Introduction

Bronchiolitis affects 30% of infants under 24 months of age (~480000 children) every winter in France, with a low mortality rate (2.4-2.6 / 100000 births) 1,2,3. However, bronchiolitis leads to a high burden that importantly impacts the healthcare system every winter. Bronchiolitis is mostly mild and resolves spontaneously within a few days, but in France, 2 to 3% of the infants will have a severe form of the disease that require hospitalization. The average cost of hospitalization for the first episode of bronchiolitis is 5671\euro (± 3354) and the average length of stay (LOS) is 3 days (±3) 4. The latest international guidelines for in-hospital management of children with bronchiolitis recommend the use of sole supportive treatments: feeding and/or oxygen supplementation for infants who require it. The referral for airway clearance techniques (ACT) application is no longer recommended worldwide since no clear benefit have been reported3,5,6,7.
Several features have been linked with a higher LOS including a premature birth <36 weeks of gestational age (GA), and the presence of comorbidities 5. Beyond these criteria, the nutrition is a determining factor in managing the LOS of these infants 8,9. On the other hand, the factors associated with the time to recover adequate feeding (LOFR) are poorly known. Nonetheless, the latest French health authority guidelines (HAS)5 proposed a new algorithm for hospital referring including feeding assessment further reinforcing the need to investigate the factors related with feeding in this population.
The main objective of this study was to investigate the factors associated with (1) the LOFR, and (2) the LOS. Among these factors, we aimed to investigate the indications for bronchiolitis ACT referring in our center.