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Luigi Matera MD1, Raffaella Nenna MD PhD 1, Antonella Frassanito MD PhD1, Laura Petrarca MD1, Enrica Mancino MD1, Valentina Rizzo MD1, Greta Di Mattia MD1, Domenico Paolo La Regina MD1, Alessandra Pierangeli MD PHD2 and Fabio Midulla MD PHD1 Low lymphocyte count: a clinical severity marker in infants with bronchiolitis. 2022.

Background: Bronchiolitis is the most frequent cause of hospitalization in infants younger than 1 year of age. We sought to evaluate the correlation between lymphocyte count and clinical manifestation in infants hospitalized with bronchiolitis.

 Materials and methods: We performed a retrospective cohort study evaluating 1297 children hospitalized for bronchiolitis from 2004 to 2019. A nasal washing was tested for 14 respiratory viruses by PCR. A clinical severity score, ranging 0-8, was assigned at hospital admission. History and clinical course were recorded for each infant. Patients were divided in 3 groups according to lymphocyte count tertiles. Parents of enrolled patients have been phoned annually over 5 years in order to evaluate respiratory sequelae.

Results: 433 children had 2914.2±745.5/mm3 lymphocytes (Group 1), 432 had 4897.6±561.5/mm3 lymphocytes (Group 2) and 432 had 7884±1903.3/mm3 lymphocytes (Group 3). Group 1 patients were more frequently infected by RSV and presented with fever, a worse clinical severity score. They more frequently needed oxygen supplementation, underwent a prolonged hospitalization needed to be admitted to pediatric Intensive Care Unit (ICU). Finally, they had more frequently a family history of eczema, wheezing and asthma. We found no differences between lymphocytes count and respiratory sequelae (at least two episodes of wheezing per year).

Conclusions: Infants with low lymphocyte count are more likely to have a worse clinical course of bronchiolitis.

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