Written by Kimiko Dunbar
Spoon Feed
10.3% of patients with bronchiolitis who had an echo performed had abnormal findings. Those with abnormalities were more likely to be younger or had a more severe course.
A echo a day keeps the CHD away…
Bronchiolitis is the most common reason for pediatric admission, diagnosed by clinical signs and symptoms including respiratory distress, cough, wheeze, and crackles. Such symptoms are non-specific and can also be manifestations of other cardiopulmonary disease.
This retrospective study evaluated echo utility in 2,137 previously healthy children <2 years hospitalized with bronchiolitis. Of 251 echo evaluations, 26 (10.3%) revealed abnormalities. Twenty (8%) had mild findings with potential clinical significance requiring outpatient follow-up such as ASD or mild coarctation. Six (2.4%) had significant findings requiring immediate intervention, including cardiomyopathy, undiagnosed congenital diaphragmatic hernia, and large VSD + ASD + PDA. Positive findings correlated with younger age, Arab ethnicity*, lower pH, higher pCO₂, and greater severity (e.g., mechanical ventilation, PICU admission). Patients with a prolonged but otherwise typical course were no more likely to have an abnormal echo. Limitations include retrospective design and incomplete follow-up given that most patients follow up with community centers after hospitalizations. While routine echo is low yield, it may be justified in infants with severe or atypical bronchiolitis.
*This study was performed in an Israeli hospital with a predominantly Jewish and Arab population. Increased abnormality in those of Arab descent was attributed by the authors to decreased rates of prenatal ultrasound in the setting of lower socioeconomic status.
How does this change my practice?
The vast majority of patients admitted with bronchiolitis will have a normal echo; common things being common, it’s probably just bronchiolitis. That said, I’ll be more likely to consider an echo in a young patient with presumed bronchiolitis with a severe course, especially with atypical features, such as negative viral testing or pathologic murmur. Further, given the even higher likelihood of abnormal echo if requiring intubation and overall rarity of mechanical ventilation in bronchiolitis, I think it’s prudent for any patient who requires intubation to have an echo to rule out underlying cardiopulmonary disease.
Source
Cardiac Echocardiography Findings in Previously Healthy Hospitalized Children With Bronchiolitis – a Retrospective Study. Pediatr Pulmonol. 2025 Apr;60(4):e71079. doi: 10.1002/ppul.71079. PMID: 40193130
