based clinical decisions during hospitalization and enable early identification of infants with a higher risk of developing severe respiratory illnesses and long-term associated diseases. Viral bronchiolitis patients can be stratified based on their hospitalized wheezing status. Wheezing patients exhibited similar clinical patterns during hospitalization and long-term clinical outcomes upon discharge. Wheezing infants were more likely to develop preschool wheezing and asthma.
根据毛细支气管炎患者入院时的临床特征进行监督聚类，有助于预测短期住院结局以及患儿童期呼吸道疾病的风险。因此，我们评估了使用喘息状态对毛细支气管炎患者进行分层的情况。
开展了一项前瞻性队列研究，纳入668名先前健康的足月智利婴儿（＜2岁），这些婴儿因毛细支气管炎住院。根据入院时的喘息状态对患者进行分类，并在住院期间进行监测，出院后随访4年。
喘息儿童病情更严重，住院期间需要更多氧气。出院时，他们在12个月时更易出现学龄前喘息，在4岁时更易患哮喘。在非喘息儿童中，感染呼吸道合胞病毒（RSV）的儿童病情更严重。与喘息儿童持续性哮喘发生仅相关的危险因素为临床细菌合并感染、父母哮喘病史以及曾有严重毛细支气管炎发作。非喘息儿童独有的危险因素为母亲孕期吸烟和严重的吸气三凹征。
毛细支气管炎患者可根据入院时的喘息状态进行分类，这有助于预测短期临床结局，并识别有发生严重短期和长期呼吸道疾病风险的婴儿。
采用基于住院时喘息状态的简单床边策略对病毒性毛细支气管炎患者进行分层，有助于改善住院期间基于个体的临床决策，并能早期识别有发生严重呼吸道疾病和长期相关疾病较高风险的婴儿。病毒性毛细支气管炎患者可根据住院时的喘息状态进行分层。喘息患者在住院期间表现出相似的临床模式，出院时具有相似的长期临床结局。喘息婴儿更易出现学龄前喘息和哮喘。
