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Occurrence and risk factors associated with seizures in infants with severe bronchiolitis

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Abstract

Neurological morbidity is a growing concern in children with severe bronchiolitis. The aim of the study was to evaluate the frequency of occurrence and the factors associated with seizures in very young infants < 3 months of age, admitted to a pediatric intensive care unit (PICU) for severe bronchiolitis. We performed a single center retrospective cohort study evaluating occurrence of seizures in infants admitted to the PICU between 2010 and 2018 for severe bronchiolitis. We described characteristics of the patients, laboratory test, brain imaging, and electroencephalogram results, as well as the treatment used. We conducted a multivariable logistic regression to identify factors associated with the occurrence of seizures. A p value < 0.05 was considered significant. A total of 805 patients were included in the study; 722 (89.6%) were mechanically ventilated. Twenty-six infants (3.2%, 95% confidence interval, 95% CI [2.1%; 4.7%]) had seizures shortly prior to admission or during PICU stay. In the multivariable analysis, hyponatremia (odds ratio, OR: 4.6, 95%CI [1.86; 11.43], p = 0.001) and invasive ventilation (OR: 2.6, 95% CI [1.14; 5.9], p < 0.001) were associated with an increased likelihood of seizures occurrence.

Conclusion: Seizures occur in at least 3% of very young infants with severe bronchiolitis, and the characteristics of these are different to those experienced by older infants, but they shared the same risk factors (hyponatremia and mechanical ventilation). This highlights the extrapulmonary morbidity associated with bronchiolitis in this population.

What is Known:

• Bronchiolitis is the leading cause of pediatric intensive care admission and use of mechanical ventilation in infants.

• Neurological morbidities have to be investigated in this population at risk of neurological complications.

What is New:

• Seizure is a complication in at least 3% of very young infants with severe bronchiolitis.

• Seizure characteristics are different, but the main risk factors are the same than in older infants (hyponatremia and mechanical ventilation).

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Individual participant data will not be made available.

Code availability

Not applicable.

Abbreviations

BIPAP:

Bilevel positive airway pressure

CI:

Confidence interval

CSF:

Cerebrospinal fluid

CT:

Computed tomography

EEG:

Electroencephalogram

HFNC:

High flow nasal cannula

IMV:

Invasive mechanical ventilation

IQR:

Interquartile range

MRI:

Magnetic resonance imaging

nCPAP:

Nasal continuous positive airway pressure

NIV:

Non-invasive ventilation

OR:

Odds ratio

PICU:

Pediatric intensive care unit

RSV:

Respiratory syncytial virus

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Acknowledgement

We thank Philip Robinson (DRCI, Hospices Civils de Lyon) for the help in the manuscript preparation.

Author information

Authors and Affiliations

  1. Hospices Civils de Lyon, réanimation pédiatrique, Hôpital Femme Mère Enfant, F-69500, Bron, France

    Annabelle Huguet, Frederic Valla, Etienne Javouhey & Florent Baudin

  2. Hospices Civils de Lyon, Epileptology, Sleep disorders and Functional Paediatric Neurology-HFME, Coordonator of the ERN EpiCare, F-69500, Bron, France

    Joseph Toulouse

  3. Agressions Pulmonaires et Circulatoires dans le Sepsis (APCSe), VetAgro Sup, Université de Lyon, F-69280, Marcy l’Etoile, France

    Florent Baudin

Authors
  1. Annabelle Huguet
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  2. Frederic Valla
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  4. Etienne Javouhey
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  5. Florent Baudin
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Contributions

AH and FB conceptualized and designed the study, collected the data, drafted the initial manuscript, and reviewed and revised the manuscript. EJ and FV conceptualized the study, interpreted the data, and critically reviewed the manuscript for important intellectual content. JT interpreted the data and critically reviewed the manuscript for important intellectual content.

All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Florent Baudin.

Ethics declarations

Ethics approval

This study was approved by the ethics committee of the French intensive care society (CE SRLF 18-29).

Consent to participate

Retrospective study (non-opposition for data collection in the PICU was checked).

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Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Piet Leroy

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Huguet, A., Valla, F., Toulouse, J. et al. Occurrence and risk factors associated with seizures in infants with severe bronchiolitis. Eur J Pediatr 180, 2959–2967 (2021). https://doi.org/10.1007/s00431-021-04070-7

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  • DOI: https://doi.org/10.1007/s00431-021-04070-7

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