Kohei Hasegawa1, Michelle D Stevenson2, Jonathan M Mansbach3, Alan R Schroeder4, Ashley F Sullivan5, Janice A Espinola5, Pedro A Piedra6, Carlos A Camargo5. 1. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; khasegawa1@partners.org. 2. Department of Pediatrics, University of Louisville, Louisville, Kentucky; 3. Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; 4. Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California; and. 5. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; 6. Departments of Molecular Virology and Microbiology, and Pediatrics, Baylor College of Medicine, Houston, Texas.
Abstract
BACKGROUND AND OBJECTIVES: It remains unclear whether hyponatremia independently predicts a higher severity of bronchiolitis in children. The objective of this study was to investigate the association between hyponatremia and bronchiolitis severity in children hospitalized in the ICU for bronchiolitis. METHODS: We conducted a 16-center, prospective cohort study of hospitalized children aged <2 years with bronchiolitis during the winters of 2007 through 2010. Patients were classified into 2 groups (normonatremic [135-145 mEq/L] and hyponatremic [<135 mEq/L]) based on the first-measured serum sodium concentration on the day of hospitalization. Outcomes were use of mechanical ventilation and ICU length of stay (LOS). To examine the association of sodium status with outcomes, we fit logistic and linear regression models with propensity score adjustment. RESULTS: Of 231 children hospitalized in the ICU for bronchiolitis, 193 (84%) were categorized into the normonatremic group and 38 (16%) into the hyponatremic group. Compared with children with normonatremia, those with hyponatremia had higher risks of mechanical ventilation use (40% vs 58%; P = .04) and longer ICU LOS (median, 3 vs 6 days; P = .007). Likewise, in the adjusted analyses, children with hyponatremia had significantly higher risks of mechanical ventilation use (odds ratio, 2.14 [95% confidence interval, 1.03-4.48; P = .04) and longer ICU LOS (β-coefficient, 2.21 days [95% confidence interval, 0.68-3.73; P = .005]). CONCLUSIONS: In this prospective, multicenter study of children hospitalized for bronchiolitis, hyponatremia on the day of hospitalization was associated with a higher severity of disease. Our data support hyponatremia as a prognostic factor that might improve the ability of clinicians to predict the disease course of children with severe bronchiolitis.
BACKGROUND AND OBJECTIVES: It remains unclear whether hyponatremia independently predicts a higher severity of bronchiolitis in children. The objective of this study was to investigate the association between hyponatremia and bronchiolitis severity in children hospitalized in the ICU for bronchiolitis. METHODS: We conducted a 16-center, prospective cohort study of hospitalized children aged <2 years with bronchiolitis during the winters of 2007 through 2010. Patients were classified into 2 groups (normonatremic [135-145 mEq/L] and hyponatremic [<135 mEq/L]) based on the first-measured serum sodium concentration on the day of hospitalization. Outcomes were use of mechanical ventilation and ICU length of stay (LOS). To examine the association of sodium status with outcomes, we fit logistic and linear regression models with propensity score adjustment. RESULTS: Of 231 children hospitalized in the ICU for bronchiolitis, 193 (84%) were categorized into the normonatremic group and 38 (16%) into the hyponatremic group. Compared with children with normonatremia, those with hyponatremia had higher risks of mechanical ventilation use (40% vs 58%; P = .04) and longer ICU LOS (median, 3 vs 6 days; P = .007). Likewise, in the adjusted analyses, children with hyponatremia had significantly higher risks of mechanical ventilation use (odds ratio, 2.14 [95% confidence interval, 1.03-4.48; P = .04) and longer ICU LOS (β-coefficient, 2.21 days [95% confidence interval, 0.68-3.73; P = .005]). CONCLUSIONS: In this prospective, multicenter study of children hospitalized for bronchiolitis, hyponatremia on the day of hospitalization was associated with a higher severity of disease. Our data support hyponatremia as a prognostic factor that might improve the ability of clinicians to predict the disease course of children with severe bronchiolitis.
Authors: Kohei Hasegawa; Jonathan M Mansbach; Stephen J Teach; Erin S Fisher; Daniel Hershey; Joyce Y Koh; Sunday Clark; Pedro A Piedra; Ashley F Sullivan; Carlos A Camargo Journal: Pediatr Infect Dis J Date: 2014-08 Impact factor: 2.129
Authors: Dorothy Damore; Jonathan M Mansbach; Sunday Clark; Maria Ramundo; Carlos A Camargo Journal: Acad Emerg Med Date: 2008-09-15 Impact factor: 3.451
Authors: Alan R Schroeder; Jonathan M Mansbach; Michelle Stevenson; Charles G Macias; Erin Stucky Fisher; Besh Barcega; Ashley F Sullivan; Janice A Espinola; Pedro A Piedra; Carlos A Camargo Journal: Pediatrics Date: 2013-10-07 Impact factor: 7.124
Authors: Jonathan Santiago; Jonathan M Mansbach; Shih-Chuan Chou; Carlos Delgado; Pedro A Piedra; Ashley F Sullivan; Janice A Espinola; Carlos A Camargo Journal: J Hosp Med Date: 2014-06-10 Impact factor: 2.960
Authors: Kohei Hasegawa; Jonathan M Mansbach; Nadim J Ajami; Janice A Espinola; David M Henke; Joseph F Petrosino; Pedro A Piedra; Chad A Shaw; Ashley F Sullivan; Carlos A Camargo Journal: Eur Respir J Date: 2016-10-06 Impact factor: 16.671