METHODS
This quantitative cross-sectional study was conducted at two PICUs of a
public emergency hospital in Goiás (Brazil) using electronic medical
records of children with bronchiolitis admitted from April 2018 to April
2020.
The inclusion criteria were children with bronchiolitis of both genders
and aged from 29 days to 2 years, with one or more of the following
comorbidities: congenital heart or gastroesophageal reflux disease,
bronchopulmonary dysplasia, pulmonary hypertension, neuropathy,
immunosuppression, respiratory complications, hypoxic-ischemic
encephalopathy, epilepsy, spinal muscular atrophy (type I), pertussis,
asthma, hemolytic anemia, seizure, hypospadias, or perforated anus.
We excluded incomplete medical records, those registered after the
analyzed period (May 2020), or children misdiagnosed with bronchiolitis.
The information technology team of the hospital provided access to the
electronic medical records of all children hospitalized from April 2018
to April 2020 and classified with the following international
classification of disease-10: J21.10 (acute bronchiolitis), J21.0 (acute
bronchiolitis caused by RSV), J21.8 (acute bronchiolitis caused by other
specified microorganisms), and J21.9 (unspecified acute bronchitis). The
extubation booklet of the physical therapy team from PICU was also used
to collect data and decide whether the children were eligible.
A semi-structured instrument collected the following data:
sociodemographic (age, gender, and city of residence), nutritional
(current weight, current weight-for-age), gestational (gestational age
birth, and birth weight), and hospitalization (previous hospitalization,
causative agent, use of oxygen therapy, NIV, IMV, tracheostomy,
aspiration, prone position, changes in decubitus, NIV failure,
respiratory complications, cardiopulmonary arrest and resuscitation, and
outcome [death or hospital discharge]).
Data were described as absolute and relative frequencies for categorical
variables or mean and standard deviation (SD) for quantitative
variables. The STATA® 14 software analyzed all data, and significance
was set at p < 0.05. The Shapiro-Wilk test verified data
normality. The Mann-Whitney and Fisher’s exact test compared continuous
and categorical variables, respectively. The weight-for-age was also
analyzed by gender using the WHO Anthro software (version 3.2.2). The
Z-score < -2 indicated low weight-for-age.
This study followed the Declaration of Helsinki and Resolution 466/2012
of the National Health Council. The study was approved by the research
ethics committee of the Centro de Excelência em Ensino, Pesquisas
e Projetos Leide das Neves Ferreira (no. 28728820.7.0000.5082), and the
informed consent form was not needed since we analyzed medical records.