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Berdah L, Romain AS, Rivière S, Schnuriger A, Perrier M, Carbajal R, Lorrot M, Guedj R, Corvol H. Retrospective observational study of the influence of the COVID-19 outbreak on infants' hospitalisation for acute bronchiolitis. BMJ Open 2022; 12:e059626. [PMID: 36316083 PMCID: PMC9627576 DOI: 10.1136/bmjopen-2021-059626] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Acute bronchiolitis is a major public health issue with high number of infants hospitalised worldwide each year. In France, hospitalisations mostly occur between October and March and peak in December. A reduction of emergency visits for bronchiolitis has been observed at onset of the COVID-19 outbreak. We aimed to assess the pandemic effects on the hospitalisations for bronchiolitis during the 2020-2021 winter (COVID-19 period) compared with three previous winters (pre-COVID-19). DESIGN Retrospective, observational and cross-sectional study. SETTING Tertiary university paediatric hospital in Paris (France). PARTICIPANTS All infants aged under 12 months who were hospitalised for acute bronchiolitis during the autumn/winter seasons (1 October to 31 March) from 2017 to 2021 were included. Clinical and laboratory data were collected using standardised forms. RESULTS During the COVID-19 period was observed, a 54.3% reduction in hospitalisations for bronchiolitis associated with a delayed peak (February instead of November-December). Clinical characteristics and hospitalisation courses were substantially similar. The differences during the COVID-19 period were: smaller proportion of infants with comorbidities (8% vs 14% p=0.02), lower need for oxygen (45% vs 55%, p=0.01), higher proportions of metapneumovirus, parainfluenzae 3, bocavirus, coronavirus NL63 and OC43 (all p≤0.01) and no influenza. The three infants positive for SARS-CoV-2 were also positive for respiratory syncytial virus, suggesting that SARS-CoV-2 alone does not cause bronchiolitis, despite previous assumptions. CONCLUSION The dramatic reduction in infants' hospitalisations for acute bronchiolitis is an opportunity to change our future habits such as advising the population to wear masks and apply additional hygiene measures in case of respiratory tract infections. This may change the worldwide bronchiolitis burden and improve children respiratory outcomes.
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Affiliation(s)
- Laura Berdah
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Trousseau Hospital, Paediatric Pulmonology Department, Paris, France
- Sorbonne Université, Inserm, Centre de Recherche Saint Antoine, Paris, France
| | - Anne-Sophie Romain
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Trousseau Hospital, General Paediatrics Department, Paris, France
| | - Simon Rivière
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Trousseau Hospital, Paediatric Emergency Department, Paris, France
| | - Aurélie Schnuriger
- Sorbonne Université, Inserm, Centre de Recherche Saint Antoine, Paris, France
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Trousseau Hospital, Virology Department, Paris, France
| | - Marine Perrier
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Trousseau Hospital, Virology Department, Paris, France
| | - Ricardo Carbajal
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Trousseau Hospital, Paediatric Emergency Department, Paris, France
| | - Mathie Lorrot
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Trousseau Hospital, General Paediatrics Department, Paris, France
| | - Romain Guedj
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Trousseau Hospital, Paediatric Emergency Department, Paris, France
| | - Harriet Corvol
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Trousseau Hospital, Paediatric Pulmonology Department, Paris, France
- Sorbonne Université, Inserm, Centre de Recherche Saint Antoine, Paris, France
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Acute bronchiolitis: Experience of home oxygen therapy in “Hospital at Home” care from 2012 to 2014. Arch Pediatr 2022; 29:610-614. [DOI: 10.1016/j.arcped.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 02/14/2022] [Accepted: 08/04/2022] [Indexed: 11/05/2022]
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Gasmi O, Hodel K, Launay E, Paillé C, Chabrol B, Delacourt C, Guen CGL. Pediatric hospital care organization: Cross-sectional enquiry in four regions in France. Arch Pediatr 2021; 28:509-513. [PMID: 34511279 DOI: 10.1016/j.arcped.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/10/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to characterize conventional pediatric care capacities in French public hospitals and identify the main difficulties in guiding upcoming health policies. The secondary objective was to assess the quality of care by the implementation of the European Charter of the Rights of Children in Hospital. METHOD Multicenter cross-sectional study using a questionnaire survey sent by e-mail to the heads of conventional pediatric departments in four French regions identified on the French Hospital Federation's website. The survey was conducted between 25 September and 25 October 2018. RESULTS Fifty-six of 113 heads of departments participated in the survey. The mean annual number of admissions per unit in 2017 was 2066 (SD, 1433), with a median length of stay of 2.7 days (range, 1-10). Children were admitted up to age 18 years in 76% of the departments, and 83% of the departments had an individualized pediatric emergency department. The nurse care load was very high, specifically during the night shift (9.5 patients/nurse). Inpatient education and academic teaching were unavailable in 38% of the departments. Overall, 89% of department heads declared knowing the European Charter of the Rights of Children in Hospital, and a copy of it was posted in all units in 57% (95% confidence interval, 44-70) of the services/departments. At all times and in all departments, parents were allowed to be with their children, and for 34% (95% CI, 21-47) of the departments, an accommodation for parents was available close to the hospital. CONCLUSION Public hospital pediatric departments lack sufficient medical and nonmedical caregivers. Department heads were well aware of the European Charter, and it was well disseminated but should be updated to address today's challenges in pediatrics. An area of improvement would be to include parents in their child's care more effectively.
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Affiliation(s)
- O Gasmi
- Department of General Pediatrics, University Hospital of Nantes, 38 boulevard Jean Monnet, 44400 Nantes, France.
| | - K Hodel
- Department of Medical Evaluation and Epidemiology, University Hospital of Nantes, 85 rue Saint-Jacques, 44093 Nantes, France
| | - E Launay
- Department of General Pediatrics, University Hospital of Nantes, 38 boulevard Jean Monnet, 44400 Nantes, France
| | - C Paillé
- Department of Medical Evaluation and Epidemiology, University Hospital of Nantes, 85 rue Saint-Jacques, 44093 Nantes, France
| | - B Chabrol
- Department of General Pediatrics, University Hospital of la Timone, APHM, 264 rue Saint-Pierre, 13005 Marseille, France
| | - C Delacourt
- Department of Pediatric Pneumology, Necker-Enfants Malades University Hospital, APHP, 149 rue de Sèvres, 75743 Paris, France
| | - C Gras-Le Guen
- Department of General Pediatrics, University Hospital of Nantes, 38 boulevard Jean Monnet, 44400 Nantes, France
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Demont C, Petrica N, Bardoulat I, Duret S, Watier L, Chosidow A, Lorrot M, Kieffer A, Lemaitre M. Economic and disease burden of RSV-associated hospitalizations in young children in France, from 2010 through 2018. BMC Infect Dis 2021; 21:730. [PMID: 34340679 PMCID: PMC8327424 DOI: 10.1186/s12879-021-06399-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is the main cause of infant and child hospitalizations. The study objective is to estimate the RSV-associated hospitalizations and economic burden in young children in France to inform future preventive strategies. METHODS We conducted a retrospective analysis of RSV-associated hospitalizations data from the French Hospital database (PMSI-MCO) which covers the entire French population. All children aged < 5 years hospitalized with RSV ICD-10 codes (J210, J219, J45, J121, J205, R062) from 2010 to 2018, were included. Descriptive analyses were conducted by RSV seasons (Oct to March), by respiratory years (July to June) and per age groups. RESULTS On average 45,225 RSV-associated hospitalizations (range: 43,715 - 54,616) per season was reported in France, 69% among children < 1 year old. This represents 28% of all-cause hospitalizations that occurred among children < 1 year old, and less than 10% of all-cause hospitalizations in older children. Number of RSV-associated hospitalizations were similar for infants born during (Oct-March) or outside (April-September) their first RSV season. The highest risk being reported for infants born from September through November. The associated hospitalization cost increased between 2010 - 11 and 2017-18, from €93.2 million to €124.1 million, respectively, and infants < 1 year old represented 80% of the economic burden. CONCLUSION RSV is an important cause of child hospitalization in France. The burden on healthcare system is mainly driven by < 1 year olds, and preventive strategies should be implemented before the first RSV season.
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Affiliation(s)
- C. Demont
- grid.417924.dSanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
| | - N. Petrica
- grid.434277.1IQVIA, 92400 Courbevoie, France
| | | | - S. Duret
- grid.434277.1IQVIA, 92400 Courbevoie, France
| | - L. Watier
- grid.463845.80000 0004 0638 6872Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France
| | - A. Chosidow
- grid.413776.00000 0004 1937 1098Department of Pediatrics, Armand Trousseau Hospital (AP-HP), 75012 Paris, France
| | - M. Lorrot
- grid.413776.00000 0004 1937 1098Department of Pediatrics, Armand Trousseau Hospital (AP-HP), 75012 Paris, France
| | - A. Kieffer
- grid.417924.dSanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
| | - M. Lemaitre
- grid.434277.1IQVIA, 92400 Courbevoie, France
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Durand P, Guiddir T, Kyheng C, Blanc F, Vignaud O, Epaud R, Dugelay F, Breant I, Badier I, Degas-Bussière V, Phan F, Soussan-Banini V, Lehnert A, Mbamba C, Barrey C, Tahiri C, Decobert M, Saunier-Pernaudet M, Craiu I, Taveira M, Gajdos V. A randomised trial of high-flow nasal cannula in infants with moderate bronchiolitis. Eur Respir J 2020; 56:13993003.01926-2019. [PMID: 32381496 DOI: 10.1183/13993003.01926-2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/23/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objective was to determine whether high-flow nasal cannula (HFNC), a promising respiratory support in infant bronchiolitis, could reduce the proportion of treatment failure requiring escalation of care. METHODS In this randomised controlled trial, we assigned infants aged <6 months who had moderate bronchiolitis to receive either HFNC at 3 L·kg-1·min-1 or standard oxygen therapy. Crossover was not allowed. The primary outcome was the proportion of patients in treatment failure requiring escalation of care (mostly noninvasive ventilation) within 7 days following randomisation. Secondary outcomes included rates of transfer to the paediatric intensive care unit (PICU), oxygen, number of artificial nutritional support-free days and adverse events. RESULTS The analyses included 268 patients among the 2621 infants assessed for inclusion during two consecutive seasons in 17 French paediatric emergency departments. The percentage of infants in treatment failure was 14% (19 out of 133) in the study group, compared to 20% (27 out of 135) in the control group (OR 0.66, 95% CI 0.35-1.26; p=0.21). HFNC did not reduce the risk of admission to PICU (21 (15%) out of 133 in the study group versus 26 (19%) out of 135 in the control group) (OR 0.78, 95% CI 0.41-1.41; p=0.45). The main reason for treatment failure was the worsening of modified Wood clinical asthma score (m-WCAS). Short-term assessment of respiratory status showed a significant difference for m-WCAS and respiratory rate in favour of HFNC. Three pneumothoraces were reported in the study group. CONCLUSIONS In patients with moderate bronchiolitis, there was no evidence of lower rate of escalating respiratory support among those receiving HFNC therapy.
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Affiliation(s)
- Philippe Durand
- Pediatric Emergency Dept, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre, France
| | - Tamma Guiddir
- Pediatric Emergency Dept, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre, France
| | - Christèle Kyheng
- Pediatric Emergency Dept, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre, France
| | - Florence Blanc
- Villeneuve-Saint Georges Intercommunal Hospital, Villeneuve-Saint Georges, France
| | | | - Ralph Epaud
- Créteil Intercommunal Hospital, Créteil, France
| | | | | | | | | | | | - Valérie Soussan-Banini
- Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | | | | | | | | | | | | | - Irina Craiu
- Pediatric Emergency Dept, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Kremlin-Bicêtre, France
| | - Mélanie Taveira
- Antoine Béclère University Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France
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Risk factors for bronchiolitis hospitalization in infants: A French nationwide retrospective cohort study over four consecutive seasons (2009-2013). PLoS One 2020; 15:e0229766. [PMID: 32142528 PMCID: PMC7059917 DOI: 10.1371/journal.pone.0229766] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/14/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives Large studies are needed to update risk factors of bronchiolitis hospitalization. We performed a nationwide analysis of hospitalization rates for bronchiolitis over four consecutive bronchiolitis seasons to identify underlying medical disorders at risk of bronchiolitis hospitalization and assess their frequency. Methods Data were retrieved from the French National Hospital Discharge database. Of all infants discharged alive from maternity wards from January 2008 to December 2013 in France (N = 3,884,791), we identified four consecutive cohorts at risk of bronchiolitis during the seasons of 2009–2010 to 2012–2013. The main outcome was bronchiolitis hospitalization during a season. Individual risk factors were collected. Results Among infants, 6.0% were preterm and 2.0% had ≥1 chronic condition including 0.2% bronchopulmonary dysplasia (BPD) and 0.2% hemodynamically significant congenital heart disease (HS-CHD). Bronchiolitis hospitalization rates varied between seasons (min: 1.26% in 2010–2011; max: 1.48% in 2012–2013; p<0.001). Except omphalocele, the following conditions were associated with an increased risk for bronchiolitis hospitalization: solid organ (9.052; 95% CI, 4.664–17.567) and stem cell transplants (6.012; 95% CI, 3.441–10.503), muscular dystrophy (4.002; 95% CI, 3.1095–5.152), cardiomyopathy (3.407; 95% CI, 2.613–4.442), HS-CHD (3.404; 95% CI, 3.153–3.675), congenital lung disease and/or bronchial abnormalities, Down syndrome, congenital tracheoesophageal fistula, diaphragmatic hernia, pulmonary hypertension, chromosomal abnormalities other than Down syndrome, hemodynamically non-significant CHD, congenital abnormalities of nervous system, cystic fibrosis, cleft palate, cardiovascular disease occurring during perinatal period, and BPD. Conclusion Besides prematurity, BPD, and HS–CHD, eighteen underlying conditions were associated with a significant increased risk for bronchiolitis hospitalization in a nationwide population.
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7
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El Basha NR, Marzouk H, Sherif MM, El Kholy AA. Prematurity, a significant predictor for worse outcome in viral bronchiolitis: a comparative study in infancy. J Egypt Public Health Assoc 2019; 94:15. [PMID: 32218612 PMCID: PMC7091660 DOI: 10.1186/s42506-019-0015-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/28/2019] [Indexed: 11/14/2022]
Abstract
Background The rate of admissions to hospital with bronchiolitis has increased over the past years. The reasons for this are likely to be multifactorial including improved survival of preterm infants. Aim To assess the severity of viral bronchiolitis in preterm compared to term infants admitted at a tertiary hospital in Cairo, Egypt, based on the outcome. Patients and methods This prospective study was conducted throughout a 3-year period from September 2011 to October 2014. It included 153 infants, 74 healthy preterm, and 79 healthy term infants admitted with clinical diagnosis of bronchiolitis at a tertiary hospital in Cairo, Egypt. Bronchiolitis severity score (BSS) was recorded, and nasopharyngeal swabs were obtained from each patient at the time of presentation. Viruses were identified using reverse transcription polymerase chain reaction (RT-PCR). The clinical course and patient’s outcome were recorded. Results This study recorded a significantly more severe BSS for preterm compared to term infants. The preterm group had an increased mean length of hospital stay and oxygen therapy and was more likely to need intensive care unit admission and mechanical ventilation (MV) compared to the term group. The mean (± SD) BSS for infections with h-MPV, RSV, and para-influenza 3 was more significantly severe in preterm compared to term infants. Bacterial co-infection was significantly correlated with severity scoring in both groups. Conclusion Prematurity significantly affects the severity of bronchiolitis, and this underscores the importance of early categorization as a high-risk group on their first visit. The physician should be aware that their illness runs a more severe course, even if they have no underlying disorders.
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Affiliation(s)
- Noussa R El Basha
- 1Department of Pediatrics, Faculty of Medicine, Cairo University, 2 Atteia Abd El Hadi St., El Maadi, Cairo, 11562 Egypt
| | - Huda Marzouk
- 1Department of Pediatrics, Faculty of Medicine, Cairo University, 2 Atteia Abd El Hadi St., El Maadi, Cairo, 11562 Egypt
| | - May M Sherif
- 2Department of Clinical Pathology, Faculty of Medicine, Cairo University, 2 Atteia Abd El Hadi St., El Maadi, Cairo, 11562 Egypt
| | - Amani A El Kholy
- 2Department of Clinical Pathology, Faculty of Medicine, Cairo University, 2 Atteia Abd El Hadi St., El Maadi, Cairo, 11562 Egypt
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Valla FV, Baudin F, Demaret P, Rooze S, Moullet C, Cotting J, Ford-Chessel C, Pouyau R, Peretti N, Tume LN, Milesi C, Le Roux BG. Nutritional management of young infants presenting with acute bronchiolitis in Belgium, France and Switzerland: survey of current practices and documentary search of national guidelines worldwide. Eur J Pediatr 2019; 178:331-340. [PMID: 30506396 DOI: 10.1007/s00431-018-3300-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022]
Abstract
Feeding difficulties are common in young infants presenting with acute bronchiolitis, but limited data is available to guide clinicians adapting nutritional management. We aimed to assess paediatricians' nutritional practices among Western Europe French speaking countries. A survey was disseminated to describe advice given to parents for at home nutritional support, in hospital nutritional management, and preferred methods for enteral nutrition and for intravenous fluid management. A documentary search of international guidelines was concomitantly conducted. Ninety-three (66%) contacted physicians responded. Feeding difficulties were a common indication for infants' admission. Written protocols were rarely available. Enteral nutrition was favoured most of the time when oral nutrition was insufficient and might be withheld in case of severe dyspnoea to decrease respiratory workload. Half of physicians were aware of hyponatremia risk and pathophysiology, and isotonic intravenous solutions were used in less than 15% of centres. International guideline search (23 countries) showed a lack of detailed nutritional management recommendations in most of them.Conclusion: practices were inconsistent among physicians. Guidelines detailed nutritional management poorly. Awareness of hyponatremia risk in relation to intravenous hypotonic fluids and of the safety of enteral hydration and nutrition is insufficient. New guidelines including detailed nutritional management recommendations are urgently needed. What is Known? • Infants presenting with acute bronchiolitis face feeding difficulties. • Underfeeding may promote undernutrition, and intravenous hydration with hypotonic fluids may induce hyponatremia. What is New? • Physicians' nutritional practices are inconsistent and awareness of hyponatremia risk and pathophysiology is insufficient among physicians. • Awareness of hyponatremia risk and pathophysiology is insufficient among physicians. • The reasons for enteral nutrition withholding in bronchiolitis infants are not evidence based, and national guidelines of acute bronchiolitis across the world are elusive regarding nutritional management. • National guidelines of acute bronchiolitis across the world are elusive regarding nutritional management.
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Affiliation(s)
- Frédéric V Valla
- Paediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500, Lyon-Bron, France.
- Faculty of Health and Applied Sciences, The University of the West of England, Glenside Campus, Blackberry Hill, Stapleton, Bristol, BS16 1DD, UK.
- CarMEN INSERM UMR 1060 Equipe INFOLIP, 69100, Villeurbanne, France.
| | - Florent Baudin
- Paediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500, Lyon-Bron, France
- Université Claude Bernard Lyon 1, Ifsttar, UMRESTTE, UMR T 9405, 69373, Lyon, France
| | - Pierre Demaret
- Division of Paediatric Critical Care Medicine, Department of Paediatrics, CHC, Liège, Belgium
| | - Shancy Rooze
- Paediatric Intensive Care, Hôpital Universitaire des Enfants Reine Fabiola, 1020, Laeken-Brussels, Belgium
| | - Clémence Moullet
- Department of Nutrition and Dietetics, Haute Ecole de Santé, University of Applied Sciences of Western Switzerland, Carouge, Geneva, Switzerland
| | - Jacques Cotting
- Paediatric Intensive Care, University Hospitals of Lausanne, Lausanne, Switzerland
| | - Carole Ford-Chessel
- Paediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500, Lyon-Bron, France
- Paediatric Nutrition and Dietetic Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500, Lyon-Bron, France
| | - Robin Pouyau
- Paediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500, Lyon-Bron, France
| | - Noël Peretti
- CarMEN INSERM UMR 1060 Equipe INFOLIP, 69100, Villeurbanne, France
- Paediatric Gastroenerology and Nutrition Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500, Lyon-Bron, France
| | - Lyvonne N Tume
- Faculty of Health and Applied Sciences, The University of the West of England, Glenside Campus, Blackberry Hill, Stapleton, Bristol, BS16 1DD, UK
- Paediatric Intensive Care Unit, Bristol Children's Hospital, Upper Maudlin Street, Bristol, UK
| | - Christophe Milesi
- Paediatric Intensive Care, Hôpital Arnaud de Villeneuve, 371 av Doyen Giraud, 34296, Montpellier, France
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[Can a simple lung ultrasound score predict length of ventilation for infants with severe acute viral bronchiolitis?]. Arch Pediatr 2017; 25:112-117. [PMID: 29248322 DOI: 10.1016/j.arcped.2017.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/11/2017] [Accepted: 11/05/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lung ultrasound (LU) is a bedside point-of-care technique in critical care and emergency medicine. LU is quick and non-irradiating, and provides accurate diagnostic information when compared with chest radiographs. Specific LU signs have been described for bronchiolitis. This study aimed to evaluate the correlation between severity of LU-diagnosed lung lesions, using a quantitative LU score, and the length of non-invasive ventilation (LOV) for infants diagnosed with severe viral bronchiolitis. METHODS This was a prospective observational single-center study conducted at a level 3 pediatric intensive care unit. A LU score was calculated for 47 infants under 6 months of age with severe acute viral bronchiolitis during the 2015-2016 epidemic, and the number of intercostal spaces with consolidation or interstitial syndrome was counted for each lung. The LU score is based on the presence of A lines or B-line artifacts and consolidation (0-2 points). The modified Wood score (mWCAS) was used to define clinical severity. Other parameters such as gestational age at birth, age, supplemental oxygen (LOS), and length of stay were recorded. All LU scans were later reviewed by two trained ultrasonographers to assess the score's inter-rater reproducibility. RESULTS The LU score on admission (3.5±2.6) did not correlate with LOV (69±68.6), mWCAS score (4±1.6), LOS (3±3.4), or length of stay (4±3.4). However, there was a significant correlation between the number of affected intercostal spaces on the right and LOS (Spearman's Rho 0.318; P=0.037). CONCLUSION This is the first study to evaluate the use of LU in infants needing PICU admission for severe acute bronchiolitis. The LU score does not correlate with LOV, mWCAS, LOS, or length of stay, but the number of pathological intercostal spaces on the right side correlates significantly with LOS. Although LU scores have been validated for the newborn and the adult, this has been in the setting of restrictive lung diseases. Bronchiolitis is a predominantly obstructive lung disease and this may explain the lack of performance observed.
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Epidemiology of patients hospitalised due to bronchiolitis in the south of Europe: Analysis of the epidemics, 2010–2015. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2016.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Epidemiología de los ingresos por bronquiolitis en el sur de Europa: análisis de las epidemias 2010-2015. An Pediatr (Barc) 2017; 87:260-268. [DOI: 10.1016/j.anpedi.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/07/2016] [Accepted: 10/04/2016] [Indexed: 11/24/2022] Open
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Drummond D, Thumerelle C, Reix P, Fayon M, Epaud R, Clement A, Mahloul M, Habouria D, Delacourt C, Hadchouel A. Effectiveness of palivizumab in children with childhood interstitial lung disease: The French experience. Pediatr Pulmonol 2016; 51:688-95. [PMID: 26636747 DOI: 10.1002/ppul.23354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/03/2015] [Accepted: 11/21/2015] [Indexed: 11/06/2022]
Abstract
INTRODUCTION There is a lack of evidence concerning the effectiveness of immunoprophylaxis with palivizumab in children with childhood interstitial lung disease (chILD). In this retrospective study, we evaluated the effectiveness of palivizumab for decreasing the rate of RSV-related hospitalizations in children under the age of 24 months with chILD treated with corticosteroids. METHODS A retrospective national study was conducted in France. Patients born between 2007 and 2013, diagnosed with chILD and on corticosteroid treatment were identified through the French online database for pediatric interstitial lung disease (Respirare(®) ). Data were collected for the etiology and severity of chILD, risk factors and preventive measures for bronchiolitis, palivizumab immunoprophylaxis, and hospitalizations for bronchiolitis and RSV-bronchiolitis. RESULTS We included and evaluated 24 children during their first two RSV seasons, corresponding to 36 patient-seasons. The observed rate of RSV-related hospitalization (305/1000 patient-seasons), and the median length of stay (7 days), were higher than those for the general population. RSV-related hospitalization rates did not differ significantly between children with and without palivizumab prophylaxis (5/16 vs. 4/18, respectively, P = 0.70). CONCLUSION Children with chILD on corticosteroid treatment are at high risk of hospitalization for RSV-bronchiolitis, which tends to be more severe in these children than in the general population. The effectiveness of palivizumab prophylaxis in this population remains to be demonstrated. Pediatr Pulmonol. 2016;51:688-695. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- David Drummond
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France.,Université Paris-Descartes, Paris, France
| | - Caroline Thumerelle
- Unité de pneumologie pédiatrique, hôpital Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - Philippe Reix
- Centre de Référence de la Mucoviscidose, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Michael Fayon
- Université de Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Bordeaux, France.,CHU de Bordeaux, Hôpital Pellegrin-Enfants, Pneumologie Pédiatrique, Centre d'Investigation Clinique (CIC 1401), Bordeaux, France
| | - Ralph Epaud
- Centre Intercommunal de Créteil, Service de Pédiatrie, Créteil, France.,Inserm, U955, Equipe 5, Créteil, France.,Université Paris-Est, Faculté de Médecine, Créteil, France
| | - Annick Clement
- PediatricPulmonary Department AP-HP Hôpital Trousseau Paris, France Université Pierre et Marie Curie-Paris, Paris, France
| | - Malika Mahloul
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,AP-HP, Hôpital Armand Trousseau, Centre de Référence des Maladies Respiratoires Rares, Paris, France
| | - Delphine Habouria
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,AP-HP, Hôpital Armand Trousseau, Centre de Référence des Maladies Respiratoires Rares, Paris, France
| | - Christophe Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France.,Université Paris-Descartes, Paris, France.,INSERM U-955, équipe 4, Créteil, France
| | - Alice Hadchouel
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, 75015, Paris, France.,Université Paris-Descartes, Paris, France.,INSERM U-955, équipe 4, Créteil, France
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Benoist G, Mokhtari M, Deschildre A, Khen-Dunlop N, Storme L, Benachi A, Delacourt C. Risk of Readmission for Wheezing during Infancy in Children with Congenital Diaphragmatic Hernia. PLoS One 2016; 11:e0155556. [PMID: 27171167 PMCID: PMC4865179 DOI: 10.1371/journal.pone.0155556] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/29/2016] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Congenital diaphragmatic hernia (CDH) is associated with a high incidence of respiratory problems, even after initial hospital discharge. These problems are likely to lead to re-hospitalization during infancy, although actual frequency of readmissions is unknown. OBJECTIVE We aimed to determine the rate of hospitalization for wheezing in infants with CDH between the time of initial discharge and 24 months of age, and to identify factors associated with readmission. METHODS Data about infants with CDH born in three French reference tertiary centers between January 2009 and March 2013 who were alive at hospital discharge, were extracted from a prospective national database. RESULTS Ninety-two children were identified, and 86 were included in the analysis. In total, 116 wheezing episodes requiring a doctor's visit occurred in 50 infants (58%) before 24 months of age. Twenty-two children (26%) were readmitted at least once for wheezing exacerbations. RSV was present in 6 of 15 (40%) of children with available nasal samples at first readmission, and 1 of 5 (20%) at second readmission. Thoracic herniation of the liver, low gestational age, longer initial hospitalization, need for oxygen therapy at home, and eczema were all significantly associated with readmission for wheezing exacerbations. Fifty-three infants (62%) received palivizumab prophylaxis, but there was no association with the overall rate of readmission for wheezing exacerbations or RSV-related hospitalization. CONCLUSIONS The rate of readmission for wheezing among infants with CDH is high, and significantly influenced by several prenatal and neonatal factors. Palivizumab prophylaxis was not associated with the rate of readmission.
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Affiliation(s)
- Gregoire Benoist
- Pneumologie Pédiatrique, Necker, AP-HP, Paris, France, Centre de Référence des Maladies Respiratoires Rares, Paris, France
| | | | | | - Naziha Khen-Dunlop
- Chirurgie Pédiatrique, Necker, AP-HP, Paris, France
- Université Paris-Descartes, Paris, France
| | | | - Alexandra Benachi
- Gynécologie Obstétrique, Antoine Béclère, AP-HP, Paris, France, Centre de Référence des Hernies Diaphragmatiques, Clamart, France
| | - Christophe Delacourt
- Pneumologie Pédiatrique, Necker, AP-HP, Paris, France, Centre de Référence des Maladies Respiratoires Rares, Paris, France
- Université Paris-Descartes, Paris, France
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Abstract
BACKGROUND There is a lack of European epidemiologic population-based studies on bronchiolitis and respiratory syncytial virus (RSV) bronchiolitis including both hospitalizations and primary care attendance. METHODS A retrospective cohort of all children born between 2009 and 2012 was followed from birth to 2 years of age using population and health databases. We searched for global bronchiolitis (International Classification of Diseases, 9th revision, Clinical Modification codes 466.1, 466.11 and 466.19) and RSV bronchiolitis (code 466.11 and code 466.19 with positive RSV test) in the first appearance either in primary care or in hospitalization databases. A preterm subcohort (International Classification of Diseases, 9th revision, Clinical Modification codes 765) was also analyzed. RESULTS The cohort consisted of 198,223 children of whom 41,479 were diagnosed of bronchiolitis (incidence rate 16.4/100 children <2 years per year). Of those, 5390 were hospitalized with the majority of hospitalizations occurring at <6 months of age (incidence rate of 5.2/100 children <6 months per year) and 3106 of the hospitalizations were RSV positive (incidence rate 3.2/100 children <6 months per year). RSV hospitalizations were 26% longer than non-RSV. In preterm infants, hospitalization incidence was more than double, and the mean length of hospitalization was 29% longer. CONCLUSIONS Most (87%) bronchiolitis cases are managed in primary care offices. Approximately 2 out of every 10 children <2 are diagnosed of bronchiolitis, 3 out of every 100 are hospitalized and 1.6 out of every 100 are hospitalized with RSV bronchiolitis in our cohort. Infants between 2 and 10 weeks constitute a risk group for severe bronchiolitis.
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Green CA, Yeates D, Goldacre A, Sande C, Parslow RC, McShane P, Pollard AJ, Goldacre MJ. Admission to hospital for bronchiolitis in England: trends over five decades, geographical variation and association with perinatal characteristics and subsequent asthma. Arch Dis Child 2016; 101:140-6. [PMID: 26342094 PMCID: PMC4752648 DOI: 10.1136/archdischild-2015-308723] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/28/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Admission of infants to hospital with bronchiolitis consumes considerable healthcare resources each winter. We report an analysis of hospital admissions in England over five decades. METHODS Data were analysed from the Hospital In-Patient Enquiry (HIPE, 1968-1985), Hospital Episode Statistics (HES, 1989-2011), Oxford Record Linkage Study (ORLS, 1963-2011) and Paediatric Intensive Care Audit Network (PICANet, 2003-2012). Cases were identified using International Classification of Diseases (ICD) codes in discharge records. Bronchiolitis was given a separate code in ICD9 (used in England from 1979). Geographical variation was analysed using Local Authority area boundaries. Maternal and perinatal risk factors associated with bronchiolitis and subsequent admissions for asthma were analysed using record-linkage. RESULTS All-England HIPE and HES data recorded 468 138 episodes of admission for bronchiolitis in infants aged <1 year between 1979 and 2011. In 2011 the estimated annual hospital admission rate was 46.1 (95% CI 45.6 to 46.6) per 1000 infants aged <1 year. Between 2004 and 2011 the rates rose by an average of 1.8% per year in the all-England HES data, whereas admission rates to paediatric intensive care changed little (1.3 to 1.6 per 1000 infants aged <1 year). A fivefold geographical variation in hospital admission rates was observed. Young maternal age, low social class, low birth weight and maternal smoking were among factors associated with an increased risk of hospital admission with bronchiolitis. CONCLUSIONS Hospital admissions for infants with bronchiolitis have increased substantially in recent years. However, cases requiring intensive care have changed little since 2004.
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Affiliation(s)
- Christopher A Green
- Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, UK
| | - David Yeates
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Allie Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Charles Sande
- Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, UK
| | - Roger C Parslow
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Philip McShane
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, UK
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Girard D, Antoine D, Che D. Epidemiology of pulmonary tuberculosis in France. Can the hospital discharge database be a reliable source of information? Med Mal Infect 2015; 44:509-14. [PMID: 25455077 DOI: 10.1016/j.medmal.2014.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/05/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In France, tuberculosis surveillance is based on mandatory notification (MN) of cases. However, the MN does not allow the full description of cases, and underreporting limits data interpretation. Aiming at better describing the cases of tuberculosis, the hospital record database (PMSI) was analyzed. PATIENTS AND METHOD Incident cases of active pulmonary tuberculosis identified in 2010 in France in the PMSI were included and their characteristics were compared with those of the cases identified through the MN. RESULTS In 2010, 5158 incident cases of pulmonary tuberculosis were identified in the PMSI. The mean duration of hospitalization was higher for cases considered contagious — at least one positive test result on pulmonary sample — (22 vs 13 days, P < 0.001). Among all cases, 5% were infected by HIV. Death was reported for 4% of cases. The number of pulmonary TB cases reported in the MN was 3781 in 2010. PMSI data by sex, region of residence and month of diagnosis were similar with those of the MN but patients were older in the PMSI (52 vs 47 years, P < 0.001). Considering the PMSI as exhaustive, sensitivity of the MN was estimated at 73.3% in 2010. CONCLUSION PMSI data were compatible with those of the MN and the estimation of the sensitivity was close to other French studies. PMSI can be considered as an interesting tool aiming at improving our knowledge about tuberculosis (TB) cases and strengthening awareness where the sensitivity of the MN is low.
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Affiliation(s)
- D Girard
- Institut de veille sanitaire, 12, rue du Val-d’Osne, 94415 Saint Maurice cedex, France
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17
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Bronchiolite aiguë du nourrisson : enquête nationale dans les services d’accueil des urgences pédiatriques. Arch Pediatr 2015; 22:373-9. [DOI: 10.1016/j.arcped.2014.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/25/2014] [Accepted: 12/24/2014] [Indexed: 11/17/2022]
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18
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[Winter viral ecology in a pediatric intensive care unit: a prospective study]. Arch Pediatr 2014; 22:368-72. [PMID: 25534558 PMCID: PMC7133265 DOI: 10.1016/j.arcped.2014.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/19/2014] [Accepted: 10/31/2014] [Indexed: 01/08/2023]
Abstract
Le but de cette étude prospective était d’évaluer l’épidémiologie des virus respiratoires chez les enfants hospitalisés dans une unité de réanimation et de soins continus pédiatriques pendant 3 mois d’hiver, en 2012–2013. Ont été inclus tous les enfants admis en réanimation pédiatrique du centre hospitalier universitaire (CHU) de Caen et ayant bénéficié d’une recherche d’infection par un virus respiratoire à partir d’un prélèvement nasal analysé par amplification génique (PCR) multiplex. Sur 105 enfants admis, 84 répondaient aux critères d’inclusion. Trente-sept enfants présentaient un ou plusieurs symptômes respiratoires à l’admission. Cinquante-quatre échantillons étaient positifs (64,3 %) avec 70 virus détectés. Le virus dont la prévalence était la plus élevée était le virus respiratoire syncytial (VRS) (n = 28 ; 40,0 %), suivi par le rhinovirus (n = 24 ; 34,3 %). Parmi les enfants sans symptômes respiratoires, 42,6 % étaient infectés par un ou plusieurs virus. Aucune différence de durée d’hospitalisation, de durée de ventilation mécanique n’a été mise en évidence en fonction du virus détecté. La principale limite de cette étude est l’analyse par PCR, beaucoup plus sensible que d’autres méthodes de détection, notamment chez des sujets asymptomatiques sur le plan respiratoire. Cette étude révèle cependant un taux élevé d’infections respiratoires causées par des virus chez les enfants qui ne présentent pas de symptômes respiratoires à leur admission en unité de réanimation et soins continus. Elle suggère un intérêt du dépistage de ces infections virales à l’admission des enfants et un bénéfice à l’extension des mesures d’isolement pour tous les enfants en réanimation pédiatrique.
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Sterling B, Bosdure E, Stremler-Le Bel N, Chabrol B, Dubus JC. [Acute bronchiolitis and chest physiotherapy: the end of a reign]. Arch Pediatr 2014; 22:98-103. [PMID: 25482994 DOI: 10.1016/j.arcped.2014.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 08/24/2014] [Accepted: 09/30/2014] [Indexed: 11/16/2022]
Abstract
Every winter, numerous infants are hospitalized for acute bronchiolitis. The severity criteria and symptomatic treatment are well known, with chest physiotherapy codified in 2000 by the French Health Authority (HAS) consensus conference (with techniques varying from one country to another) and becoming nearly systematic for the treatment of bronchial obstruction in infants. However, is this treatment really effective and legitimate for acute bronchiolitis? The objective of this study was to review the main studies on this subject. Few studies are available and most have a low level of evidence. However, they all tend to agree that chest physiotherapy does not change the natural history of the disease and most particularly the duration of hospitalization. Therefore, it does not seem that the prescription of chest physiotherapy in infant acute bronchiolitis is recommended.
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Affiliation(s)
- B Sterling
- Service de spécialités pédiatriques et unité de pneumopédiatrie, CHU de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
| | - E Bosdure
- Service de spécialités pédiatriques et unité de pneumopédiatrie, CHU de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - N Stremler-Le Bel
- Service de spécialités pédiatriques et unité de pneumopédiatrie, CHU de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - B Chabrol
- Service de spécialités pédiatriques et unité de pneumopédiatrie, CHU de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - J-C Dubus
- Service de spécialités pédiatriques et unité de pneumopédiatrie, CHU de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
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Bronchiolite aiguë du nourrisson : facteurs de risque et évaluation de la gravité : un enjeu majeur dans la prise en charge. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Alvarez AE, Marson FADL, Bertuzzo CS, Arns CW, Ribeiro JD. Epidemiological and genetic characteristics associated with the severity of acute viral bronchiolitis by respiratory syncytial virus. J Pediatr (Rio J) 2013; 89:531-43. [PMID: 24035870 DOI: 10.1016/j.jped.2013.02.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/06/2013] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE to assess the epidemiological and genetic factors associated with severity of acute viral bronchiolitis (AVB) by respiratory syncytial virus (RSV). DATA SOURCE the key words "bronchiolitis", "risk factor", "genetics" and "respiratory syncytial virus", and all combinations among them were used to perform a search in the PubMed, SciELO, and Lilacs databases, of articles published after the year 2000 that included individuals younger than 2 years of age. DATA SYNTHESIS a total of 1,259 articles were found, and their respective summaries were read. Of these, 81 were selected, which assessed risk factors for the severity of AVB, and were read in full; the 60 most relevant studies were included. The epidemiologic factors associated with AVB severity by RSV were prematurity, passive smoking, young age, lack of breastfeeding, chronic lung disease, congenital heart disease, male gender, ethnicity, viral coinfection, low weight at admission, maternal smoking during pregnancy, atopic dermatitis, mechanical ventilation in the neonatal period, maternal history of atopy and/or asthma during pregnancy, season of birth, low socioeconomic status, Down syndrome, environmental pollution, living at an altitude > 2,500 meters above sea level, and cesarean section birth. Conversely, some children with severe AVB did not present any of these risk factors. In this regard, recent studies have verified the influence of genetic factors on the severity of AVB by RSV. Polymorphisms of the TLRs, RANTES, JUN, IFNA5, NOS2, CX3CR1, ILs, and VDR genes have been shown to be associated with more severe evolution of AVB by RSV. CONCLUSION the severity of AVB by RSV is a phenomenon that depends on the varying degrees of interaction among epidemiological, environmental, and genetic variables.
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Affiliation(s)
- Alfonso Eduardo Alvarez
- Pediatrics Department, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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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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Barbier C, Llerena C, Hullo E, Michard-Lenoir AP, Pin I. Bronchiolite aiguë : actualités sur les thérapeutiques inhalées. Arch Pediatr 2013. [DOI: 10.1016/s0929-693x(13)71376-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cohen-Bacrie S, Halfon P. Prospects for molecular point-of-care diagnosis of lower respiratory infections at the hospital’s doorstep. Future Virol 2013. [DOI: 10.2217/fvl.12.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Now that molecular assays have been simplified, they can be performed at the point of care (POC). As we aimed to evaluate POC detection of respiratory viruses, we have collected studies on the molecular detection of viruses in children and adults with a well-characterized diagnosis, made in hospital settings, of community-acquired acute bronchiolitis (AB) or pneumonia (CAP). We then present the epidemiological issues for each disease. The prevalence of 18 virus species and types was determined separately for each disease, virus by virus. Overall, the median detection rate of viruses was 90% (interquartile range [IQR]: 69.25–93.5%) and 71.8% (IQR: 69.25–74.25%) in children with AB and CAP, respectively, and 24.5% (IQR: 20–30%) in adults with CAP. The observations on the relationship between virological findings and severity of disease were conflicting in AB, while those for influenza-related CAP were significantly associated with high morbidity/mortality. There is evidence supporting the suggestion that molecular POC detection of targeted pathogens could optimize bed management in emergency departments, guide anti-infective therapies and prevent nosocomial outbreaks. However, further investigations are required to determine when the detection of a large panel of viruses should be processed in clinical practice.
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Affiliation(s)
- Stéphan Cohen-Bacrie
- Clinical Microbiology, Alphabio Laboratory, 23 Rue de Friedland, 13006 Marseille, France
| | - Philippe Halfon
- Clinical Microbiology, Alphabio Laboratory, 23 Rue de Friedland, 13006 Marseille, France
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