Clinical and Epidemiological Characteristics Associated with the Severity of Bronchiolitis in Hospitalized Children in Iraq

Background: Bronchiolitis is the most common acute infection of infants’ lower respiratory tract especially in the first two years of age. Its clinical course is complex where symptoms vary in severity and may progress rapidly to respiratory failure. Some factors can predispose to severe bronchiolitis like inhalation of cigarette smoke, crowded living environment, congenital heart defects and lack of breastfeeding. Aim of the study: The study aims to study the clinical and sociodemographic factors that are related to the severity of acute bronchiolitis in the patients included in the study. Patients and Methods: A cross-sectional study achieved at Hevi pediatric teaching Children Hospital in Duhok north of Iraq in the period from 1st November 2022 to 1st February 2023. The study included all patients aged 1-24 months diagnosed to have bronchiolitis and treated as inpatient in the hospital during that period. The diagnosis was made according to the American Academy of Pediatrics (AAP) diagnostic criteria in 2014. The severity of bronchiolitis was classified according to the Modified Cincinnati Bronchiolitis Score (MCBS). For every participant, the clinical aspects and epidemiological factors associated with bronchiolitis were obtained through a questionnaire filled by direct interview with parents. The data were analyzed by using Statistical Package for Social Sciences (SPSS) software version 26; the clinical significance was considered when P value is less than 0.05. Results: The study included 148 patients with bronchiolitis. Most of them were of moderate severity and female were more common. The age group (3-6 months) was significantly associated with severity. Most of patients lived in urban areas and were delivered by Caesarean section. Exposure to tobacco smoke was significantly associated with the severity of the disease. The artificial feeding was the most common with significant association with the severity. Most of patients had siblings attending school and childcare without significant association with the severity and less than a quarter of them had a family history of asthma. Poor living conditions was significantly associated with severity. Local cradle (landik) was significantly associated with severity. Most chest X ray findings were normal in 126 patients (85.1%) with no significant association with severity. Conclusion: Age, exposure to tobacco smoke, type of feeding, poor living conditions and sleeping in the local cradle (landik) were significantly related to the bronchiolitis severity in Duhok.