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Gutiérrez Moreno M, Barajas Sánchez V, Gil Rivas T, Hernández González N, Marugán Isabel VM, Ochoa-Sangrador C. Efectividad de la oxigenoterapia de alto flujo en hospital de segundo nivel en bronquiolitis. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Effectiveness of high-flow oxygen therapy in a second-level hospital in bronchiolitis. An Pediatr (Barc) 2022; 96:485-491. [DOI: 10.1016/j.anpede.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/09/2021] [Indexed: 11/20/2022] Open
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Xu Q, Li L, Shen L, Huang X, Lu M, Hu C. Development and external validation of a simple nomogram for predicting apnea in children hospitalized with bronchiolitis. Front Pediatr 2022; 10:922226. [PMID: 36340712 PMCID: PMC9627176 DOI: 10.3389/fped.2022.922226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Apnea is one of the most life-threatening complications of bronchiolitis in children. This study aimed to determine early predictors of apnea in children hospitalized with bronchiolitis and develop a simple nomogram to identify patients at risk of apnea. METHODS This retrospective, observational study included children hospitalized with bronchiolitis in two hospitals in China. Demographic and clinical characteristics, laboratory results, pathogens, and pulmonary iconography results were recorded. A training cohort of 759 patients (one hospital) was used to identify early predictors of apnea during hospitalization. The least absolute shrinkage and selection operator (LASSO) regression analysis method was used to optimize variable selection. The nomogram was developed visually based on the variables selected by multivariable logistic regression analysis. Discrimination (concordance index, C-index), calibration, and decision curve analysis (DCA) were used to assess the model performance and clinical effectiveness. RESULTS A total of 1,372 children hospitalized with bronchiolitis were retrospectively evaluated, 133 (9.69%) of whom had apnea. Apnea was observed in 80 of the 759 patients with bronchiolitis in the training cohort and 53 of the 613 patients in the external validation cohort. Underlying diseases, feeding difficulties, tachypnea, retractions and pulmonary atelectasis in the training cohort were independent risk factors for apnea and were assembled into the nomogram. The nomogram exhibited good discrimination with a C-index of 0.883 (95% CI: 0.839-0.927) and good calibration. The DCA showed that the nomogram was clinically useful in estimating the net benefit to patients. CONCLUSION We developed a nomogram that is convenient to use and able to identify the individualized prediction of apnea risk in patients with bronchiolitis. These patients might benefit from early triage and more intensive monitoring.
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Affiliation(s)
- Qiuyan Xu
- Department of Pediatrics, Suzhou Science / Technology Town Hospital, Suzhou, China
| | - Linlin Li
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Li Shen
- Department of Pharmacy, Suzhou Science / Technology Town Hospital, Suzhou, China
| | - Xia Huang
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Min Lu
- Department of Pediatrics, Suzhou Science / Technology Town Hospital, Suzhou, China
| | - Chunxia Hu
- Department of Respiratory Medicine, Children's Hospital of Wujiang District, Children's Hospital of Soochow University, Suzhou, China
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Bogdan RD, Rusu L, Toma AI, Nastase L. Respiratory Outcome of the Former Premature Infants. J Med Life 2020; 12:381-394. [PMID: 32025257 PMCID: PMC6993307 DOI: 10.25122/jml-2019-0123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The research aims to identify the respiratory pathology during the first two years of life in premature infants with gestational ages between 30-34 weeks and the risk factors for these conditions (familial, prenatal, and neonatal). There were investigated 31 premature infants with gestational ages between 30-34 weeks and the incidence of bronchopulmonary dysplasia, infections with the respiratory syncytial virus, or other viral infections requiring hospitalization, recurrent wheezing, and nasal colonization with pathogenic bacteria were noted. Also, regression models for each type of respiratory pathology as a function of the antenatal (smoking in the family, atopy, mother’s age) and neonatal (gestational age, respiratory distress syndrome, duration of the treatment with antibiotics, use of the reserve antibiotics) factors were elaborated. Respiratory distress syndrome was present in 20 premature infants, and 19 infants received respiratory support. Two former premature infants presented with bronchopulmonary dysplasia, 3 with severe respiratory syncytial virus infections, 7 with recurrent wheezing, and 16 with viral infections requiring hospitalization. Respiratory distress syndrome and severe viral infections were more frequently found in families of smokers. Low gestational age and familial atopy were identified as good predictors of severe respiratory syncytial virus infections (p< 0.03) Premature infants with gestational ages between 30-34 weeks present with the risk of appearance of respiratory diseases during the first two years of life, especially disorders of the airways. Familial atopy and low gestational age represent independent risk factors for severe respiratory syncytial virus infections.
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Affiliation(s)
| | - Lidia Rusu
- Regional Center of Public Health, Iasi, Romania
| | | | - Leonard Nastase
- Alessandrescu - Rusescu National Institute of Mother and Child Health, Bucharest, Romania
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Ramos-Fernández JM, Piñero-Domínguez P, Abollo-López P, Moreno-Pérez D, Cordón-Martínez AM, Milano-Manso G, Urda-Cardona A. Validation study of an acute bronchiolitis severity scale to determine admission to a paediatric intensive care unit. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ramos-Fernández JM, Moreno-Pérez D, Antúnez-Fernández C, Milano-Manso G, Cordón-Martínez AM, Urda-Cardona A. Lower lymphocyte response in severe cases of acute bronchiolitis due to respiratory syncytial virus. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.anpede.2017.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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The economic impact of prematurity and bronchopulmonary dysplasia. Eur J Pediatr 2017; 176:1587-1593. [PMID: 28889192 DOI: 10.1007/s00431-017-3009-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Bronchopulmonary dysplasia (BPD) is one of the most serious chronic lung diseases in infancy and one of the most important sequels of premature birth (prevalence of 15-50%). Our objective was to estimate the cost of BPD of one preterm baby, with no other major prematurity-related complications, during the first 2 years of life in Spain. Data from the Spanish Ministry of Health regarding costs of diagnosis-related group of preterm birth, hospital admissions and visits, palivizumab administration, and oxygen therapy in the year 2013 were analyzed. In 2013, 2628 preterm babies were born with a weight under 1500 g; 50.9% were males. The need for respiratory support was 2.5% needed only oxygen therapy, 39.5% required conventional mechanical ventilation, and 14.9% required high-frequency ventilation. The incidence of BPD was of 34.9%. The cost of the first 2 years of life of a preterm baby with BPD and no other major prematurity-related complications ranged between 45,049.81 € and 118,760.43 €, in Spain, depending on birth weight and gestational age. If the baby required home oxygen therapy or developed pulmonary hypertension, this cost could add up to 181,742.43 €. CONCLUSION Prematurity and BPD have an elevated cost, even for public health care systems. This cost will probably increase in the coming years if the incidence and survival of preterm babies keeps rising. The development of new therapies and preventive strategies to decrease the incidence of BPD and other morbidities associated with prematurity should be a priority. What is known: • Bronchopulmonary dysplasia (BPD) is a serious chronic lung disease related with premature birth. • BPD is an increasing disease due to the up-rise in the number of premature births. What is new: • The economic cost of preterm birth and BPD has never before been estimated in Spain nor published with European data. • Preterm babies with BPD and a good clinical outcome carry also an important economic and social burden.
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Ramos-Fernández JM, Piñero-Domínguez P, Abollo-López P, Moreno-Pérez D, Cordón-Martínez AM, Milano-Manso G, Urda-Cardona A. [Validation study of an acute bronchiolitis severity scale to determine admission to a Paediatric Intensive Care Unit]. An Pediatr (Barc) 2017; 89:104-110. [PMID: 29132843 DOI: 10.1016/j.anpedi.2017.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION At present, there are few validated scoring tests for assessing acute bronchiolitis (AB) severity, and limited information on their test power. The aim of the present study is to evaluate the validity of an acute bronchiolitis severity score (ABSS) to help in deciding PICU admission. PATIENTS AND METHOD Prospective, descriptive, observational study of previously healthy infants under 1 year of age with AB, where the ABSS was used to compare severity as regards the need for PICU admission. The sample size was estimated as at least 175 patients. The research team was trained in the use of ABSS. All patients in the study were evaluated with ABSS daily, as well as in the case of clinical deterioration. The initial and maximum ABSS scores were contrasted to the need for PICU admission. A receiver operative curve was constructed, and the area under the curve was calculated, and the optimum point of sensitivity / specificity was estimated. RESULTS The study included a total of 190 patients (male / female: 58% / 42%). PICU was required in 11 (6%). The mean± SD ABSS-maximal score for patients who required and did not require PICU was 10.55± 1.12 and 6.35± 2.3, respectively (P<.001). The AUC for ABSS-maximal was 0.94 (P<.001, 95% CI: 0.90-0.98). The optimal cut-off point was set at ≥10 points for a sensitivity of 82% and a specificity of 91%. CONCLUSIONS ABSS estimates the severity of AB regarding the need for PICU admission, with a sensitivity and specificity of clinical usefulness.
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Affiliation(s)
- José Miguel Ramos-Fernández
- Unidad de Gestión Clínica de Pediatría, Grupo de Investigación IBIMA, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España.
| | - Pedro Piñero-Domínguez
- Unidad de Gestión Clínica de Pediatría, Grupo de Investigación IBIMA, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España
| | - Pilar Abollo-López
- Unidad de Gestión Clínica de Pediatría, Grupo de Investigación IBIMA, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España
| | - David Moreno-Pérez
- Infectología Pediátrica e Inmunodeficiencias, Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España; Grupo de Investigación IBIMA, Departamento de Pediatría y Farmacología, Facultad de Medicina de la Universidad de Málaga, Málaga, España
| | - Ana María Cordón-Martínez
- Unidad de Gestión Clínica de Pediatría, Grupo de Investigación IBIMA, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España
| | - Guillermo Milano-Manso
- Grupo de Investigación IBIMA, Departamento de Pediatría y Farmacología, Facultad de Medicina de la Universidad de Málaga, Málaga, España; Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España
| | - Antonio Urda-Cardona
- Unidad de Gestión Clínica de Pediatría, Grupo de Investigación IBIMA, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España
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Ramos-Fernández JM, Moreno-Pérez D, Antúnez-Fernández C, Milano-Manso G, Cordón-Martínez AM, Urda-Cardona A. [Lower lymphocyte response in severe cases of acute bronchiolitis due to respiratory syncytial virus]. An Pediatr (Barc) 2017; 88:315-321. [PMID: 28818563 DOI: 10.1016/j.anpedi.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 07/01/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Acute bronchiolitis (AB) of the infant has a serious outcome in 6-16% of the hospital admitted cases. Its pathogenesis and evolution is related to the response of the T lymphocytes. The objective of the present study is to determine if the lower systemic lymphocytic response is related to a worse outcome of AB in hospitalised infants. PATIENTS AND METHOD Retrospective observational-analytical study of cases-controls nested in a cohort of patients admitted due to RSV-AB between the period from October 2010 to March 2015. Those with a full blood count in the first 48hours of respiratory distress were included. Infants with underlying disease, bacterial superinfection, and premature infants <32 weeks of gestation were excluded. The main dichotomous variable was PICU admission. Other variables were: gender, age, post-menstrual age, gestational and post-natal tobacco exposure, admission month, type of lactation, and days of onset of respiratory distress. Lymphocyte counts were categorised by quartiles. Bivariate analysis was performed with the main variable and then by logistic regression to analyse confounding factors. RESULTS The study included 252 infants, of whom 6.6% (17) required PICU admission. The difference in mean±SD of lymphocytes for patients admitted to and not admitted to PICU was 4,044±1755 and 5,035±1786, respectively (Student-t test, P<.05). An association was found between PICU admission and lymphocyte count <3700/ml (Chi-squared, P=.019; OR: 3.2) and it was found to be maintained in the logistic regression, regardless of age and all other studied factors (Wald 4.191 P=.041, OR: 3.8). CONCLUSIONS A relationship was found between lymphocytosis <3700/ml in the first days of respiratory distress and a worse outcome in previously healthy infants <12 months and gestational age greater than 32 weeks with RSV-AB.
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Affiliation(s)
- José Miguel Ramos-Fernández
- Unidad de Gestión Clínica de Pediatría, Grupo de Investigación IBIMA, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España.
| | - David Moreno-Pérez
- Infectología Pediátrica e Inmunodeficiencias, Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA, Departamento de Pediatría y Farmacología, Facultad de Medicina de la Universidad de Málaga, Málaga, España
| | - Cristina Antúnez-Fernández
- Unidad de Gestión Clínica de Pediatría, Grupo de Investigación IBIMA, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España
| | - Guillermo Milano-Manso
- Unidad de Gestión Clínica de Cuidados Críticos y Urgencias, Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA, Departamento de Pediatría y Farmacología, Facultad de Medicina de la Universidad de Málaga, Málaga, España
| | - Ana María Cordón-Martínez
- Unidad de Gestión Clínica de Pediatría, Grupo de Investigación IBIMA, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España
| | - Antonio Urda-Cardona
- Unidad de Gestión Clínica de Pediatría, Grupo de Investigación IBIMA, Hospital Materno-Infantil Regional Universitario de Málaga, Málaga, España
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Balaguer M, Alejandre C, Vila D, Esteban E, Carrasco JL, Cambra FJ, Jordan I. Bronchiolitis Score of Sant Joan de Déu: BROSJOD Score, validation and usefulness. Pediatr Pulmonol 2017; 52:533-539. [PMID: 28328090 DOI: 10.1002/ppul.23546] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/15/2016] [Accepted: 07/18/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To validate the bronchiolitis score of Sant Joan de Déu (BROSJOD) and to examine the previously defined scoring cutoff. PATIENTS AND METHODS Prospective, observational study. BROSJOD scoring was done by two independent physicians (at admission, 24 and 48 hr). Internal consistency of the score was assessed using Cronbach's α. To determine inter-rater reliability, the concordance correlation coefficient estimated as an intraclass correlation coefficient (CCC) and limits of agreement estimated as the 90% total deviation index (TDI) were estimated. An expert opinion was used to classify patients according to clinical severity. A validity analysis was conducted comparing the 3-level classification score to that expert opinion. Volume under the surface (VUS), predictive values, and probability of correct classification (PCC) were measured to assess discriminant validity. RESULTS About 112 patients were recruited, 62 of them (55.4%) males. Median age: 52.5 days (IQR: 32.75-115.25). The admission Cronbach's α was 0.77 (CI95%: 0.71; 0.82) and at 24 hr it was 0.65 (CI95%: 0.48; 0.7). The inter-rater reliability analysis was: CCC at admission 0.96 (95%CI 0.94-0.97), at 24 h 0.77 (95%CI 0.65-0.86), and at 48 hr 0.94 (95%CI 0.94-0.97); TDI 90%: 1.6, 2.9, and 1.57, respectively. The discriminant validity at admission: VUS of 0.8 (95%CI 0.70-0.90), at 24 h 0.92 (95%CI 0.85-0.99), and at 48 hr 0.93 (95%CI 0.87-0.99). The predictive values and PCC values were within 38-100% depending on the level of clinical severity. CONCLUSION There is a high inter-rater reliability, showing the BROSJOD score to be reliable and valid, even when different observers apply it. Pediatr Pulmonol. 2017;52:533-539. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mònica Balaguer
- Pediatric Critical Care Unit, Hospital Sant Joan de Deu, Pg. Sant Joan de Deu n°2, Esplugues de Llobregat 08950, Barcelona, Spain
| | - Carme Alejandre
- Pediatric Critical Care Unit, Hospital Sant Joan de Deu, Pg. Sant Joan de Deu n°2, Esplugues de Llobregat 08950, Barcelona, Spain
| | - David Vila
- Pediatric Critical Care Unit, Hospital Sant Joan de Deu, Pg. Sant Joan de Deu n°2, Esplugues de Llobregat 08950, Barcelona, Spain
| | - Elisabeth Esteban
- Pediatric Critical Care Unit, Hospital Sant Joan de Deu, Pg. Sant Joan de Deu n°2, Esplugues de Llobregat 08950, Barcelona, Spain
| | - Josep L Carrasco
- Biostatistics, Public Health Department, University of Barcelona, Barcelona, Spain
| | - Francisco José Cambra
- Pediatric Critical Care Unit, Hospital Sant Joan de Deu, Pg. Sant Joan de Deu n°2, Esplugues de Llobregat 08950, Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Critical Care Unit, Hospital Sant Joan de Deu, Pg. Sant Joan de Deu n°2, Esplugues de Llobregat 08950, Barcelona, Spain.,Paediatric Intensive Care Unit, CIBERESP, Agrupación Hospitalaria Clínic-Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
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Figueras-Aloy J, Manzoni P, Paes B, Simões EAF, Bont L, Checchia PA, Fauroux B, Carbonell-Estrany X. Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Preterm Infants Without Chronic Lung Disease or Congenital Heart Disease. Infect Dis Ther 2016; 5:417-452. [PMID: 27628014 PMCID: PMC5125133 DOI: 10.1007/s40121-016-0130-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The REGAL (RSV Evidence-a Geographical Archive of the Literature) series provide a comprehensive review of the published evidence in the field of respiratory syncytial virus (RSV) in Western countries over the last 20 years. This second publication covers the risk and burden of RSV infection in preterm infants born at <37 weeks' gestational age (wGA) without chronic lung disease or congenital heart disease. METHODS A systematic review was undertaken for articles published between January 1, 1995 and December 31, 2015. Studies reporting data for hospital visits/admissions for RSV infection among preterm infants as well as studies reporting RSV-associated morbidity, mortality, and risk factors were included. Study quality and strength of evidence (SOE) were graded using recognized criteria. RESULTS 2469 studies were identified of which 85 were included. Preterm infants, particularly those born at lower wGA, tended to have higher RSV hospitalization (RSVH) rates compared with otherwise healthy term infants (high SOE). RSVH rates ranged from ~5 per 1000 children to >100 per 1000 children with the highest rates shown in the lowest gestational age infants (high SOE). Independent risk factors associated with RSVH include: proximity of birth to the RSV season, living with school-age siblings, smoking of mother during pregnancy or infant exposure to environmental smoking, reduced breast feeding, male sex, and familial atopy (asthma) (high SOE). Predictive models can identify 32/33-35 wGA infants at risk of RSVH (high SOE). CONCLUSION RSV infection remains a major burden on Western healthcare systems and is associated with significant morbidity. Further studies focusing on the prevalence and burden of RSV in different gestational age cohorts, the changing risk of RSVH during the first year of life, and on RSV-related mortality in preterm infants are needed to determine the true burden of disease. FUNDING AbbVie.
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Affiliation(s)
- Josep Figueras-Aloy
- Hospital Clínic, Catedràtic de Pediatria, Universitat de Barcelona, Barcelona, Spain
| | | | - Bosco Paes
- Department of Paediatrics (Neonatal Division), McMaster University, Hamilton, Canada
| | - Eric A F Simões
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Louis Bont
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul A Checchia
- Baylor College of Medicine, Texas Children's Hospital Houston, Texas, USA
| | - Brigitte Fauroux
- Necker University Hospital and Paris 5 University, Paris, France
| | - Xavier Carbonell-Estrany
- Hospital Clinic, Institut d'Investigacions Biomediques August Pi Suñer (IDIBAPS), Barcelona, Spain.
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Nizarali Z, Cabral M, Silvestre C, Abadesso C, Nunes P, Loureiro H, Almeida H. Noninvasive ventilation in acute respiratory failure from respiratory syncytial virus bronchiolitis. Rev Bras Ter Intensiva 2015; 24:375-80. [PMID: 23917936 PMCID: PMC4031822 DOI: 10.1590/s0103-507x2012000400014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 12/03/2012] [Indexed: 11/24/2022] Open
Abstract
Objectives The present study focused on respiratory syncytial virus bronchiolitis with
respiratory failure. The aim of the study was to determine whether noninvasive
ventilation reduces the need for endotracheal intubation or slows the clinical
progression of acute respiratory syncytial virus bronchiolitis by reducing the
incidence of infectious complications. Methods The present study was a retrospective cohort study. Cohort A was comprised of
children who were admitted to the pediatric intensive and special care unit from
2003-2005 before starting noninvasive ventilation; cohort B was comprised of
children who were admitted to the pediatric intensive and special care unit from
2006-2008 after starting noninvasive ventilation. With the exception of
noninvasive ventilation, the therapeutic support was the same for the two groups.
All children who were diagnosed with respiratory syncytial virus bronchiolitis and
respiratory failure between November 2003 and March 2008 were included in the
cohort. Demographic, clinical and blood gas variables were analyzed. Results A total of 162 children were included; 75% of the subjects were less than 3 months
old. Group A included 64 children, and group B included 98 children. In group B,
34 of the children required noninvasive ventilation. The distributions of the
variables age, preterm birth, congenital heart disease, cerebral palsy and chronic
lung disease were similar between the two groups. On admission, the data for blood
gas analysis and the number of apneas were not significantly different between the
groups. In group B, fewer children required invasive ventilation (group A: 12/64
versus group B: 7/98; p=0.02), and there was a reduction in
the number of cases of bacterial pneumonia (group A: 19/64 versus
group B: 12/98; p=0.008). There was no record of mortality in either of the
groups. Conclusion By comparing children with the same disease both before and after noninvasive
ventilation was used for ventilation support, we verified a reduction in
infectious complications and cases requiring intubation.
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Brand HK, Ahout IML, de Ridder D, van Diepen A, Li Y, Zaalberg M, Andeweg A, Roeleveld N, de Groot R, Warris A, Hermans PWM, Ferwerda G, Staal FJT. Olfactomedin 4 Serves as a Marker for Disease Severity in Pediatric Respiratory Syncytial Virus (RSV) Infection. PLoS One 2015; 10:e0131927. [PMID: 26162090 PMCID: PMC4498630 DOI: 10.1371/journal.pone.0131927] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/08/2015] [Indexed: 12/20/2022] Open
Abstract
Background Respiratory viral infections follow an unpredictable clinical course in young children ranging from a common cold to respiratory failure. The transition from mild to severe disease occurs rapidly and is difficult to predict. The pathophysiology underlying disease severity has remained elusive. There is an urgent need to better understand the immune response in this disease to come up with biomarkers that may aid clinical decision making. Methods In a prospective study, flow cytometric and genome-wide gene expression analyses were performed on blood samples of 26 children with a diagnosis of severe, moderate or mild Respiratory Syncytial Virus (RSV) infection. Differentially expressed genes were validated using Q-PCR in a second cohort of 80 children during three consecutive winter seasons. FACS analyses were also performed in the second cohort and on recovery samples of severe cases in the first cohort. Results Severe RSV infection was associated with a transient but marked decrease in CD4+ T, CD8+ T, and NK cells in peripheral blood. Gene expression analyses in both cohorts identified Olfactomedin4 (OLFM4) as a fully discriminative marker between children with mild and severe RSV infection, giving a PAM cross-validation error of 0%. Patients with an OLFM4 gene expression level above -7.5 were 6 times more likely to develop severe disease, after correction for age at hospitalization and gestational age. Conclusion By combining genome-wide expression profiling of blood cell subsets with clinically well-annotated samples, OLFM4 was identified as a biomarker for severity of pediatric RSV infection.
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Affiliation(s)
- H. K. Brand
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - I. M. L. Ahout
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - D. de Ridder
- Delft Bioinformatics Lab, Faculty of Electrical Engineering, Mathematics and Computer Science, Delft University of Technology, Delft, The Netherlands
| | - A. van Diepen
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Y. Li
- Department of Bioinformatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M. Zaalberg
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
| | - A. Andeweg
- Department of Virology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N. Roeleveld
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
- Department for Health Evidence, Radboud university medical center, Nijmegen, the Netherlands
| | - R. de Groot
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - A. Warris
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - P. W. M. Hermans
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - G. Ferwerda
- Laboratory of Pediatric Infectious Diseases, Department of Pediatrics, Radboud university medical center, Nijmegen, The Netherlands
- Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands
- * E-mail:
| | - F. J. T. Staal
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Bronchiolitis. PEDIATRIC AND NEONATAL MECHANICAL VENTILATION 2015. [PMCID: PMC7122073 DOI: 10.1007/978-3-642-01219-8_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Everyone on the planet is exposed to respiratory syncytial virus (RSV) infection by the age of 2 years. Most infants admitted to the pediatric intensive care unit (PICU) for respiratory support during this infection are previously healthy, but their principal risk for needing PICU treatment is young age. That is, if you are born in October/November in the northern hemisphere, then your first winter exposure to RSV is likely to be when you are less than 4 months of age and vulnerable because of poor respiratory mechanical reserve (Alonso et al. 2007). However, if you are born in May/June, then you will be 7–8 months during your first winter exposure to RSV, much bigger and stronger and have more efficient thoracic and diaphragmatic mechanics. In the PICU, the main predictors of severe outcome in previously well infants appear to be young age, presence of apnea, and pulmonary consolidation on admission chest radiograph (Tasker et al. 2000; Lopez Guinea et al. 2007). Taken together, we can say that more severe RSV bronchiolitis in PICU practice is typically a problem of pulmonary consolidation, poor respiratory mechanics, and poor reserve, in the younger infant.
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Alvarez AE, Marson FA, Bertuzzo CS, Arns CW, Ribeiro JD. Epidemiological and genetic characteristics associated with the severity of acute viral bronchiolitis by respiratory syncytial virus. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2013. [DOI: 10.1016/j.jpedp.2013.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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16
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Butt ML, Symington A, Janes M, Elliott L, Steele S, Paes BA. The impact of prophylaxis on paediatric intensive care unit admissions for RSV infection: a retrospective, single-centre study. Eur J Pediatr 2011; 170:907-13. [PMID: 21174120 DOI: 10.1007/s00431-010-1376-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 12/02/2010] [Indexed: 10/18/2022]
Abstract
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infections and hospitalizations in children aged < 2 years. The aim of this retrospective, single-centre study was to examine the characteristics of patients admitted to a paediatric intensive care unit (PICU) with RSV infection following the implementation of a RSV prophylaxis programme. Electronic hospital medical records of all PICU admissions for RSV infection were searched from 2003 to 2009. Data on baseline demographics, underlying disease, criteria for hospitalization, respiratory diagnosis and management, complications and palivizumab prophylaxis were collected. A total of 181 patients were admitted with RSV infection, accounting for 5.7% of all admissions. Eighty-four percent were ≤ 2 years of age. Majority (70.2%) had no underlying medical illness, and 79.6% received antibiotics as part of their medical treatment. Comparison of children aged ≤ 2 years and those >2 years revealed that fewer of the younger cohort (20.4% versus 79.3%; p < 0.001) had an underlying medical condition. RSV infection occurred in 3.3% (n = 6) children who had received palivizumab prophylaxis, and there were two deaths. The results indicate that > 88% of all PICU admissions would not qualify for RSV prophylaxis under our established guidelines and 66% of the children aged ≤ 2 years were > 36 weeks gestation and are not currently targeted for prophylaxis. The number of high-risk infants admitted to PICU with RSV infection has likely plateaued, and further reductions in admission rates may only be realised with the use of universal, vaccine immunization programmes.
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Affiliation(s)
- Michelle L Butt
- School of Nursing, McMaster University, Hamilton, ON, L8N 3Z5, Canada
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17
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Oñoro G, Pérez Suárez E, Iglesias Bouzas M, Serrano A, Martínez De Azagra A, García-Teresa M, Casado Flores J. Bronquiolitis grave. Cambios epidemiológicos y de soporte respiratorio. An Pediatr (Barc) 2011; 74:371-6. [DOI: 10.1016/j.anpedi.2011.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 12/10/2010] [Accepted: 01/11/2011] [Indexed: 11/16/2022] Open
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Garrido Ocaña AI, Mora Navarro D, García Soblechero E, González Fuentes C, Domínguez Quintero ML. [Paroxysmal supraventricular tachycardia and severe respiratory syncytial virus infection in the neonatal period]. An Pediatr (Barc) 2011; 74:277-8. [PMID: 21315670 DOI: 10.1016/j.anpedi.2010.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 08/31/2010] [Accepted: 10/12/2010] [Indexed: 10/18/2022] Open
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Guía de práctica clínica sobre la bronquiolitis aguda: recomendaciones para la práctica clínica. An Pediatr (Barc) 2010; 73:208.e1-10. [DOI: 10.1016/j.anpedi.2010.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 04/14/2010] [Indexed: 11/20/2022] Open
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Hernando Puente M, López-Herce Cid J, Bellón Cano J, Villaescusa JU, Santiago Lozano M, Sánchez Galindo A. Factores pronósticos de evolución complicada en la bronquiolitis que requiere ingreso en cuidados intensivos pediátricos. An Pediatr (Barc) 2009; 70:27-33. [DOI: 10.1016/j.anpedi.2008.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2008] [Revised: 08/20/2008] [Accepted: 08/25/2008] [Indexed: 10/20/2022] Open
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Prospective population-based study of RSV-related intermediate care and intensive care unit admissions in Switzerland over a 4-year period (2001-2005). Infection 2008; 37:109-16. [PMID: 19412586 DOI: 10.1007/s15010-008-8130-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Respiratory syncytial virus (RSV) infections are a leading cause of hospital admissions in small children. A substantial proportion of these patients require medical and nursing care, which can only be provided in intermediate (IMC) or intensive care units (ICU). This article reports on all children aged < 3 years who required admission to IMC and/or ICU between October 1, 2001 and September 30, 2005 in Switzerland. PATIENTS AND METHODS We prospectively collected data on all children aged < 3 years who were admitted to an IMC or ICU for an RSV-related illness. Using a detailed questionnaire, we collected information on risk factors, therapy requirements, length of stay in the IMC/ICU and hospital, and outcome. RESULTS Of the 577 cases reported during the study period, 90 were excluded because the patients did not fulfill the inclusion criteria; data were incomplete in another 25 cases (5%). Therefore, a total of 462 verified cases were eligible for analysis. At the time of hospital admission, only 31 patients (11%) were older than 12 months. Since RSV infection was not the main reason for IMC/ICU admission in 52% of these patients, we chose to exclude this subgroup from further analyses. Among the 431 infants aged < 12 months, the majority (77%) were former near term or full term (NT/FT) infants with a gestational age > or = 35 weeks without additional risk factors who were hospitalized at a median age of 1.5 months. Gestational age (GA) < 32 weeks, moderate to severe bronchopulmonary dysplasia (BPD), and congenital heart disease (CHD) were all associated with a significant risk increase for IMC/ICU admission (relative risk 14, 56, and 10, for GA < or = 32 weeks, BPD, and CHD, respectively). Compared with NT/FT infants, high-risk infants were hospitalized at an older age (except for infants with CHD), required more invasive and longer respiratory support, and had longer stays in the IMC/ICU and hospital. CONCLUSIONS In Switzerland, RSV infections lead to the IMC/ICU admission of approximately 1%-2% of each annual birth cohort. Although prematurity, BPD, and CHD are significant risk factors, non-pharmacological preventive strategies should not be restricted to these high-risk patients but also target young NT/FT infants since they constitute 77% of infants requiring IMC/ICU admission.
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Mayordomo-Colunga J, Medina A, Rey C, Los Arcos M, Concha A, Menéndez S. [Success and failure predictors of non-invasive ventilation in acute bronchiolitis]. An Pediatr (Barc) 2008; 70:34-9. [PMID: 19174117 DOI: 10.1016/j.anpedi.2008.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 09/03/2008] [Accepted: 09/04/2008] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The objective was to identify predictive factors for non-invasive ventilation (NIV) failure and to describe its use in bronchiolitis. PATIENTS AND METHODS Prospective observational study that included patients diagnosed with bronchiolitis with a modified Wood's Clinical Asthma Score 5, or oxygen saturation <92%, or venous CO(2) partial pressure (PCO(2)) 60 mm Hg, with no response to medical treatment, who received NIV from December 2005 to May 2008. We collected clinical data before NIV began and at 1, 6, 12, 24 and 48 h. Need for intubation was considered as NIV failure. RESULTS NIV was successful in 83% of 47 cases included. Patients in whom NIV failed had lower weight (5.2+/-2.2 vs. 3.5+/-0.8 kg, P=.011), lower age [1.8 (0.3-12.3) vs. 0.8 (0.4-4.3) months, P=.038)], lower heart rate (HR) before NIV began (176.3+/-19.1 vs. 160.4+/-9.7 beats/minute, P=.010), lower HR decrease at hours 1 (-16.0+/-17.3 vs.+1.1+/-11.6, P=.005) and 12 (-31.5+/-19.7 vs. -0.75+/-12.2, P=.002), presence of apnoeas (23.1% vs. 75%; P=.004) and of a predisposing condition (84.6% vs. 50%; P=.029). Multivariate analysis identified the absence of a predisposing condition, and a greater HR decrease during the first hour as success-associated independent factors (OR 0.004; 95% CI 0.000-0.664 and OR 0.896; 95% CI: 0.809-0.993, respectively). CONCLUSIONS NIV has a high success rate in bronchiolitis. The main parameters which can predict NIV success are the absence of a predisposing condition and a higher HR decrease in the first hour.
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Affiliation(s)
- J Mayordomo-Colunga
- Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, España.
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