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Bermúdez-Barrezueta L, López-Casillas P, Rojo-Rello S, Sáez-García L, Marugán-Miguelsanz JM, Pino-Vázquez MDLA. Outcomes of viral coinfections in infants hospitalized for acute bronchiolitis. Virol J 2023; 20:235. [PMID: 37845714 PMCID: PMC10577995 DOI: 10.1186/s12985-023-02197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The clinical relevance of the detection of multiple respiratory viruses in acute bronchiolitis (AB) has not been established. Our goal was to evaluate the effect of viral coinfections on the progression and severity of AB. METHODS A retrospective observational study was conducted in a tertiary hospital in Spain from September 2012 to March 2020. Infants admitted for AB with at least one respiratory virus identified by molecular diagnostic techniques were included. A comparison was made between single-virus infections and viral coinfections. The evolution and severity of AB were determined based on the days of hospitalization and admission to the pediatric intensive care unit (PICU). RESULTS Four hundred forty-five patients were included (58.4% male). The median weight was 5.2 kg (IQR 4.2-6.5), and the median age was 2.5 months (IQR 1.4-4.6). A total of 105 patients (23.6%) were admitted to the PICU. Respiratory syncytial virus (RSV) was the most frequent etiological agent (77.1%). A single virus was detected in 270 patients (60.7%), and viral coinfections were detected in 175 (39.3%), of which 126 (28.3%) had two viruses and 49 (11%) had three or more viruses. Hospital length of stay (LOS) increased in proportion to the number of viruses detected, with a median of 6 days (IQR 4-8) for single infections, 7 days (IQR 4-9) for coinfections with two viruses and 8 days (IQR 5-11) for coinfections with ≥ 3 viruses (p = 0.003). The adjusted Cox regression model showed that the detection of ≥ 3 viruses was an independent risk factor for a longer hospital LOS (HR 0.568, 95% CI 0.410-0.785). No significant association was observed between viral coinfections and the need for PICU admission (OR 1.151; 95% CI 0.737-1.797). CONCLUSIONS Viral coinfections modified the natural history of AB, prolonging the hospital LOS in proportion to the number of viruses detected without increasing the need for admission to the PICU.
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Affiliation(s)
- Lorena Bermúdez-Barrezueta
- División of Pediatric and Neonatal Intensive Care, Department of Pediatrics, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain.
- Department of Pediatrics, Faculty of Medicine, Valladolid University, Valladolid, Spain.
| | - Pablo López-Casillas
- División of Pediatric and Neonatal Intensive Care, Department of Pediatrics, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain
| | - Silvia Rojo-Rello
- Microbiology and Immunology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Laura Sáez-García
- Division of Pediatric Intensive Care, Reina Sofía Hospital, Córdoba, Spain
| | - José Manuel Marugán-Miguelsanz
- Department of Pediatrics, Faculty of Medicine, Valladolid University, Valladolid, Spain
- Division of Gastroenterology and Pediatric Nutrition, Head of Department of Pediatrics, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - María de la Asunción Pino-Vázquez
- División of Pediatric and Neonatal Intensive Care, Department of Pediatrics, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain
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Isa HM, Hasan AZ, Khalifa SI, Alhewaizem SS, Mahroofi AD, Alkhan FN, Al-Beltagi M. Hepatic involvement in children with acute bronchiolitis. World J Hepatol 2022; 14:1907-1919. [PMID: 36340752 PMCID: PMC9627436 DOI: 10.4254/wjh.v14.i10.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/22/2022] [Accepted: 10/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a prevalent cause of lower respiratory tract infections. It may be associated with hepatocellular involvement, as indicated by increased liver enzymes aspartate aminotransferase and alanine transaminase (ALT).
AIM To evaluate the rate of increased liver enzyme levels in children with acute bronchiolitis and correlate them with clinical, laboratory, and radiological variables.
METHODS The study was a retrospective review of the medical records of children who presented with acute bronchiolitis when admitted to the Pediatric Department, Salmaniya Medical Complex, the Kingdom of Bahrain, between 2019 and 2020. We collected the demographic data, the clinical presentation, the laboratory and radiological findings, and the clinical outcomes. We compared the patients with elevated liver enzymes to those with normal levels at the time of presentation and at follow-up.
RESULTS We included 166 (57.8%) of 287 patients with acute bronchiolitis who fulfilled the inclusion criteria. Ninety-three (56%) patients were males. The median age at presentation was 3.4 (interquartile range 1.1 to 12.4) mo. Fifty-four (28%) patients tested positive for RSV, which was confirmed in 15 of them (28%) by PCR. Laboratory findings of 161 patients tested at presentation showed high ALT levels in 14 (8.7%) patients and normal ALT in 147 (91.3%). Coagulation profiles were measured in 46 (27.7%) of 166 patients. High prothrombin time was present in 15 (32.6%), a high international normalized ratio was present in 13 (28.3%), and high activated partial thromboplastin time was present in three (6.5%). Thrombin time was elevated in nine (27.3%) of 33 patients. Five (21.7%) of 23 patients with available radiological data had hepatomegaly; one of them had findings suggestive of fatty infiltration. High ALT had a significant association with lengthy hospital stays (P < 0.05) and positive urine culture (P < 0.05). Seventy (42.2%) patients had documented follow-up with liver function tests over a median follow-up period of 10.2 (IQR, 2.4-23.3) mo. Total serum protein and serum globulin levels were normalized at the follow-up time, with a significant P value of < 0.05.
CONCLUSION This study showed a low prevalence of liver function involvement in patients with acute bronchiolitis with a benign course. However, there was a rising trend in ALT during follow-up. Prolonged hospital stay and positive urine cultures were associated with elevated liver enzymes.
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Affiliation(s)
- Hasan M Isa
- Department of Pediatrics, Salmaniya Medical Complex, Manama 12, Bahrain
- Department of Pediatrics, Arabian Gulf University, Manama 26671, Bahrain
| | - Asma Z Hasan
- Department of Pediatrics, Sulwan Psychiatric Hospital, Manama 973, Bu Quwah, Bahrain
| | - Sara I Khalifa
- Department of Pediatrics, Salmaniya Medical Complex, Manama 12, Bahrain
| | - Sana S Alhewaizem
- Department of Pediatrics, Dream Reem Medical Center, Muharraq 50573, Bahrain
| | | | - Fatema N Alkhan
- Department of Pediatrics, Salmaniya Medical Complex, Manama 12, Bahrain
| | - Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Bahrain
- Department of Pediatrics, University Medical Center, Dr. Sulaiman Al-Habib Medical Group, Bahrain, Manama 26671, Bahrain
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Cataño-Jaramillo ML, Jaramillo-Bustamante JC, Florez ID. Continuous Positive Airway Pressure vs. High Flow Nasal Cannula in children with acute severe or moderate bronchiolitis. A systematic review and Meta-analysis. Med Intensiva 2022; 46:72-80. [PMID: 35115112 DOI: 10.1016/j.medine.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/18/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the safety and effectiveness of Continuous Positive Airway Pressure (CPAP) vs. High Flow Nasal Cannula (HFNC) to prevent therapeutic failure and the need of invasive ventilation in children with acute moderate-severe bronchiolitis. DESIGN A systematic review and meta-analysis. SETTING Medline, Embase, Lilacs, Cochrane and gray literature (May 2020) was performed. PARTICIPANTS Randomized clinical trials patients with moderate to severe bronchiolitis. MAIN VARIABLES Therapeutic failure, need for invasive ventilation, adverse events, length of PCCU and of hospital stay. INTERVENTION The quality of the studies was assessed with the Cochrane risk and bias tool. We conducted meta-analysis using fixed effect model and random effects model. RESULTS Three RCTs were included. Showed less risk of therapeutic failure with CPAP compared with HFNC (RR=0.7; 95%CI 0.5-0.99) developed hours later in patients with CPAP (MD=3.16; 95%CI 1.55-4.77). We did not find differences in other outcomes, such as need of invasive ventilation (RR=0.60; 95%CI 0.25-1.43), apnea (RR=0.40; 95%CI 0.08-1.99), or number of days in the intensive care unit (MD=0.02; 95%CI -0.38 to 0.42), and length of hospitalization (MD=-1.00; 95%IC -2.66 to 0.66). Adverse events (skin lesions) were more common with CPAP (RR 2.47; 95%CI 1.17-5.22). CONCLUSIONS In moderate/severe bronchiolitis CPAP demonstrated a lower risk of therapeutic failure and a longer time to failure. But more adverse events like nasal injury. There were no differences in other variables.
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Affiliation(s)
| | - J C Jaramillo-Bustamante
- Hospital General Medellín, Medellín, Colombia; Department of Pediatrics, University of Antioquia, Medellín, Colombia
| | - I D Florez
- Department of Pediatrics, University of Antioquia, Medellín, Colombia; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, Jayashree M. Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study. Indian J Crit Care Med 2021; 25:1301-1307. [PMID: 34866830 PMCID: PMC8608649 DOI: 10.5005/jp-journals-10071-24016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The objective of the study was to describe the clinico-virological profile, treatment details, intensive care needs, and outcome of infants with acute viral bronchiolitis (AVB). METHODOLOGY In this prospective observational study, 173 infants with AVB admitted to the pediatric emergency room and pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India during November 2019 to February 2020 were enrolled. The data collection included clinical features, viruses detected [respiratory syncytial virus (RSV), rhinovirus, influenza A virus, parainfluenza virus (PIV) 2 and 3, and human metapneumovirus (hMPV)], complications, intensive care needs, treatment, and outcomes. Multivariate analysis was performed to determine independent predictors for PICU admission. RESULTS Most common symptoms were rapid breathing (98.8%), cough (98.3%), and fever (74%). On examination, tachypnea (98.8%), chest retractions (93.6%), respiratory failure (84.4%), wheezing (49.7%), and crepitations (23.1%) were observed. RSV and rhinovirus were the predominant isolates. Complications were noted in 25% of cases as encephalopathy (17.3%), transaminitis (14.3%), shock (13.9%), acute kidney injury (AKI) (7.5%), myocarditis (6.4%), multiple organ dysfunction syndrome (MODS) (5.8%), and acute respiratory distress syndrome (ARDS) (4.6%). More than one-third of cases required PICU admission. The treatment details included nasal cannula oxygen (11%), continuous positive airway pressure (51.4%), high-flow nasal cannula (14.5%), mechanical ventilation (23.1%), nebulization (74%), antibiotics (35.9%), and vasoactive drugs (13.9%). The mortality was 8.1%. Underlying comorbidity, chest retractions, respiratory failure at admission, presence of shock, and need for mechanical ventilation were independent predictors of PICU admission. Isolation of virus or coinfection was not associated with disease severity, intensive care needs, and outcomes. CONCLUSION Among infants with AVB, RSV and rhinovirus were predominant. One-third infants with AVB needed PICU admission. The presence of comorbidity, chest retractions, respiratory failure, shock, and need for mechanical ventilation independently predicted PICU admission. HOW TO CITE THIS ARTICLE Angurana SK, Takia L, Sarkar S, Jangra I, Bora I, Ratho RK, et al. Clinico-virological Profile, Intensive Care Needs, and Outcome of Infants with Acute Viral Bronchiolitis: A Prospective Observational Study. Indian J Crit Care Med 2021;25(11):1301-1307.
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Affiliation(s)
| | - Lalit Takia
- Department of Pediatrics, PGIMER, Chandigarh, India
| | | | | | - Ishani Bora
- Department of Virology, PGIMER, Chandigarh, India
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Jerath N. Viral Bronchiolitis in Children: Less is More. Indian J Crit Care Med 2021; 25:1219-1220. [PMID: 34866816 PMCID: PMC8608641 DOI: 10.5005/jp-journals-10071-24035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Jerath N. Viral Bronchiolitis in Children: Less is More. Indian J Crit Care Med 2021;25(11):1219-1220.
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Affiliation(s)
- Nameet Jerath
- Department of Pediatric Intensive Care, Indraprastha Apollo Hospitals, New Delhi, India
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Bermúdez Barrezueta L, Miñambres Rodríguez M, Palomares Cardador M, Torres Ballester I, López Casillas P, Moreno Carrasco J, Pino Vázquez A. Effect of prenatal and postnatal exposure to tobacco in the development of acute bronchiolitis in the first two years of life. An Pediatr (Barc) 2021; 94:385-395. [PMID: 34090635 DOI: 10.1016/j.anpede.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/06/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Environmental exposure to tobacco increases the risk of respiratory disease in infants. However, the impact of maternal smoking on the development of acute bronchiolitis has hardly been assessed. The aim of this study was to determine the incidence of acute bronchiolitis and to analyse the effect of prenatal and postnatal maternal smoking on the development of this disease. PATIENTS AND METHODS A prospective, observational study was performed on healthy newborns from a third level hospital born between October 2015 and February 2016. Questionnaires were completed by the mothers at discharge from maternity and followed-up for two years. These collected information about prenatal and postnatal smoking, lifestyle, family and personal history, and the development of bronchiolitis. A bivariate and multivariate logistic regression analysis was performed. RESULTS A total of 223 newborns were included, of whom 13.9% were exposed to tobacco smoking during gestation, 21.4% in the postnatal period, and 12.4% in both times. The incidence of bronchiolitis was 28.7% at one year of life, and 34.5% at two years. The multivariate analysis demonstrated that the prenatal and postnatal exposure to tobacco is an independent risk factor for the development of bronchiolitis (OR 4.38; 95% CI; 1.63-11.76), while prolonged breastfeeding is a protective factor (OR 0.13; 95% CI; 0.04-0.48). Other factors that were statistically significant were: atopic dermatitis (OR 2.91; 95% CI; 1.26-6.73), and gestational age (OR 1.42; 95% CI; 1.08-1.88). CONCLUSIONS Children exposed to prenatal and postnatal maternal smoking have a higher risk of suffering bronchiolitis. Reducing the smoking habit in women that intend to become pregnant must be a priority in preventive medicine.
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Affiliation(s)
- Lorena Bermúdez Barrezueta
- Unidad de Cuidados Intensivos Pediátricos y Neonatales, Hospital Clínico Universitario, Valladolid, Spain.
| | - María Miñambres Rodríguez
- Unidad de Cuidados Intensivos Pediátricos y Neonatales, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | | | | | - Asunción Pino Vázquez
- Unidad de Cuidados Intensivos Pediátricos y Neonatales, Hospital Clínico Universitario, Valladolid, Spain
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Buendía JA, Patiño DG. Budget impact analysis of surfactant therapy for bronchiolitis in critically ill infants: the Colombian National Health System perspective. BMC Health Serv Res 2021; 21:334. [PMID: 33849521 PMCID: PMC8042831 DOI: 10.1186/s12913-021-06347-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Severe bronchiolitis requiring mechanical ventilation was associated with an absence of surfactant activity and phosphatidylglycerol, causing airway obstruction in acute bronchiolitis. Exogen surfactant in mechanically ventilated infants decreased duration of stay in the intensive care unit and had favorable effects on oxygenation and carbon dioxide removal. This study aimed to evaluate the budget impact of surfactant therapy for bronchiolitis in critically ill infants in Colombia. Methods Budget impact analysis was performed to estimate the economic impact of surfactant therapy (ST) for the treatment of infants with a diagnosis of bronchiolitis, requiring mechanical ventilation. The analysis considered a 4-year time horizon and Colombian National Health System perspective. The model estimated drug costs associated with current scenario using humidified oxygen or adrenaline nebulization, and new scenario adding exogen surfactant. The size of the target population was calculated using epidemiological national data. Univariate one-way sensitivity analyses and scenario analyses were performed. Results In the base-case analysis the 4-year costs associated to ST and no-ST were estimated to be US$ 55,188,132 and US$ 55,972,082 respectively, indicating savings for Colombian National Health equal to US$ 783,950 if ST is adopted for the routine management of patients with bronchiolitis requiring mechanical ventilation. In the one-way sensitivity analysis, only increases in the cost of the surfactant drug and cost or length of stay in the pediatric intensive unit reduce the potential savings of ST. Conclusion ST was cost-saving in emergency settings for treating infants with severe bronchiolitis requiring mechanical ventilation. This shift in treatment approach proved to be economically favorable in the Colombian context.
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Affiliation(s)
- Jefferson Antonio Buendía
- Department of Pharmacology and Toxicology, Facultad de Medicina, School of Medicine, Research Group in Pharmacology and Toxicology (INFARTO), Universidad de Antioquia, Carrera 51D #62-29, Medellín, Colombia.
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Buendía JA, Feliciano-Alfonso JE. Inappropriate antibiotic prescribing for acute bronchiolitis in Colombia: a predictive model. J Pharm Policy Pract 2021; 14:2. [PMID: 33397498 DOI: 10.1186/s40545-020-00284-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Acute bronchiolitis is the leading cause of hospitalization in the pediatric population. The inappropriate prescription of antibiotics in acute bronchiolitis is associated with bacterial resistance, higher costs, and risk of adverse effects in this population. The objective of this work is to develop a predictive model of inappropriate use of antibiotics in children with acute bronchiolitis in Colombia. Methods A retrospective cohort study was conducted in patients under 2 years of age with a diagnosis of acute bronchiolitis from two hospitals in Rionegro, Colombia. To identify factors independently associated with inappropriate use of antibiotics, we used logistic regression and estimated odds ratios (ORs). To assess discrimination, area under the curve (AUC) was estimated with a 95% confidence interval and plotted using AUC–ROC plots. To correct sampling bias of variance parameters and to evaluate the internal validity of the model, repeated curved validation “tenfold cross-validation” was used, comparing the area under the ROC curve obtained in the repetitions with that observed in the model Results A total of 415 patients were included. 142 patients (34.13%) had a prescription of some antibiotic during their hospital stay. In 92 patients (64.78%, 95% CI 56.3 to 72.6%) the prescription of antibiotics was classified as inappropriate. Age older than 1 year, chest retractions, temperature between 37.5 °C and 38.5 °C and leukocyte count between 10,000 and 15,000 million/mm3 were the predictive variables of inappropriate use of medications in this population. Conclusion The presence of fever between 37.5 °C and 38.5 °C, leukocytosis between 10,000 and 15,000 million/mm3, and age older than 1 year and presence of chest retractions, should alert the physician regarding the high risk of inappropriate prescription of antibiotics. Patients with acute bronchiolitis with a score on our scale greater than 2 should be carefully evaluated regarding the need for the use of antibiotics, if prescribed.
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Marcos-Morales A, García-Salido A, Leoz-Gordillo I, de Lama Caro-Patón G, Martínez de Azagra-Garde A, García-Teresa MÁ, Iglesias-Bouzas MI, Nieto-Moro M, Serrano-González A, Casado-Flores J. Respiratory and pharmacological management in severe acute bronchiolitis: Were clinical guidelines not written for critical care? Arch Pediatr 2020; 28:150-155. [PMID: 33339722 DOI: 10.1016/j.arcped.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/15/2020] [Accepted: 11/21/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The treatment applied for children admitted to the pediatric intensive care unit (PICU) for severe acute bronchiolitis may differ from general recommendations. The first objective of our study was to describe the treatments offered to these children in a Spanish tertiary PICU. The second objective was to analyse the changes in management derived from the publication of the American Academy of Pediatrics (AAP) bronchiolitis guideline in 2014. METHODS This was a retrospective-prospective observational study conducted during two epidemic waves (2014-2015 and 2015-2016). The AAP guidelines were distributed and taught to PICU staff between both epidemic waves. RESULTS A total of 138 children were enrolled (78 male). In the first period, 78 children were enrolled. The median age was 1.8 months (IQR 1.1-3.6). There were no differences between the management in the two periods, except for the use of high-flow oxygen therapy (HFOT); its use increased in the second period. Overall, 83% of patients received non-invasive ventilation or HFOT. Children older than 12 months received HFOT exclusively. In comparison, continuous positive airway pressure and bi-level positive airway pressure were used less during the period 2015-2016 (P=0.036). Regarding pharmacological therapy, 70% of patients received antibiotics, 23% steroids, 33% salbutamol, 31% adrenaline, and 7% hypertonic saline. The mortality rate was zero. CONCLUSIONS Our PICU did not follow the AAP recommendations. There were no differences between the two periods, except in the use of HFOT. All children older than 12 months received HFOT exclusively. The rate of using invasive mechanical ventilation was also low.
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Affiliation(s)
- A Marcos-Morales
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - A García-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain.
| | - I Leoz-Gordillo
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - G de Lama Caro-Patón
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - A Martínez de Azagra-Garde
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - M Á García-Teresa
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - M I Iglesias-Bouzas
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - M Nieto-Moro
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - A Serrano-González
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
| | - J Casado-Flores
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, avenida Menéndez Pelayo 65, Madrid, Spain
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Cataño-Jaramillo ML, Jaramillo-Bustamante JC, Florez ID. Continuous Positive Airway Pressure vs. High Flow Nasal Cannula in children with acute severe or moderate bronchiolitis. A systematic review and Meta-analysis. Med Intensiva 2020; 46:S0210-5691(20)30324-7. [PMID: 33168328 DOI: 10.1016/j.medin.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the safety and effectiveness of Continuous Positive Airway Pressure (CPAP) vs. High Flow Nasal Cannula (HFNC) to prevent therapeutic failure and the need of invasive ventilation in children with acute moderate-severe bronchiolitis. DESIGN A systematic review and meta-analysis. SETTING Medline, Embase, Lilacs, Cochrane and gray literature (May 2020) was performed. PARTICIPANTS Randomized clinical trials patients with moderate to severe bronchiolitis. MAIN VARIABLES Therapeutic failure, need for invasive ventilation, adverse events, length of PCCU and of hospital stay. INTERVENTION The quality of the studies was assessed with the Cochrane risk and bias tool. We conducted meta-analysis using fixed effect model and random effects model. RESULTS Three RCTs were included. Showed less risk of therapeutic failure with CPAP compared with HFNC (RR=0.7; 95%CI 0.5-0.99) developed hours later in patients with CPAP (MD=3.16; 95%CI 1.55-4.77). We did not find differences in other outcomes, such as need of invasive ventilation (RR=0.60; 95%CI 0.25-1.43), apnea (RR=0.40; 95%CI 0.08-1.99), or number of days in the intensive care unit (MD=0.02; 95%CI -0.38 to 0.42), and length of hospitalization (MD=-1.00; 95%IC -2.66 to 0.66). Adverse events (skin lesions) were more common with CPAP (RR 2.47; 95%CI 1.17-5.22). CONCLUSIONS In moderate/severe bronchiolitis CPAP demonstrated a lower risk of therapeutic failure and a longer time to failure. But more adverse events like nasal injury. There were no differences in other variables.
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Affiliation(s)
| | - J C Jaramillo-Bustamante
- Hospital General Medellín, Medellín, Colombia; Department of Pediatrics, University of Antioquia, Medellín, Colombia
| | - I D Florez
- Department of Pediatrics, University of Antioquia, Medellín, Colombia; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Ziemele I, Xu M, Vilmane A, Rasa-Dzelzkaleja S, Hedman L, Hedman K, Söderlund-Venermo M, Nora-Krukle Z, Murovska M, Gardovska D. Acute human bocavirus 1 infection in child with life-threatening bilateral bronchiolitis and right-sided pneumonia: a case report. J Med Case Rep 2019; 13:290. [PMID: 31519214 PMCID: PMC6744643 DOI: 10.1186/s13256-019-2222-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 08/08/2019] [Indexed: 01/04/2023] Open
Abstract
Background Human bocavirus 1 is a commonly detected human parvovirus. Many studies have shown human bocavirus 1 as a pathogen in association with acute respiratory tract infections in children. However, because human bocavirus 1 persists in the upper airways for extensive time periods after acute infection, the definition and diagnostics of acute human bocavirus 1 infection is challenging. Until now, detection of human bocavirus 1 exclusively, high viral load in respiratory samples, and viremia have been associated with a clinical picture of acute respiratory illness. There are no studies showing detection of human bocavirus 1 messenger ribonucleic acid in the peripheral blood mononuclear cells as a diagnostic marker for acute lower respiratory tract infection. Case presentation We report the case of a 17-month-old Latvian boy who presented in intensive care unit with acute bilateral bronchiolitis, with a history of rhinorrhea and cough for 6 days and fever for the last 2 days prior to admission, followed by severe respiratory distress and tracheal intubation. Human bocavirus 1 was the only respiratory virus detected by a qualitative multiplex polymerase chain reaction panel. For the diagnosis of acute human bocavirus 1 infection, both molecular and serological approaches were used. Human bocavirus 1 deoxyribonucleic acid (DNA) was detected simultaneously in nasopharyngeal aspirate, stool, and blood, as well as in the corresponding cell-free blood plasma by qualitative and quantitative polymerase chain reaction, revealing high DNA-copy numbers in nasopharyngeal aspirate and stool. Despite a low-load viremia, human bocavirus 1 messenger ribonucleic acid was found in the peripheral blood mononuclear cells. For detection of human bocavirus 1-specific antibodies, non-competitive immunoglobulin M and competitive immunoglobulin G enzyme immunoassays were used. The plasma was positive for both human bocavirus 1-specific immunoglobulin M and immunoglobulin G antibodies. Conclusions The presence of human bocavirus 1 genomic DNA in blood plasma and human bocavirus 1 messenger ribonucleic acid in peripheral blood mononuclear cells together with human bocavirus 1-specific immunoglobulin M are markers of acute human bocavirus 1 infection that may cause life-threatening acute bronchiolitis.
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Affiliation(s)
- Inga Ziemele
- Children's Clinical University Hospital, Riga, Latvia. .,Department of Pediatrics Rīga Stradiņš University, Riga, Latvia.
| | - Man Xu
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - Anda Vilmane
- Institute of Microbiology and Virology, Rīga Stradiņš University Riga, Riga, Latvia
| | | | - Lea Hedman
- Department of Virology, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital Laboratory Service, Helsinki, Finland
| | - Klaus Hedman
- Department of Virology, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital Laboratory Service, Helsinki, Finland
| | | | - Zaiga Nora-Krukle
- Institute of Microbiology and Virology, Rīga Stradiņš University Riga, Riga, Latvia
| | - Modra Murovska
- Institute of Microbiology and Virology, Rīga Stradiņš University Riga, Riga, Latvia
| | - Dace Gardovska
- Children's Clinical University Hospital, Riga, Latvia.,Department of Pediatrics Rīga Stradiņš University, Riga, Latvia
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12
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Hirai K, Nukaga M, Tabata H, Enseki M, Furuya H, Niimura F, Yamaguchi K, Mochizuki H. Objective measurement of nocturnal cough in infants with acute bronchiolitis. Respir Investig 2019; 57:605-610. [PMID: 31327680 DOI: 10.1016/j.resinv.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/10/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The objective measurement of the cough severity and the assessment of the pattern of nocturnal coughing could be useful in the treatment of respiratory diseases in children. STUDY DESIGN In children with respiratory syncytial virus (RSV)-induced acute bronchiolitis, coughs were recorded using our original system with a microphone and accelerometer, and analyzed using our customized software program. The number of coughs in every 30-minute interval was measured in patients with acute bronchiolitis (n = 20), and their results were compared with those of infants with asthma exacerbation (n = 16). RESULTS The cough count in children with acute bronchiolitis (median: 108.0/night) was almost as high as that in children with asthma exacerbation (median: 119/night). However, the time-dependent pattern of overnight cough was different in infants with acute bronchiolitis and those with asthma exacerbation. In the infants with asthma exacerbation, cough frequency significantly increased while falling asleep and waking up as compared to midnight (p < 0.001 and p < 0.001, respectively). However, these differences were not found in infants with acute bronchiolitis. CONCLUSIONS Our data demonstrated that the number of coughing events due to acute bronchiolitis was similar to that of acute asthma exacerbation, although the acute bronchiolitis did not show a characteristic overnight cough pattern.
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Affiliation(s)
- Kota Hirai
- Department of Pediatrics, Tokai University Hachioji Hospital, 1838, Ishikawa, Hachioji, Tokyo, 192-0032 Japan.
| | - Mariko Nukaga
- Department of Pediatrics, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
| | - Hideyuki Tabata
- Department of Pediatrics, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
| | - Mayumi Enseki
- Department of Pediatrics, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
| | - Hiroyuki Furuya
- Department of Basic Clinical Science and Public Health, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
| | - Fumio Niimura
- Department of Pediatrics, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
| | - Koichi Yamaguchi
- Department of Pediatrics, Tokai University Hachioji Hospital, 1838, Ishikawa, Hachioji, Tokyo, 192-0032 Japan.
| | - Hiroyuki Mochizuki
- Department of Pediatrics, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa, 259-1193 Japan.
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13
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Abstract
PURPOSE OF REVIEW Cough becomes a pathologic reflex when the airways are inflamed and overwhelmed with excessive mucus. The goal of this review is to discuss acute and chronic cough syndromes caused by non-asthmatic airway diseases. RECENT FINDINGS Acute cough syndrome is short-lived and self-limited. Acute bronchitis and diffuse acute infectious bronchiolitis (DAIB) are examples. The former is usually caused by a viral illness; the latter by Mycoplasma pneumoniae, influenza, and Haemophilus influenzae. Causes of chronic cough in the adult include chronic bronchitis, non-infectious bronchiolitis, and non-cystic fibrosis bronchiectasis. SUMMARY Supportive measures are recommended for acute bronchitis and antibiotic use is discouraged. Antibiotics may be needed for DAIB. Smoking cessation and bronchodilators can control cough in chronic bronchitis. Therapeutic approaches for non-infectious bronchiolitis depend on the varied etiology. The hallmark of bronchiectasis is a chronic infection of the airways, and antibiotics, mucus clearance measures, and bronchodilators are all supportive.
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Affiliation(s)
- Sidney S. Braman
- Icahn School of Medicine at Mount Sinai, 1 Gustav L. Levy Pl., Box 1232, New York, NY 10029 USA
- Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Armeen Poor
- Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
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14
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Gjengstø Hunderi JO, Lødrup Carlsen KC, Rolfsjord LB, Carlsen K, Mowinckel P, Skjerven HO. Parental severity assessment predicts supportive care in infant bronchiolitis. Acta Paediatr 2019; 108:131-137. [PMID: 29889987 DOI: 10.1111/apa.14443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/14/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
Abstract
AIM In infants with acute bronchiolitis, the precision of parental disease severity assessment is unclear. We aimed to determine if parental assessment at the time of hospitalisation predicted the use of supportive care, and subsequently determine the likelihood that the infant with acute bronchiolitis would receive supportive care. METHODS From the Bronchiolitis ALL south-east Norway study, we included all 267, 0-12 month old, infants with acute bronchiolitis whose parents at the time of hospitalisation completed a three-item visual analogue scale (VAS) concerning Activity, Feeding and Illness. Respiratory rate, oxygen saturation (SpO2 ) and use of supportive care were recorded daily. By multivariate logistic regression analyses we included significant predictors available at hospital admission to predict the use of supportive care. RESULTS The parental Activity, Feeding and Illness VAS scores significantly predicted supportive care with odds ratios of 1.23, 1.26 and 1.36, respectively. The prediction algorithm included parental Feeding and Illness scores, SpO2 , gender and age, with an area under the curve of 0.76 (95% CI 0.69, 0.81). A positive likelihood ratio of 2.1 gave the highest combined sensitivity of 81% and specificity of 61%. CONCLUSION Parental assessment at hospital admission moderately predicted supportive care treatment in infants with acute bronchiolitis.
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Affiliation(s)
- Jon Olav Gjengstø Hunderi
- Department of Pediatrics and Adolescent Medicine Østfold Hospital Trust Sarpsborg Norway
- Division of Pediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Karin C. Lødrup Carlsen
- Division of Pediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Leif Bjarte Rolfsjord
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Pediatrics Innlandet Hospital Trust Elverum Norway
| | - Kai‐Håkon Carlsen
- Division of Pediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Petter Mowinckel
- Division of Pediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Håvard Ove Skjerven
- Division of Pediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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15
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Montejo Fernández M, Benito Manrique I, Montiel Eguía A, Benito Fernández J. [An initiative to reduce the use of unnecessary medication in infants with bronchiolitis in primary care]. An Pediatr (Barc) 2018; 90:19-25. [PMID: 29803642 DOI: 10.1016/j.anpedi.2018.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Although evidence-based guidelines for acute bronchiolitis recommend primarily supportive care unnecessary treatments remain well documented. The objective of this study was to analyse a quality improvement initiative to reduce overuse of unnecessary treatments in infants with acute bronchiolitis in primary care settings. METHOD To determine the number of unnecessary treatments we reviewed the charts corresponding to infants aged <24 months of age diagnosed with acute bronchiolitis in two Primary Care areas during two bronchiolitis seasons [October-Mars of 2015-2016 (pre-intervention period) and 2016-2017 (post-intervention period)]. Between those seasons we distributed an evidence-based management protocol and developed interactive sessions with on-line data collection and feed-back. Outcomes were the rate of infants receiving salbutamol, steroids or antibiotics. RESULTS Twenty outpatient clinics contributed with 1,277 chart reviews (619 in the pre-intervention period and 658 in the post-intervention period). Overall, the use of any medication was reduced from 72.5% (95% CI, 68.8-75.9) to 52.1% (95% CI, 48.3-55.9) (p<0.01): salbutamol from 56.0% (95% CI, 52.1-59.9) to 38.3% (95% CI, 34.6-42.0) (p<0.01), corticosteroids from 23.7% (95% CI, 20.5-27.2) to 12.9% (95% CI, 10.5-15.7) (p<0.01) and antibiotics from 36.1% (95% CI; 32.5-40.0) to 29.6% (95% CI; 26.2-33.2) (p<0.05). The number of medications per patient decreased from a mean of 1.81 (SD: 0.86) to 1.62 (SD: 0.81) (p<0.01). CONCLUSIONS We significantly decreased the use of unnecessary treatments in infants with acute bronchiolitis. This quality improvement initiative may be applied to the settings where the majority of infants with acute bronchiolitis are attended in western countries.
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Affiliation(s)
| | | | | | - Javier Benito Fernández
- Servicio de Urgencias de Pediatría, OSI Ezkerraldea-Enkarterri-Cruces, Vizcaya, País Vasco, España
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16
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Seliem W, Sultan AM. [Does heliox administered by low-flow nasal cannula improve respiratory distress in infants with respiratory syncytial virus acute bronchiolitis? A randomized controlled trial]. An Pediatr (Barc) 2018; 90:3-9. [PMID: 29627312 DOI: 10.1016/j.anpedi.2018.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The aim of our study is to evaluate whether the use of heliox (79:21) delivered through a low flow nasal cannula would improve respiratory distress in infants with acute bronchiolitis caused by respiratory syncytial virus. METHODS We have conducted a prospective randomized controlled study. All patients fulfilled inclusion criteria were randomized to either heliox (79:21) or air via NC at 2 L/min for a continuous 24hours. Measurements were taken at baseline, after 2hours and at the end of the 24hours. RESULTS We have included 104 patients into our study. The MCA-S did not show any significant difference between the two groups after 2hours 4.3 vs. 4.1 (P =.78), or at 24hours after 4.2 vs. 4.3 (P =.89). No difference was found in the proportion of participants progressed to MV, n-CPAP or oxygen via nasal cannula (RR 1.0, 0.86 and 0.89) (P= 1.0, .77 and .73). There was no notable reduction in length of treatment in Heliox group 2.42 days vs. 2.79 days in air group P =.65. The in oxygen saturation, PaO2, and PaCO2 did not to have any statistical difference between the two studied groups after 2hours and 24hours of treatment. CONCLUSION Our data showed absence of any beneficial effect of heliox in a concentration (79:21) delivered through low flow nasal cannula in terms of respiratory distress improvement in infants with RSV acute bronchiolitis.
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Affiliation(s)
- Wael Seliem
- Facultad de Medicina, Universidad de El Mansura, El Mansura, Egipto; Departamento de Pediatría, Hospital Infantil Universitario de El Mansura, El Mansura, Egipto.
| | - Amira M Sultan
- Facultad de Medicina, Universidad de El Mansura, El Mansura, Egipto; Departamento de Microbiología Clínica e Inmunología, Hospital Infantil Universitario de El Mansura, El Mansura, Egipto
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17
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Gökçe Ş, Kurugöl Z, Şöhret Aydemir S, Çiçek C, Aslan A, Koturoğlu G. Bordetella Pertussis Infection in Hospitalized Infants with Acute Bronchiolitis. Indian J Pediatr 2018; 85:189-193. [PMID: 29076101 PMCID: PMC7090534 DOI: 10.1007/s12098-017-2480-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 09/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the frequency of B. pertussis infection among young infants hospitalized with acute bronchiolitis and to determine whether B. pertussis infection affects the clinical course of acute bronchiolitis. METHODS A total of 172 infants <6 months of age hospitalized with acute bronchiolitis were tested for B. pertussis and respiratory viruses with real-time PCR. Cases were divided into 2 groups according to B. pertussis positive or negative. Clinical parameters, clinical severity scores and laboratory characteristics of the pertussis-positive and pertussis-negative cases were compared. RESULTS Bordetella pertussis infection was detected in 44 (25.6%) of the 172 infants hospitalized for acute bronchiolitis, and as co-infection with respiratory viral agents in 27 (61.4%) infants. Of the 44 pertussis-positive infants, only 17 (38.6%) experienced a paroxysmal cough, 13 (29.5%) had whooping and 15 (34.1%) had post-tussive vomiting. There was no significant difference between pertussis-positive and pertussis-negative infants according to Wang clinical score at admission (4.9 ± 1.5 vs. 5.2 ± 2.5; p = 0.689). The overall disease severity score was also similar between the two groups (6.5 ± 1.4 vs. 6.9 ± 1.6; p = 0.095). CONCLUSIONS Bordetella pertussis infection is common in young infants hospitalized for acute bronchiolitis, mostly as co-infection with respiratory viruses. The clinical features of pertussis in the infants are not characteristic. Viral bronchiolitis and pertussis cases could not be differentiated by clinical findings. Co-infection with pertussis did not affect the clinical outcome in infants hospitalized with acute bronchiolitis.
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Affiliation(s)
- Şule Gökçe
- Department of Pediatrics, General Pediatrics Unit, Ege University, Izmir, Bornova, Turkey
| | - Zafer Kurugöl
- Division of Pediatric Infection, Department of Pediatrics, Ege University, 35700, Izmir, Bornova, Turkey.
| | - S Şöhret Aydemir
- Department of Microbiology, Ege University, Izmir, Bornova, Turkey
| | - Candan Çiçek
- Department of Microbiology, Ege University, Izmir, Bornova, Turkey
| | - Aslı Aslan
- Department of Pediatrics, General Pediatrics Unit, Ege University, Izmir, Bornova, Turkey
| | - Güldane Koturoğlu
- Department of Pediatrics, General Pediatrics Unit, Ege University, Izmir, Bornova, Turkey
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18
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Carsin A, Sauvaget E, Bresson V, Retornaz K, Cabrera M, Jouve E, Truillet R, Bosdure E, Dubus JC. Early Halt of a Randomized Controlled Study with 3% Hypertonic Saline in Acute Bronchiolitis. Respiration 2017. [PMID: 28647745 DOI: 10.1159/000477495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Albeit not recommended because of contradictory results, nebulized 3% hypertonic saline is widely used for treating acute viral bronchiolitis. Whether clinical differences may be attributed to the type of nebulizer used has never been studied. OBJECTIVES By modifying the amount of salt deposited into the airways, the nebulizer characteristics might influence clinical response. METHODS A prospective, randomized, controlled trial included infants hospitalized in a French university hospital for a first episode of bronchiolitis. Each child received 6 nebulizations of 3% hypertonic saline during 48 h delivered with 1 of the 3 following nebulizers: 2 jet nebulizers delivering large or small particles, with a low aerosol output, and 1 mesh nebulizer delivering small particles, with a high aerosol output. The primary endpoint was the difference in the Wang score at 48 h. RESULTS Only 61 children of 168 were recruited before stopping this study because of severe adverse events (n = 4) or parental requests for discontinuation due to discomfort to their child during nebulization (n = 2). One minor adverse event was noted in 91.8% (n = 56/61) of children. A high aerosol output induced 75% of the severe adverse events; it was significantly associated with the nebulization-induced cough between 24 and 48 h (p = 0.036). Decreases in Wang scores were not significantly different between the groups at 48 h, 9 recoveries out of 10 being obtained with small particles. CONCLUSION No beneficial effects and possibly severe adverse events are observed with 3% hypertonic saline in the treatment of bronchiolitis.
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Affiliation(s)
- Ania Carsin
- Pediatric Pulmonology and Pediatrics, University Hospital of La Timone-Enfants, Aix-Marseille University, Marseille, France
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Wu KW, Wang SM, Shen CF, Ho TS, Wang JR, Liu CC. Clinical and epidemiological characteristics of human parainfluenza virus infections of children in southern Taiwan. J Microbiol Immunol Infect 2018; 51:749-55. [PMID: 28757139 DOI: 10.1016/j.jmii.2016.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Human parainfluenza viruses (HPIV) 1-4 had been analyzed as being one of the most frequent causes of hospitalizations for young children with respiratory tract illnesses. METHODS This retrospective study was performed from children virologically confirmed as HPIV infection through throat swab or nasopharyngeal aspirates at a tertiary care university hospital, between January 2012 and December 2014. HPIV4 was not checked and analyzed, due to not include in the commercial kit. The demographic, epidemiological, clinical presentations, diagnosis, treatment, outcomes, and laboratory data were analyzed. RESULTS Totally 398 cases were enrolled, including 39 (9.8%) of HPIV1, 67 (16.8%) of HPIV2, and 292 (73.4%) of HPIV3. The mean age of HPIV-infected children was 2.9 year-old, and 50.5% were among one to three year-old. A total of 56.8% HPIV3-infected children were among one to three years old, however, no HPIV2-infected children was younger than one year-old. The HPIV1-infected patients were more common to develop wheezing and diagnose as acute bronchiolitis. HPIV2-infected children were more likely to have hoarseness (23.9%), and were associated with croup (25.4%). HPIV3 was isolated from two fatal cases, with neurological underlying diseases. CONCLUSION The impact caused by HPIVs infections is significant in hospitalized children. In the current study, our results contribute to the epidemiologic, clinical and laboratory information of HPIV infection in children in the important areas of respiratory tract infection that could support the development of optimization management.
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Ramagopal G, Brow E, Mannu A, Vasudevan J, Umadevi L. Demographic, Clinical and Hematological Profile of Children with Bronchiolitis: A Comparative Study between Respiratory Synctial Virus [RSV] and [Non RSV] Groups. J Clin Diagn Res 2016; 10:SC05-8. [PMID: 27656520 DOI: 10.7860/jcdr/2016/20331.8262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 05/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acute bronchiolitis is one of major disease affecting the lower airways in infants and children with Respiratory Syncitial Virus (RSV) being most common causative organism accounting for 50%-80% of bronchiolitis cases. AIM To analyse the demographic characteristics, clinical features and haematological profile of children with Bronchiolitis. To compare the findings of demographic characteristics, clinical features and haematological profile between RSV and Non -RSV bronchiolitis. MATERIALS AND METHODS This is a prospective study, conducted in a teritiary care center for 1 year period from Jan 2015 to Dec 2015. The demographic characteristics, clinical features and haematological profile of children aged between 1 month to 3 years who fulfilled the inclusion criteria were noted in predesigned proforma, nasopharyngeal swab was sent for RSV analysis and then the findings of the parameters were compared between the two groups of RSV bronchiolitis and Non RSV bronchiolitis. RESULTS Among 80 cases with 40 in each group, children below the age of 1year were affected more in RSV group, with male preponderance. Among the clinical features except that 89.7% of RSV cases had wheeze that was statistically significant with no difference in other features. Investigations showed no much difference in both the groups. Percentage of Non RSV subjects who received nebulisation with bronchodilators, steroid and antibiotic therapy were higher than RSV subjects. The hospital stay was significantly higher in RSV cases and none of the study participants met with mortality. CONCLUSION Children with RSV bronchiolitis had prolonged hospital stay compared to Non RSV group. Need for nebulisation with bronchodilators, steroids and antibiotic therapy was more in Non RSV group.
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Affiliation(s)
- Ganavi Ramagopal
- Assistant Professor, Department of Paediatrics, Chettinad Hospital and Research Institute , Kelambakkkam, Chennai, India
| | - Edin Brow
- Post Graduate Student, Department of Paediatrics, Chettinad Hospital and Research Institute , Kelambakkkam, Chennai, India
| | - Alexander Mannu
- Assistant Professor, Department of Paediatrics, Chettinad Hospital and Research Institute , Kelambakkkam, Chennai, India
| | - Jaishree Vasudevan
- Professor, Department of Paediatrics, Chettinad Hospital and Research Institute , Kelambakkkam, Chennai, India
| | - Lala Umadevi
- Professor and Head of Department, Department of Paediatrics, Chettinad Hospital and Research Institute , Kelambakkkam, Chennai, India
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Rolfsjord LB, Skjerven HO, Carlsen KH, Mowinckel P, Bains KES, Bakkeheim E, Lødrup Carlsen KC. The severity of acute bronchiolitis in infants was associated with quality of life nine months later. Acta Paediatr 2016; 105:834-41. [PMID: 26970427 PMCID: PMC5074291 DOI: 10.1111/apa.13396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 02/02/2016] [Accepted: 03/07/2016] [Indexed: 12/15/2022]
Abstract
Aim Acute bronchiolitis in infancy increases the risk of later asthma and reduced health‐related quality of life (QoL). We aimed to see whether the severity of acute bronchiolitis in the first year of life was associated with QoL nine months later. Methods The parents of 209 of 404 of children hospitalised for acute bronchiolitis in eight paediatric departments in south‐east Norway at a mean four months of age (range 0–12 months) completed the Infant/Toddler Quality of Life Questionnaire sent by mail nine months after the acute illness. Disease severity was measured by length of stay and the need for supportive treatment. Interactions with gender, inclusion age, prematurity, maternal ethnicity and maternal education were examined. Results Reduced QoL in four domains was associated with increased length of stay and need for ventilatory support. Physical abilities and general health were associated with both severity markers, whereas bodily pain and discomfort and change in health were associated with length of stay. Ventilatory support was more negatively associated with QoL than atopic eczema and also associated with reduced parental emotions and parental time. Conclusion The severity of acute bronchiolitis in infants was associated with reduced QoL nine months later.
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Affiliation(s)
- Leif Bjarte Rolfsjord
- Department of Paediatrics; Innlandet Hospital Trust; Elverum Norway
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Håvard Ove Skjerven
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Kai-Håkon Carlsen
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Petter Mowinckel
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
| | - Karen Eline Stensby Bains
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Egil Bakkeheim
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
| | - Karin C. Lødrup Carlsen
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; Institute of Clinical Medicine; University of Oslo; Oslo Norway
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Tórtora RP, Guimarães MAAM, de Souza LM, Santos IA, Varella RB, de Fátima Pombo March M, da Cunha AJLA, Sant' Anna CC. Adenovirus species C detection in children under four years of age with acute bronchiolitis or recurrent wheezing. J Clin Virol 2015; 73:77-80. [PMID: 26580407 DOI: 10.1016/j.jcv.2015.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/25/2015] [Accepted: 11/01/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Lower respiratory tract viral infection is an important cause of morbidity and mortality in children worldwide. Among viral etiological agents the human Adenovirus (AdV) has been associated to mild or severe respiratory tract infection. OBJECTIVE To detect the presence of human Adenovirus (AdV) in children with acute bronchiolitis or recurrent wheezing, describing their clinical features and determining Adenovirus species and AdV association to Respiratory Syncytial Virus (RSV), Human Metapneumovirus (MPV) and Parainfluenza virus (PIV). STUDY DESIGN A total of 155 children bellow 48 months of age with acute bronchiolitis or recurrent wheezing were investigated for the presence of AdV, RSV, MPV and PIV in nasopharyngeal aspirate, by real-time PCR method. RESULTS AdV, predominantly of species C, has been detected as the unique pathogen (AdVi) or in association to other pathogens (AdVa.), in 39/155 samples. Crackles were more frequent in children with AdV. RSVi was detected predominantly in children with acute bronchiolitis while AdVi and AdVa were detected more frequently in patients with recurrent wheezing. CONCLUSION A small outbreak of AdV species C was observed in 2012 and 2013. AdV was detected more frequently in children with recurrent wheezing while RSVi was more frequent in infants with acute bronchiolitis.
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Affiliation(s)
- Rosângela Prendin Tórtora
- Laboratório do Nucleo de Apoio a Criança e ao Adolescente do Instituto de Puericultura e Pediatria Martagão Gesteira, UFRJ, Brazil; Laboratório de Virologia, Hospital Universitário Clementino Fraga Filho, UFRJ, Brazil
| | - Maria Angélica Arpon Marandino Guimarães
- Laboratório do Nucleo de Apoio a Criança e ao Adolescente do Instituto de Puericultura e Pediatria Martagão Gesteira, UFRJ, Brazil; Laboratório de Virologia, Hospital Universitário Clementino Fraga Filho, UFRJ, Brazil; Depto de Medicina Preventiva, Faculdade de Medicina, UFRJ, Brazil; Programa de Pós graduação em Doenças Infecciosas, Faculdade de Medicina, UFRJ, Brazil.
| | - Leandro Magalhães de Souza
- Laboratório do Nucleo de Apoio a Criança e ao Adolescente do Instituto de Puericultura e Pediatria Martagão Gesteira, UFRJ, Brazil; Laboratório de Virologia, Hospital Universitário Clementino Fraga Filho, UFRJ, Brazil
| | - Isabela Arruda Santos
- Laboratório do Nucleo de Apoio a Criança e ao Adolescente do Instituto de Puericultura e Pediatria Martagão Gesteira, UFRJ, Brazil; Depto de Pediatria, Faculdade de Medicina, UFRJ, Brazil
| | - Rafael Brandão Varella
- Programa de Pós graduação em Doenças Infecciosas, Faculdade de Medicina, UFRJ, Brazil; Depto de Microbiologia, Instituto Biomédico, UFF, Brazil
| | | | - Antonio Jose Ledo Alves da Cunha
- Laboratório do Nucleo de Apoio a Criança e ao Adolescente do Instituto de Puericultura e Pediatria Martagão Gesteira, UFRJ, Brazil; Depto de Pediatria, Faculdade de Medicina, UFRJ, Brazil
| | - Clemax Couto Sant' Anna
- Laboratório do Nucleo de Apoio a Criança e ao Adolescente do Instituto de Puericultura e Pediatria Martagão Gesteira, UFRJ, Brazil; Depto de Pediatria, Faculdade de Medicina, UFRJ, Brazil; Programa de Pós graduação em Doenças Infecciosas, Faculdade de Medicina, UFRJ, Brazil
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Tahan F, Celik S, Eke Gungor H. Effect of montelukast on clinical score and cytokine levels of infants for clinically diagnosed acute bronchiolitis. Allergol Immunopathol (Madr) 2015; 43:376-82. [PMID: 25575728 DOI: 10.1016/j.aller.2014.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 06/22/2014] [Accepted: 06/30/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute bronchiolitis comprises a major cause for morbidity in infants with viral infection which induces an immune inflammatory response that may produce long lasting harmful effects. Currently, there is no effective therapy for bronchiolitis. OBJECTIVE Our aim was to investigate the efficacy of five-day montelukast therapy in acute bronchiolitis management. METHODS The study included 50 infants with acute bronchiolitis. The infants with first episode of acute bronchiolitis were randomly assigned to receive daily montelukast dose of 4mg over five days after admission or no treatment. Plasma eotaxin, IL-4, IL-8 and IFN-gamma levels were evaluated before and after treatment by ELISA method. In the present study, the primary outcome measure was change in clinical severity score, whilst secondary outcome measures were changes in plasma eotaxin, IL-4, IL-8, IFN-gamma levels. RESULTS No significant differences was found in clinical severity score with five-day montelukast treatment (p>0.05, Mann-Whitney U test). There were no significant differences in plasma eotaxin, IL-4, IL-8, IFN-gamma levels between the groups (p>0.05 Mann-Whitney U test). There was significant decrease in plasma IFN-gamma levels following five-day montelukast treatment (p=0.027, Wilcoxon). There were no significant differences in plasma IL-4, IL-8, IFN-gamma levels between the groups after five-day montelukast treatment (p>0.05, Wilcoxon). There was significant increase in eotaxin levels after five-day montelukast treatment (p=0.009, Wilcoxon). CONCLUSION Our study showed that montelukast affected plasma IFN-gamma and eotaxin levels after five days of treatment. Further studies are needed to demonstrate effects of montelukast on chemokine levels in bronchiolitis.
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Affiliation(s)
- Fulya Tahan
- Erciyes University, School of Medicine, Department of Pediatric Allergy, 38039 Kayseri, Turkey.
| | - Serkan Celik
- Erciyes University, School of Medicine, Department of Pediatric Allergy, 38039 Kayseri, Turkey
| | - Hatice Eke Gungor
- Erciyes University, School of Medicine, Department of Pediatric Allergy, 38039 Kayseri, Turkey
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Moreno-Solís G, Torres-Borrego J, de la Torre-Aguilar M, Fernández-Gutiérrez F, Llorente-Cantarero F, Pérez-Navero J. Analysis of the local and systemic inflammatory response in hospitalized infants with respiratory syncitial virus bronchiolitis. Allergol Immunopathol (Madr) 2015; 43:264-71. [PMID: 24985791 DOI: 10.1016/j.aller.2014.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 02/06/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Respiratory syncytial virus acute bronchiolitis (RSV-AB) is a major cause of hospital admission among our infants. The immune and inflammatory mechanisms involved in the RSV-AB and factors influencing severity have not been clearly established, although an imbalanced Th1 and Th2 response seems to be crucial. OBJECTIVES To assess the local and systemic inflammatory response in RSV-AB. To find a possible marker of clinical severity and/or oxygen requirements. PATIENTS AND METHODS Levels of nine cytokines were measured in nasopharyngeal aspirate (NPA) and peripheral blood (PB) of 45 infants with RSV-AB and 27 peer controls, including IFNγ, TNFα, VEGF, interleukins 4, 6 and 10, and chemokines (IL-8 and macrophage inflammatory proteins 1-α and 1-β). RESULTS The levels of the analyzed cytokines and chemokines were significantly higher in the NPA of RSV-AB group, with a decrease in IL-4/IFNγ ratio. IL-6 and MIP-1β levels in NPA were directly correlated to oxygen therapy. PB showed an increase in IL-8 and a decrease in MIP-1α and MIP-1β in the RSV-AB group (only MIP-1β associated to the need for oxygen therapy). No correlation was found between cytokines and chemokines levels in NPA and PB. CONCLUSIONS This study shows that RSV triggers an inflammatory response fundamentally at the respiratory level, with scant systemic repercussion. This local response is characterized by an increase in Th1 and Th2 cytokines, although with a relative predominance of Th1. The determination upon patient admission of IL-6 and MIP-1β levels in NPA, and of MIP-1β in PB could help predict severe forms and the need for oxygenotherapy.
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Rolfsjord LB, Skjerven HO, Bakkeheim E, Carlsen K, Hunderi JOG, Kvenshagen BK, Mowinckel P, Lødrup Carlsen KC. Children hospitalised with bronchiolitis in the first year of life have a lower quality of life nine months later. Acta Paediatr 2015; 104:53-8. [PMID: 25169812 DOI: 10.1111/apa.12792] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/20/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Abstract
AIM Acute bronchiolitis increases the risk of asthma, and reduced quality of life (QoL) is reported in children with asthma and allergy. However, the impact of asthma risk factors on QoL is unclear. This study investigated whether bronchiolitis and common asthma risk factors in infancy had an influence on later QoL. METHODS The parents of 209 infants recruited during hospitalisation for bronchiolitis at a mean age of 4 months, and 206 controls responded to the generic Infant Toddler Quality of Life Questionnaire 9 months later. We used robust regression analyses to assess the association between four asthma risk factors, atopic eczema, parental asthma, parental allergic rhinoconjunctivitis and second-hand smoke and QoL in the two groups. RESULTS QoL was lower among children with previous bronchiolitis in the overall health and general health domains and lower in six of 13 domains in children with atopic eczema. Compared with no risk factors, children with previous bronchiolitis and three risk factors had lower scores in four domains, and control children with three risk factors had lower scores in three domains. CONCLUSION Having acute bronchiolitis, atopic eczema and three asthma risk factors were negatively associated with later QoL in early childhood.
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Affiliation(s)
- Leif Bjarte Rolfsjord
- Department of Paediatrics Innlandet Hospital Trust Elverum Norway
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Håvard Ove Skjerven
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Egil Bakkeheim
- Department of Paediatrics Oslo University Hospital Oslo Norway
| | - Kai‐Håkon Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Jon Olav Gjengstø Hunderi
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | | | | | - Karin C. Lødrup Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
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Ochoa Sangrador C, González de Dios J. Overuse of bronchodilators and steroids in bronchiolitis of different severity: bronchiolitis-study of variability, appropriateness, and adequacy. Allergol Immunopathol (Madr) 2014; 42:307-15. [PMID: 23769739 DOI: 10.1016/j.aller.2013.02.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/02/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the management of acute bronchiolitis there is a generalised use of treatments that have not been shown to be useful or efficacious in clinical studies. The objective of this study was to determine the appropriateness in the treatment of acute bronchiolitis of different severity within different clinical care settings. METHODS This is a cross-sectional, descriptive study of 5647 cases of acute bronchiolitis in 91 Spanish hospitals and primary care centres. We classified the appropriateness of the treatments according to the recommendations of a consensus conference. RESULTS There was an inappropriate use of treatments in 58.3% of the cases during the acute phase and in 45.4% during the maintenance phase. There was a generalised use of inhaled beta 2 agonists, regardless of the severity of the patients (hospitalised patients 69.3%, emergency care 63.2% and ambulatory 64.1%). Adrenaline was used in 30.1% of hospitalised cases and in 80.2% of intensive care patients. Systemic corticosteroids were not only used in one-third of hospitalised patients but also in 25.8% of ambulatory cases. CONCLUSIONS In acute bronchiolitis in Spain there is a wide use of treatments that are not recommended by the available clinical practice guidelines. Beta 2 agonist bronchodilators and corticosteroids are widely used and maintained, regardless of the severity of the patients.
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Affiliation(s)
| | - J González de Dios
- Service of Pediatrics, Hospital General Universitario de Alicante, Department of Pediatrics, Universidad Miguel Hernández, Alicante, Spain
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Oñate Ramírez AL, Rendón Macías ME, Iglesias Leboreiro J, Bernárdez Zapata I. [Use of the evidence-based guidelines for management of bronchiolitis]. Bol Med Hosp Infant Mex 2014; 71:227-232. [PMID: 29421255 DOI: 10.1016/j.bmhimx.2014.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/31/2014] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION The aim of this study was to analyze the medical care of children<5 years of age with acute bronchiolitis in relation to the most relevant practices of evidence-based guidelines for bronchiolitis. METHODS We reviewed the charts of 197 hospitalized infants with acute bronchiolitis during 2012 to 2013 to analyse whether the guideline recommendations were used according to: American Academic of Pediatritians (AAP), Scotish Intercollegiate Guidelines Network (SIGN), Sector Salud México (SS), and Guía Práctica Clínica Bronquiolitis, España (GPCBA). RESULTS We evaluated 197 patients attended by 49 pediatricians. Of the recommended actions, in 110 patients (55.8%) aspirate secretions were indicated, 105 patients (53%) received supplemental oxygen and 63 patients (31.9%) used inhaled hypertonic solution. Non-recommended actions were carried out in 166 patients (84%) who received inhaled bronchodilators, 143 patients (72%) who inhaled steroids, 110 patients (55.8%) who were prescribed antibiotics, 76 patients (38%) who had nebulization and 52 patients (26.3%) were administered systemic steroids. Physicians with<10 years of expertise prescribed more systemic steroids. CONCLUSIONS Despite the dissemination of good clinical practice guidelines for the management of acute bronchiolitis, its adoption has not been totally completed.
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Affiliation(s)
| | - Mario Enrique Rendón Macías
- Unidad de Investigación en Epidemiología Clínica, Hospital de Pediatría Centro Médico Nacional S. XXI, Instituto Mexicano del Seguro Social, México, D.F., México.
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Abstract
Bronchiolitis is the most common lower respiratory tract infection to affect infants and toddlers. High-risk patients include infants younger than 3 months, premature infants, children with immunodeficiency, children with underlying cardiopulmonary or neuromuscular disease, or infants prone to apnea, severe respiratory distress, and respiratory failure. Bronchiolitis is a self-limited disease in healthy infants and children. Treatment is usually symptomatic, and the goal of therapy is to maintain adequate oxygenation and hydration. Use of a high-flow nasal cannula is becoming common for children with severe bronchiolitis.
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Affiliation(s)
- Getachew Teshome
- Division of Emergency Medicine, Department of Pediatrics, University of Maryland School of Medicine, 22 South Greene Street, WGL 266, Baltimore, MD 21201, USA.
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