Viral bronchiolitis in children: a common condition with few therapeutic options

Factors Influencing Feeding Decisions in Children With Bronchiolitis on High-Flow Nasal Cannula

BACKGROUND AND OBJECTIVES

High-flow nasal cannula (HFNC) is used in up to 50% of children admitted with bronchiolitis. Consensus recommendations for feeding these children have not been established, and there is variability in practice. We sought to identify factors influencing feeding decisions for general care patients admitted with bronchiolitis on HFNC from a national sample of interdisciplinary care team members.

METHODS

In this qualitative study, we conducted semi-structured virtual interviews with care team members involved in making feeding decisions at 10 US hospitals from June 2022 to March 2023. Eligible participants included 1 nurse, respiratory therapist, speech language pathologist, and physician from each site. Interviews were audio-recorded, transcribed, and conducted until reaching sufficiency. Three researchers analyzed transcript data using content analysis guided by the Systems Engineering Initiative for Patient Safety 2.0 model.

RESULTS

We interviewed 29 participants, including 19 nurses, respiratory therapists, and speech language pathologists and 10 physicians. Participants identified 11 factors influencing feeding decisions related to hospital work systems and processes outlined in the Systems Engineering Initiative for Patient Safety model, including people (child and parent characteristics, care team experience), tools and technology (guideline, protocol, ordersets), organization (institutional culture, education), environment (time of day, care location), task (interventions to optimize feeding), and process (clinical assessment, feeding trial, communication).

CONCLUSIONS

Our findings suggest that feeding decisions are driven by factors related to the child, care team experience, institutional tools, and culture. These key factors may inform local improvement efforts to decrease variation in feeding children with bronchiolitis requiring HFNC.

Pediatric Respiratory Infections ‎After the COVID-19 Pandemic: A Single-Center Experience

Background Pediatric respiratory infections, mainly bronchiolitis, are a substantial clinical burden. The most common etiology is respiratory syncytial virus (RSV). Other viruses include human rhinovirus, human metapneumovirus, influenza, adenovirus, coronavirus, and parainfluenza viruses. Objective We aimed to study the epidemiology and clinical characteristics of children with confirmed viral bronchiolitis and flu after the COVID-19 pandemic season and compare the behavior of each virus. Methods This retrospective observation study was done over seven months, from October 2022 to April 2023. All children (0-14) were included in the study if they met the clinical diagnosis of bronchiolitis or flu. Viral etiology is confirmed by PCR, using the respiratory panel available in our center which included the detection of four viruses: COVID-19, RSV, influenza A, and B. Clinical data, lab results, and X-rays were collected and correlated with each viral infection for all admitted patients. Results We recruited 237 children with bronchiolitis and flu symptoms from October 2022 to April 2023. The peak of infections (41%) was in November. Seasonal variations for each virus showed distinct patterns across the year. RSV peaked at the beginning of the season, gradually declining after that. In contrast, influenza A and B maintained a relatively consistent presence throughout the season. Meanwhile, COVID-19 reached its peak during March and April. One hundred forty-four (60%) of the patients were under two years of age. RSV was predominant in 150 patients (63.3%). COVID-19 was only detected in 25 patients (10%), whereas influenza A and B were equally isolated in 31 (13%) patients each. Fifty-one children (21%) were initially sick and required pediatric intensive care unit (PICU) admission, with no deaths reported. Notably, COVID-19 had a milder disease course, a shorter length of stay (LOS) in the hospital (two days) and a shorter duration of illness (five days) compared to other viruses. RSV infection was linked to more profound hypoxia and more sick children with more extended hospital stays. Conclusion Our study showed that, following the pandemic and the release of lockdown measures, there was another peak of upper respiratory tract infections (URTI) and flu, which was more aggressive, primarily due to other viruses, especially RSV. This resurgence was associated with more severe respiratory symptoms and an increased need for hospitalization. Notably, children with COVID-19 were in better condition compared to those with RSV.

Saudi Initiative of Bronchiolitis Diagnosis, Management, and Prevention 2024 updated consensus on the prevention of respiratory syncytial virus

Respiratory syncytial virus (RSV) is the major cause of bronchiolitis among children under 5 years of age worldwide, accounting for a prevalence of 25%-88% in Saudi Arabia. Although no effective treatment for the virus exists, passive immunoprophylaxis reduced RSV hospitalizations in high-risk children. With recent advances in immunization, the Saudi Initiative of Bronchiolitis Diagnosis, Management, and Prevention panel screened recent relevant international guidelines, locally published data, and expert consensus to update guidelines for RSV prevention, taking into consideration the resources, timing, varying health profiles, and RSV burden in Saudi Arabia. The panel updated its recommendations to include immunization of infants, mothers, and older adults. Practical guidelines were prepared to facilitate the administration of the short-acting and newly developed long-acting RSV monoclonal antibodies (mAb) during the regular follow-ups of high-risk infants in specialized clinics. In addition, long-acting mAb was highlighted as all-infant protection in the routine immunization calendar.

Bronchiolitis Due to RSV and HMPV-Epidemiology, Clinical Course, and Prognosis: Experience of a Single Tertiary Center

Acute bronchiolitis is a leading cause of hospitalization in infants. In this retrospective study, 645 patients with acute bronchiolitis diagnosed as respiratory syncytial virus (RSV; n = 538) or human metapneumovirus (HMPV; n = 107) were compared in terms of demographic, clinical, and laboratory findings. The HMPV patients presented later in the winter, were older (20 vs 7.55 months; P < .001)), had higher levels of C-reactive protein (4.55 vs 3.03 mg/dL; P = .007), and a higher prevalence of complications (43.9% vs 32.7%; P = .03). This study highlights the similarities and differences between these 2 common respiratory viral pathogens and shows that HMPV has a slightly more severe disease course than RSV. These findings can help guide approaches to these 2 common viruses that cause bronchiolitis.

Epidemiology and Risk Factor Analysis of Children with Bronchiolitis Admitted to the Intensive Care Unit at a Tertiary Care Center in Saudi Arabia

Bronchiolitis is a leading cause of hospitalization worldwide for children aged ≤2 years. Few studies have compared general ward and pediatric intensive care unit (PICU) admissions, particularly in Saudi Arabia. This retrospective cohort study aimed to compare the demographic and clinical characteristics of children with bronchiolitis admitted to the general ward with those admitted to the PICU. Children (≤6 years) previously diagnosed with bronchiolitis and admitted to the PICU or general ward at a tertiary center in Saudi Arabia between May 2016 and May 2021 were included. Multiplex polymerase chain reaction was used to identify respiratory viruses. Of the 417 patients enrolled, 67 (16.06%) were admitted to the PICU. The PICU group was younger (median, 2 months; interquartile range [IQR], 1-5 months) vs. (6 months; IQR, 2.65-13.25 months). There was a dramatic reduction in bronchiolitis admissions during the COVID-19 pandemic. The most common causative virus was respiratory syncytial virus (RSV) (54.9%). In the multivariate regression analysis, hypoxia, hyperinflation on X-ray, and non-RSV bronchiolitis were independently associated with PICU admission. However, a higher chronological age and cough were protective. Children with Down syndrome, immunodeficiency, or neuromuscular disorders, and intermediate preterm infants (29-33 weeks of gestation) are at a high risk of PICU admission (adjusted odds ratio: 2.4, 7.1, 2.9, and 2.9; p = 0.037, 0.046, 0.033, and 0.029, respectively). Bronchiolitis is still one of the leading causes of PICU admission. Particular attention should be paid to preventive measures, especially in the post-COVID-19 era, targeting high-risk groups.

When is asthma not guilty?

Asthma is a common childhood condition. Its prevalence in Saudi Arabia is high, increasing, and could exceed 20% at the current trajectory. Asthma is a syndrome with different clinical presentations and phenotypes. Many conditions are often misdiagnosed as asthma because they share the same symptoms, particularly coughing and shortness of breath; physical findings, such as wheezing; radiological findings, such as hyperinflation on chest X-ray; or even responses to asthma therapies, as in some patients with bronchiolitis. When treating the younger age group (>5 years old), there should be a high degree of suspicion of alternative causes when evaluating patients presenting with clinical features suggestive of asthma or patients who do not respond well to asthma therapies. This study will highlight common conditions that may mimic asthma and, as a result of incorrect treatment, unnecessarily expose patients to steroids and other therapies for extended periods. Furthermore, we seek to alert healthcare providers to common symptoms and signs that suggest a cause other than asthma and suggest when to refer the patient to subspecialists.

Clinical Epidemiological Characteristics and Risk Factors for Severe Bronchiolitis Caused by Respiratory Syncytial Virus in Vietnamese Children

Introduction

Bronchiolitis is the most prevalent cause of hospitalization in infants under the age of 12 months. The disease is caused by respiratory syncytial virus (RSV) infection, which can cause breathing difficulties and respiratory failure. Therefore, it is necessary to discover the risk factors of severe bronchiolitis to diagnose and treat promptly. This study is aimed at describing the epidemiological characteristics and clinical features of acute bronchiolitis caused by RSV and assessing the related factors to severe acute bronchiolitis in studied patients.

Methods

A descriptive cross-sectional study was carried out in Haiphong Children's Hospital, Haiphong, Vietnam, for one year, from October 1, 2016, to September 30, 2017. All bronchiolitis admissions < 2 years were included.

Results

377 children were evaluated, including 261 boys and 116 girls; children under 6 months accounted for the highest proportion (57%), and 47 (12.5%) of all patients had severe disease. Wheezing was the main reason to be taken to the hospital 261 (69.2%). Clinical symptoms of acute bronchiolitis such as cough, tachypnea, and runny nose were found in all patients. Bronchiolitis cases increased in the winter-spring season, and the highest registered number of patients was 42 in March. Image of bronchiolitis on chest X-ray was found in all patients, and air trapping lung was found in 124 (32.9%) patients. The risk factors included age (≤6 months), low birth weight, preterm birth, nonbreastfeeding for the first six months, early weaning, and exposition to cigarette smoke increased the severe disease (p < 0.05).

Conclusion

The number of hospitalized infants with bronchiolitis caused by RSV has an upward trend during the winter-spring season (from October to March). This study confirms that age, preterm birth, breastfeeding under 6 months, history of exposure to cigarette smoking, low birth weight, having sibling(s) under five years old going to kindergarten, history of undergoing cesarean section, history of mechanical ventilation, poor living condition, and maternal education are 10 risk factors of severe bronchiolitis caused by RSV.

Parent Experiences Caring for a Child With Bronchiolitis: A Qualitative Study

Background:

Bronchiolitis is an acute lower respiratory infection, with significant impacts on children and families and strains on the health care system. Understanding parents’ experiences and information needs caring for a child with bronchiolitis is crucial to highlight misconceptions or issues contributing to the high burden. The objective of this qualitative study was to describe parents’ experiences caring for a child with bronchiolitis.

Methods:

Qualitative description guided this study. Participants were recruited from the Stollery Children’s Hospital emergency department (ED), a specialized pediatric ED in a major Canadian urban center. Semi-structured interviews were conducted with 15 parents.

Results:

Five major themes were identified: (a) their children’s symptoms and behaviors, (b) bronchiolitis affects the entire family, (c) factors influencing parent’s decision to go to ED, (d) ED experience for parents and their children, and (e) bronchiolitis treatment and management. Interviews revealed bronchiolitis has significant effects on both children and families and parents are generally unaware of bronchiolitis symptoms, treatment, and management.

Conclusions:

Our study highlights that parents have knowledge deficits when it comes to recognizing the presence and severity of bronchiolitis symptoms. Parents would benefit from having more evidence-based resources to enhance their knowledge about the nature of bronchiolitis.

Predictors for the prescription of albuterol in infants hospitalized for viral bronchiolitis

INTRODUCTION AND OBJECTIVES

Despite the recommendation against routine use of inhaled bronchodilators in infants with viral bronchiolitis given in the main clinical practice guidelines (CPGs) on viral bronchiolitis, albuterol is widely prescribed to patients with this disease. The aim of this study was to identify predictors of prescription of albuterol in a population of infants hospitalized for viral bronchiolitis.

MATERIAL AND METHODS

An analytical cross-sectional study performed during the period from March 2014 to August 2015, in a random sample of patients <2 years old hospitalized in the Fundacion Hospital La Misericordia, a hospital located in Bogota, Colombia. After reviewing the electronic medical records, we collected demographic, clinical, and disease-related information, including prescription of albuterol at any time during the course of hospitalization as the outcome variable.

RESULTS

For a total of 1365 study participants, 1042 (76.3%) were prescribed with albuterol therapy. After controlling for potential confounders, it was found that age (OR 1.11; CI 95% 1.08-1.15; p<0.001), and a prolonged length of stay (LOS) (OR 1.93; CI 95% 1.44-2.60; p<0.001) were independent predictors of prescription of albuterol in our sample of patients. By contrast, albuterol prescription was less likely in the post-guideline assessment period (OR 0.41; CI 95% 0.31-0.54; p<0.001), and in infants with RSV isolation (OR 0.71; CI 95% 0.52-0.97; p=0.035).

CONCLUSIONS

Albuterol was highly prescribed in our population of inpatients with the disease. The independent predictors of prescription of albuterol in our sample of patients were age, implementation of a CPG on viral bronchiolitis, RSV isolation, and LOS.

Parents' information needs and preferences related to bronchiolitis: a qualitative study

BACKGROUND

Bronchiolitis affects more than one-third of children less than age 2 years and can cause substantial anxiety for parents, leading them to seek information on how to care for their sick child. The aim of our qualitative study was to explore the information needs and preferences of parents caring for a child with bronchiolitis.

METHODS

We used a qualitative descriptive approach. Participants were recruited by means of purposive sampling from Oct. 1, 2017, to Mar. 15, 2018 from the Stollery Children's Hospital emergency department, a specialized pediatric emergency department in Edmonton. Individual semistructured interviews were conducted.

RESULTS

Fifty-three parents were recruited to participate, of whom 30 could not be reached after 4 contact attempts and 8 refused. Thus, 15 parents participated (16 children). Three major themes were identified: 1) parents' information needs about bronchiolitis, 2) parents' preferred information sources and 3) parents' preferred information delivery formats. Participants indicated that they want and require credible, easy-to-understand information about bronchiolitis in a variety of formats, and especially valued information obtained directly from a health care professional or an evidence-based website.

INTERPRETATION

This study provides important information about parents' information needs concerning bronchiolitis in children. Identifying the information that parents want and value in relation to acute pediatric illnesses is imperative to developing innovative educational approaches for parents that reflect patient-centred care.

Parent experiences and information needs related to bronchiolitis: A mixed studies systematic review

OBJECTIVE

To inform evidence-based knowledge products (i.e., infographics, videos, eBooks) of relevance to parents, we systematically reviewed evidence on parent experiences and information needs related to bronchiolitis.

METHODS

We searched Medline, CINAHL, PsycINFO, and ProQuest Dissertations & Theses Global, and scanned reference lists for studies published post-2000. We appraised quality in duplicate using the Mixed Methods Appraisal Tool (MMAT) and synthesized findings narratively.

RESULTS

We retrieved 797 records and included 29; 14 (48%) met >50% of MMAT criteria. Studies predominantly enrolled mothers. Most reported quantitatively on hospitalization experiences (n = 9, 31%), treatments (n = 5, 17%), or respiratory syncytial virus (RSV) prophylaxis (n = 9, 31%). Ten (34%) studies reported on information needs; 3 contributed qualitative data. Parents could not always identify bronchiolitis symptoms. During hospitalization, parents endured guilt and anxiety. Mothers wanted to take an active role in their child's care but often felt uninvolved. Barriers to RSV prophylaxis included transportation, scheduling, and insurance issues.

CONCLUSIONS

Evidence focused primarily on hospitalization, which parents found frightening. More information is needed on home care experiences and information preferences.

PRACTICE IMPLICATIONS

Timely education and support from healthcare providers may help to alleviate parents' fears and enhance involvement in their child's care.

Overview of prevention and management of acute bronchiolitis due to respiratory syncytial virus

INTRODUCTION

Respiratory Syncytial Virus (RSV) is the most common cause of Acute Bronchiolitis (AVB) in infants. AVB causes significant morbidity and mortality worldwide, most deaths occurring in the developing world. AVB causes respiratory distress in infants, leading to respiratory failure in some cases. Disease is more severe in infants with risk factors, such as prematurity, chronic cardiac and lung disease and immunodeficiency. Areas covered: Despite major advances in supportive care in the developed world, which has led to a significant reduction in mortality, treatment remains symptomatic and supportive. No specific antiviral treatment has yet proven to be effective. Prevention of disease with monoclonal antibodies has proven to reduce illness severity in those with risk factors, however, this is prohibitively expensive, particularly for the developing world. Prospects for vaccine development are improving. However, because most disease is in young infants, maternal immunization is necessary. However, due to the transient nature of RSV immunity and the circulation of multiple subtypes, vaccines proven to be effective in adult challenge models have yet to be translated to protection in infants. Expert commentary: Despite advances in preventative treatments, adherence to evidence-based guidelines provides the best prospect for successful reduction in morbidity and mortality.

The effect of outdoor air pollution on the risk of hospitalisation for bronchiolitis in infants: a systematic review

OBJECTIVE

To systematically review the evidence around the effect of ambient levels of particulate and gaseous pollutants, and the risk of hospitalisation with bronchiolitis for infants under two years of age.

DESIGN

Systematic review of observational epidemiological studies including cohort, time series, case crossover and case control study designs.

DATA SOURCES

Medline, Scopus, and Web of Science searched to November 2017 with no language restrictions.

ELIGIBILITY CRITERIA

Studies investigating impact of air pollution levels on particulate pollutants (diameter <2.5 μm (PM2.5) or <10 μm (PM10) and gaseous pollutants (nitrogen dioxide (NO2), sulphur dioxide (SO2), carbon monoxide (CO), ozone (O3)) on hospital admission for bronchiolitis.

MAIN OUTCOME MEASURE

Risk of hospitalisation from bronchiolitis.

RESULTS

Eight studies were eligible for review. Long term exposure to PM2.5 may be associated with increased risk of hospitalisation for bronchiolitis. SO2 may also be associated with hospitalisation, but results for other pollutants are inconsistent between studies. In three of the five studies that showed a positive association between air pollutants and hospitalisation, measured concentrations were below World Health Organization (WHO) recommended levels.

CONCLUSIONS

Certain particulate and gaseous pollutants may have a clinically relevant effect on hospital admissions for bronchiolitis in children below age two years old. Large cohort or time series studies are needed to examine this possible association.

PROTOCOL

The protocol can be found at PROSPERO (CRD42017080643).

Effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis

OBJECTIVE

To evaluate the effects of the use of respiratory physiotherapy in children admitted with acute viral bronchiolitis (AVB).

METHODS

A literature review was done searching the Pubmed, LILACS, PEDro, and Scielo databases. The following key words were used: bronchiolitis, physiotherapy, techniques, physical therapy, and chest physiotherapy. Both controlled and uncontrolled clinical trials, without limits as to date, were selected.

RESULTS

Fifteen articles were included and the use of different techniques of respiratory physiotherapy showed positive results in eight studies. Most (11) were controlled clinical trials, and only two had a double-blind design. Of the 14 studies with a control group, in six this group was submitted to nasopharyngeal aspiration. The most widely used techniques were manual vibration and postural drainage (eight studies), and then tapping/percussion (seven studied). The maneuvers considered as current, e.g., prolonged slow expiration, expiratory flow acceleration, and rhinopharyngeal retrograde clearance, were used in four, four, and two studies, respectively.

CONCLUSIONS

The use of respiratory physiotherapy in children with AVB remains controversial. The heterogeneity of techniques evaluated in the studies limits the interpretation of efficacy, although its use was considered safe. Recent findings indicating a reduction in the length of the hospital stay remain to be confirmed.

Bronchiolitis in children: The Saudi initiative of bronchiolitis diagnosis, management, and prevention (SIBRO)

Bronchiolitis is the leading cause of admissions in children less than two years of age. It has been recognized as highly debated for many decades. Despite the abundance of literature and the well-recognized importance of palivizumab in the high risk groups, and despite the existence of numerous, high-quality, recent guidelines on bronchiolitis, the number of admissions continues to increase. Only supportive therapy and few therapeutic interventions are evidence based and proved to be effective. Since Respiratory Syncytial Virus (RSV) is the major cause of bronchiolitis, we will focus on this virus mostly in high risk groups like the premature babies and children with chronic lung disease and cardiac abnormalities. Further, the prevention of RSV with palivizumab in the high risk groups is effective and well known since 1998; we will discuss the updated criteria for allocating infants to this treatment, as this medication is expensive and should be utilized in the best condition. Usually, diagnosis of bronchiolitis is not challenging, however there has been historically no universally accepted and validated scoring system to assess the severity of the condition. Severe RSV, especially in high risk children, is unique because it can cause serious respiratory sequelae. Currently there is no effective curative treatment for bronchiolitis. The utility of different therapeutic interventions is worth a discussion.

Clinical definition of respiratory viral infections in young children and potential bronchiolitis misclassification

Viral respiratory infections are often grouped as a single respiratory syndrome named 'viral bronchiolitis', independently of the viral etiology or individual risk factors. Clinical trials and guidelines have used a more stringent definition of viral bronchiolitis, including only the first episode of wheezing in children less than 12 months of age without concomitant respiratory comorbidities. There is increasing evidence suggesting that this definition is not being followed by pediatric care providers, but it is unclear to what extent viral respiratory infections are currently misclassified as viral bronchiolitis using standard definitions. We conducted a retrospective analysis of hospitalized young children (≤3 years) due to viral respiratory infections. Bronchiolitis was defined as the first wheezing episode less than 12 months of age. Demographic variables and comorbidities were obtained by electronic medical record review. The study comprised a total of 513 hospitalizations (n=453). Viral bronchiolitis was diagnosed in 144 admissions (28.1%). Notably, we identified that the majority of children diagnosed with bronchiolitis (63%) were misclassified as they had prior episodes of wheezing. Many children with bronchiolitis misclassification had significant comorbidities, including prematurity (51%), neuromuscular conditions (9.8%), and congenital heart disease (9.8%). Misclassification of bronchiolitis is a common problem that may lead to inappropriate management of viral respiratory infections in young children. A comprehensive approach that takes into consideration viral etiology and individual risk factors may lead to a more accurate clinical assessment of this condition and would potentially prevent bronchiolitis misclassification.

Predictors of Inappropriate Use of Diagnostic Tests and Management of Bronchiolitis

Background

The aim of the present study was to determine predictors of inappropriate use of diagnostic tests and management of bronchiolitis in a population of hospitalized infants.

Methods

In an analytical cross-sectional study, we determined independent predictors of the inappropriate use of diagnostic tests and management of bronchiolitis in a population of hospitalized infants. We defined a composite outcome score as the main outcome variable.

Results

Of the 303 included patients, 216 (71.3%) experienced an inappropriate use of diagnostic tests and treatment of bronchiolitis. After controlling for potential confounders, it was found that atopic dermatitis (OR 5.30; CI 95% 1.14–24.79; p = 0.034), length of hospital stay (OR 1.48; CI 95% 1.08–2.03; p = 0.015), and the number of siblings (OR 1.92; CI 95% 1.13–3.26; p = 0.015) were independent predictors of an inappropriate use of diagnostic tests and treatment of the disease.

Conclusions

Inappropriate use of diagnostic tests and treatment of bronchiolitis was a highly prevalent outcome in our population of study. Participants with atopic dermatitis, a longer hospital stay, and a greater number of siblings were at increased risk for inappropriate use of diagnostic tests and management of the disease.

Characteristics and progression of children with acute viral bronchiolitis subjected to mechanical ventilation

OBJECTIVE

To analyze the characteristics of children with acute viral bronchiolitis subjected to mechanical ventilation for three consecutive years and to correlate their progression with mechanical ventilation parameters and fluid balance.

METHODS

Longitudinal study of a series of infants (< one year old) subjected to mechanical ventilation for acute viral bronchitis from January 2012 to September 2014 in the pediatric intensive care unit. The children's clinical records were reviewed, and their anthropometric data, mechanical ventilation parameters, fluid balance, clinical progression, and major complications were recorded.

RESULTS

Sixty-six infants (3.0 ± 2.0 months old and with an average weight of 4.7 ± 1.4kg) were included, of whom 62% were boys; a virus was identified in 86%. The average duration of mechanical ventilation was 6.5 ± 2.9 days, and the average length of stay in the pediatric intensive care unit was 9.1 ± 3.5 days; the mortality rate was 1.5% (1/66). The peak inspiratory pressure remained at 30cmH2O during the first four days of mechanical ventilation and then decreased before extubation (25 cmH2O; p < 0.05). Pneumothorax occurred in 10% of the sample and extubation failure in 9%, which was due to upper airway obstruction in half of the cases. The cumulative fluid balance on mechanical ventilation day four was 402 ± 254mL, which corresponds to an increase of 9.0 ± 5.9% in body weight. Thirty-seven patients (56%) exhibited a weight gain of 10% or more, which was not significantly associated with the ventilation parameters on mechanical ventilation day four, extubation failure, duration of mechanical ventilation or length of stay in the pediatric intensive care unit.

CONCLUSION

The rate of mechanical ventilation for acute viral bronchiolitis remains constant, being associated with low mortality, few adverse effects, and positive cumulative fluid balance during the first days. Better fluid control might reduce the duration of mechanical ventilation.

Etiology and clinical features of viral bronchiolitis in infancy

BACKGROUND

Bronchiolitis is a common lower respiratory tract infection in infancy. The aim of this review is to present the clinical profile of viral bronchiolitis, the different culprit viruses and the disease severity in relation to the viral etiology.

DATA SOURCES

Databases including PubMed and Google Scholar were searched for articles about the clinical features of bronchiolitis and its viral etiology. The most relevant articles to the scope of this review were analyzed.

RESULTS

Currently there are two main definitions for bronchiolitis which are not identical, the European definition and the American one. The most common viral pathogen that causes bronchiolitis is respiratory syncytial virus which was identified in 1955; now many other viruses have been implicated in the etiology of bronchiolitis such as rhinovirus, adenovirus, metapneumovirus, and bocavirus. Several studies have attempted to investigate the correlation of bronchiolitis severity with the type of detected virus or viruses. However, the results were not consitent.

CONCLUSIONS

For the time being, the diagnosis of bronchiolitis remains clinical. The isolation of the responsible respiratory pathogens does not seem to confer to the prognosis of the disease severity.

Trends in respiratory syncytial virus bronchiolitis hospitalizations in children less than 1 year: 2004-2012

OBJECTIVE

To analyze trends in health outcomes and the influence of risk factors in children under 1 year with acute bronchiolitis due to respiratory syncytial virus (RSV bronchiolitis). A risk-adjustment model for RSV bronchiolitis in-hospital mortality was also developed.

RESEARCH DESIGN AND METHODS

Retrospective study of hospitalizations for RSV bronchiolitis in children aged <1 year from 2004 to 2012. We used nationally representative data from the Spanish National Health Service records.

RESULTS

Over the study period, the annual hospital discharges for RSV bronchiolitis ranged between 6390 and 8637. The annual in-hospital mortality rate ranged from 120 (2004) to 69 (2012) per 100,000 hospitalizations and the mean length of stay decreased steadily from 6.5 to 5.2 days (p < 0.001); 98.3% of hospitalizations for RSV bronchiolitis were children without risk factors. The in-hospital mortality rate due to RSV bronchiolitis in children with risk factors was 18.8 times higher than non-high-risk children and, in adjusted analyses, the OR of in-hospital mortality due to RSV bronchiolitis was higher than that due to other causes.

LIMITATIONS

This study is a retrospective analysis, based on administrative data. It does not include data about pre- or in-hospital treatments, and has the limitations inherent in procedures for determining risk-adjusted mortality rates. Socioeconomic and environmental factors have not been considered in this study.

CONCLUSIONS

RSV bronchiolitis is a leading cause of hospitalizations for infants under 1 year and has not shown incidence reduction over a 9 year period. Risk factors increase the in-hospital mortality risk and it is higher if the hospitalization cause is RSV bronchiolitis than any other reason.

High flow therapy versus hypertonic saline in bronchiolitis: randomised controlled trial

OBJECTIVE

To demonstrate that heated humidified high-flow nasal cannula (HHHFNC) is superior to inhaled hypertonic saline solution (HSS) in improving respiratory distress in moderate bronchiolitis. In addition, it could improve comfort and reduce length of hospital stay (LOS) and admission to Paediatric Intensive Care Unit (PICU).

DESIGN

Randomised Clinical Trial from 1 October 2010 to 31 December 2012.

SETTING

Two urban secondary (no PICU available) paediatric hospitalisation units.

PATIENTS

Hospitalised children aged up to 6 months with moderate acute bronchiolitis (Respiratory Distress Assessment Instrument, RDAI ≥4).

INTERVENTION

Patients were randomised to HHHFNC or HSS. All of them received epinephrine as bronchodilator.

MAIN OUTCOMES

Primary outcome was difference in mean Respiratory Assessment Change Score (RACS) between both groups measured in six previously defined consecutive moments. Secondary outcomes were difference in mean comfort scores in this period, LOS and rate of PICU admission.

RESULTS

Seventy-five previously healthy patients were enrolled. Mean age was 2.4 months (95% CI 2.04 to 2.76). 43 were allocated to HSS group and 32 in HHHFNC. Data of 1 patient were lost, and 8 changed group over the study period. Intention-to-treat principle was applied. There were no significant differences in mean RACS and mean comfort scores between groups at the evaluation points. Median LOS or PICU admission rate were similar in both groups. No adverse events were observed.

CONCLUSIONS

HHHFNC was not superior to HSS in treatment of moderate acute bronchiolitis with respect to severity and comfort scores, LOS or PICU admission rate.

CLINICAL TRIAL REGISTRATION CLINICALTRIALSGOV IDENTIFIER

NCT01873144.