Clinical Spectrum, Management, and Predictors of Severity in Children with Bronchiolitis Admitted to A Tertiary Care Center

Background: Bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization among infants and young children worldwide. Although most cases are self-limiting, a proportion of children develop severe disease requiring intensive respiratory support. Early identification of predictors of severity is essential for improving clinical outcomes.

Objectives: To evaluate the clinical spectrum, management strategies, outcomes, and predictors of disease severity among children admitted with bronchiolitis at a tertiary care centre.

Materials and Methods: This prospective observational study was conducted in the Department of Pediatrics, ESIC Medical College and Hospital, Kalaburagi, Karnataka, from March 2025 to March 2026. A total of 110 children aged 1–24 months with clinically diagnosed bronchiolitis were enrolled. Demographic characteristics, clinical features, management modalities, and outcomes were recorded. Disease severity was assessed using the Modified Tal Score. Statistical analysis was performed using IBM SPSS Statistics version 26.0, with a p-value <0.05 considered statistically significant.

Results: Of the 110 children, 52.7% were younger than 6 months and 60.0% were males. Cough (100%), rhinorrhea (92.7%), difficulty in breathing (89.1%), and wheezing (83.6%) were the most common presenting symptoms. Moderate bronchiolitis was observed in 47.3% of patients, while 25.4% had severe disease. Oxygen therapy was required in 67.3% of patients, high-flow nasal cannula in 18.2%, CPAP in 9.1%, and mechanical ventilation in 5.5%. PICU admission was required in 20.0% of cases. The mean hospital stay was 4.8 ± 2.1 days, the recovery rate was 98.2%, and the mortality rate was 1.8%. Significant predictors of severe bronchiolitis included age <6 months, prematurity, low birth weight, malnutrition, passive smoke exposure, poor feeding, apnea, hypoxemia (SpO₂ <92%), elevated C-reactive protein, chest radiographic abnormalities, and the need for respiratory support (p<0.05).

Conclusion: Bronchiolitis predominantly affected infants younger than six months and was associated with excellent outcomes following supportive management. Younger age, prematurity, low birth weight, malnutrition, passive smoke exposure, hypoxemia, elevated CRP, and abnormal chest radiographic findings were significant predictors of severe disease. Early recognition of these risk factors may facilitate timely intervention and improve outcomes in hospitalized children