Clinical Outcomes of Systemic Steroid Use in Children Under 2 with Bronchiolitis and BPD

Abstract

OBJECTIVES: No guidelines exist for managing children with bronchopulmonary dysplasia (BPD) hospitalized with acute bronchiolitis. This study evaluated clinical practice and outcomes associated with systemic steroid use in children with BPD and acute bronchiolitis. We hypothesized there would be significant practice variation and improvement in outcomes with steroid use. METHODS: A retrospective study was conducted using the PHIS (Pediatric Health Information System) database. Children aged younger than 2 years with BPD hospitalized from 2012 to 2023 were included. Primary outcomes were systemic steroid use, factors associated with use, and temporal trends. Secondary outcomes were length of stay (LOS), readmissions, intensive care unit use, maximum respiratory support, duration on oxygen, and mortality. Systemic steroid use vs no systemic steroid use groups were compared. RESULTS: Of the 1239 children, 35% received systemic steroids. Steroid use varied from 0% to 75% across hospitals. Hospital-level variation was unrelated to case volume (P = .83). Systemic steroid use was significantly associated with older age, home inhaled corticosteroid (ICS), and in-hospital bronchodilator use, but not with gestational age, birth weight, or BPD severity. Systemic steroid use was significantly associated with longer LOS (2.8 vs 2.2 days, P < .001) and more time on oxygen (2.8 vs 2.3 days, P = .008). CONCLUSION: A total of 35% of hospitalized children with BPD and bronchiolitis received systemic steroids with significant variation in use. Systemic steroid use was associated with older age, home ICS use, longer LOS, and more time on oxygen. Further studies are needed to understand the clinical implications of these associations.