Comparative analysis of care for bronchiolitis requiring observation in pediatric emergency departments after immunoprophylaxis with monoclonal antibodies

Abstract

Introduction: The implementation of immunoprophylaxis against Respiratory Syncytial Virus (RSV) in infants under 6 months of age has led to a shift in the care burden caused by bronchiolitis in Pediatric Emergency Departments. The aim of this study was to analyze emergency episodes diagnosed as bronchiolitis that required hospital observation before and after the introduction of prophylaxis.

Methods: Episodes included were from children under 24 months of age, diagnosed with bronchiolitis, and admitted to a Short Stay Unit linked to the emergency department. Two periods corresponding to the bronchiolitis epidemic season were analyzed. The variables studied included: age, sex, triage level, length of stay in observation, discharge and microbiological isolation.

Results: There was a 58% reduction in bronchiolitis cases between the two periods and a 66% decrease in those requiring observation. In both periods, most cases occurred in infants under 3 months of age, with a decrease in cases among those aged 3 to 6 months in the second season. No differences were found in observation time or discharge/transfer destination. A significant reduction in RSV detection was observed between the two seasons.

Conclusions: The introduction of RSV prophylaxis has had an impact on the prevalence of RSV-related bronchiolitis in our setting, both in urgent episodes and in the need for observation, with a substantial reduction in absolute numbers and frequency. No significant differences were observed regarding the duration of clinical evolution or the rate of hospital admissions between the seasons.