2004 OPEN FORUM Abstracts
THE IMPACT OF MATERNAL AND ENVIRONMENTAL TOBACCO SMOKE EXPOSURE ON INPATIENTS WITH BRONCHIOLITIS.
Julie Ballard BS RRT and
Kim Bennion BS RRT, Primary Children’s Medical Center, Salt
Lake City, Utah.
Introduction: Studies suggest an association
in children < 2 years of age between environmental smoke exposure
(ESE), maternal smoking exposure (MSE) during pregnancy and the
development of lower respiratory tract infections. We sought to test
the hypothesis that clinical outcomes are worse for children with ESE
&/or MSE who were admitted with bronchiolitis (a lower
respiratory tract infection).
Methods: Children hospitalized
with bronchiolitis during the 2002-2003 & 2003-2004 respiratory
seasons ( Nov. 1-April 30) were included in the retrospective
analysis. Data were extracted from hospital databases. Pts were
studied if they met the following criteria: (1) < 2 years of age,
(2) any diagnosis of bronchiolitis, (3) a complete history, (4) an
assigned severity of illness score (SOI) where scores are 1-4 with 1
being the least and 4 being the most severe. SOI scores were based on
procedural & co-morbidity coding by medical records staff after
pt discharge. Pt records were analyzed to determine the utilization
of inhaled medication treatments (tx) including albuterol,
epinephrine &/or xopenex, antibiotic & steroid utilization &
length of stay (LOS). Statistical analysis included ANOVA with
multiple comparison post-hoc analysis for continuous data and Chi
square analysis for nominal data.
Results: 1583 pts met the
first criteria with 547 being excluded for incomplete histories. This
left us 1036 pts to study. Outcomes for all pts are reported in Table
One.
| Table One: Tobacco Smoke Exposure Outcomes | No Smoke Exposure | MSE | ESE | P-value |
| Mean # Inhaled Medication Txs | 2.2 | 4.2 | 4.2 | < 0.01 |
| Initial O2 Need (L/min) | 0.57 | 0.76 | 0.71 | < 0.01 |
| Steroid Utilization # (%) | 111 (15) | 24 (35) | 44 (21) | < 0.01 |
| Antibiotic Utilization # (%) | 279 (37) | 25 (37) | 78 (36) | 0.98 |
| Severity of Illness (SOI) Score # (%) Level 1 | 225 (30) | 20 (29) | 64 (30) | 0.08 |
| Level 2 | 405 (54) | 32 (47) | 104 (48) | |
| Level 3 | 85 (11) | 15 (22) | 36 (17) | |
| Level 4 | 38 (5) | 1 (2) | 11 (5) | |
| LOS (hours) | 94 | 108 | 118 | < 0.02 |
| All Patients # (%) | 753 (77) | 68 (7) | 215 (22) | --- |
Discussion:
Five pts initially required continuous positive airway pressure
(CPAP), but there was no significance in their exposure to smoke.
Given the results of our findings, pts with no smoke exposure
presented with better outcomes when compared to those pts exposed to
smoke either in utero or in the environment. Initial O2
requirement, inhaled medication txs, steroid utilization & LOS
were all decreased in the no exposure group. Further study is needed
on the effects of prenatal & postnatal smoke exposure on hospital
outcomes in pt with bronchiolitis.