1
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Gelbart B, Shann F. The combination of systemic corticosteroids and inhaled adrenaline for bronchiolitis. Lancet 2024; 403:1335. [PMID: 38582555 DOI: 10.1016/s0140-6736(23)01224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 06/12/2023] [Indexed: 04/08/2024]
Affiliation(s)
- Ben Gelbart
- Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC 3052, Australia.
| | - Frank Shann
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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2
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Porcaro F, Cutrera R, Vittucci AC, Villani A. Bronchiolitis guidelines: what about the Italian situation in a primary care setting? Ital J Pediatr 2023; 49:123. [PMID: 37726761 PMCID: PMC10510229 DOI: 10.1186/s13052-023-01527-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023] Open
Abstract
Acute viral bronchiolitis is the most common cause of hospitalization in children under 12 months of age. The variable clinical presentation and the potential for sudden deterioration of the clinical conditions require a close monitoring by healthcare professionals.In Italy, first access care for children is provided by primary care physicians (PCPs) who often must face to a heterogeneous disease presentation that, in some cases, make the management of patient with bronchiolitis challenging. Consequently, Italian studies report poor adherence to national and international guidelines processed to guide the clinicians in decision making in acute viral bronchiolitis.This paper aims to identify the potential factors contributing to the lack of adherence to the suggested guidelines derived by clear and evidence-based recommendations among primary care physicians operating in an outpatient setting, with a specific focus on the context of Italy. Particularly, we focus on the prescription of medications such as β2-agonists, systemic steroids, and antibiotics which are commonly prescribed by PCPs to address conditions that can mimic bronchiolitis.
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Affiliation(s)
- Federica Porcaro
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCCS, piazza di Sant'Onofrio 4, Rome, 00165, Italy.
| | - Renato Cutrera
- Pediatric Pulmonology and Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, IRCCS, piazza di Sant'Onofrio 4, Rome, 00165, Italy
| | - Anna Chiara Vittucci
- Pediatric Unit, Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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3
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Gelbart B, Shann F. Severe bronchiolitis in infants less than 12 months old. Intensive Care Med 2023; 49:886-887. [PMID: 37160592 DOI: 10.1007/s00134-023-07083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/11/2023]
Affiliation(s)
- Ben Gelbart
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, 3052, Australia.
| | - Frank Shann
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3052, Australia
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4
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Milesi C, Mortamet G, Bordessoule A, Rambaud J, Emeriaud G. Severe bronchiolitis in infants less than 12 months old. Authors' reply. Intensive Care Med 2023; 49:888-889. [PMID: 37256339 DOI: 10.1007/s00134-023-07093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Christophe Milesi
- Pediatric Intensive Care Unit, Montpellier University Hospital, Montpellier, France.
- Department of Neonatal Medicine and Paediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 371 Avenue du Doyen Gaston Giraud, 34295 Cedex 5, Montpellier, France.
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Alice Bordessoule
- Pediatric Intensive Care Unit, Geneva University Hospital, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jérôme Rambaud
- Pediatric Intensive Care Unit, Trousseau Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, Sainte-Justine University Hospital, Montreal, Canada
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5
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Carlone G, Graziano G, Trotta D, Cafagno C, Aricò MO, Campodipietro G, Marabini C, Lizzi M, Fornaro M, Caselli D, Valletta E, Aricò M. Bronchiolitis 2021-2022 epidemic: multicentric analysis of the characteristics and treatment approach in 214 children from different areas in Italy. Eur J Pediatr 2023; 182:1921-1927. [PMID: 36807514 PMCID: PMC9943040 DOI: 10.1007/s00431-023-04853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/23/2023]
Abstract
Bronchiolitis causes a remarkable number of hospitalizations; its epidemiology follows that of respiratory syncytial virus (RSV), its main pathogen. The aim of this study was to evaluate the presenting features, treatment approach, and impact of medical therapy in four pediatric hospitals in Italy. Data on infants < 24 months of age hospitalized with bronchiolitis in the 2021-2022 season were collected. Between October 2021 and February 2022, 214 children were admitted. Median hospital stay was 5 days; none of the patients died. The distribution of the presenting features is largely comparable in the 33 (15.8%) RSV-negative versus the 176 (84.2%) RSV-positive children; also, no difference was observed in medical therapy provided: duration of oxygen therapy, administration of steroid, and duration of hospital stay. Systemic steroids, inhalation, or antibiotic therapy were given to 34.6%, 79.4%, and 49.1% of children respectively. Of the 214 patients with bronchiolitis, only 19 (8.8%) were admitted to ICU. Conclusion: Our data suggest that, irrespective of treatments provided, RSV-positive and RSV-negative children had a similar clinical course. The results of our retrospective study further underline the need to improve adherence to existing guidelines on bronchiolitis treatment. What is Known: • Bronchiolitis is a common diseases with seasonal peak. The outcome is usually favorable but hospitalization and even ICU admission is not exceptional. What is New: • Children with RSV associated bronchiolitis do not have a different course and outcome. The analysis of the 2021-2022 cohort, following COVID pandemic peaking, did not show a different course and outcome. • Adherence to literature recommendation, i.e. to focus on oxygen and hydration therapy while avoiding unnecessary systemic therapy with steroid and antibiotics, should be improved.
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Affiliation(s)
- Giorgia Carlone
- grid.415245.30000 0001 2231 2265S. Spirito Hospital, Azienda Sanitaria Locale Pescara, Pescara, Italy
| | - Giusi Graziano
- grid.512242.2CORESEARCH (Center for Outcomes Research and Clinical Epidemiology), Pescara, Italy
| | - Daniela Trotta
- grid.415245.30000 0001 2231 2265S. Spirito Hospital, Azienda Sanitaria Locale Pescara, Pescara, Italy
| | - Claudio Cafagno
- grid.488556.2Pediatric Infectious Diseases, Children’s Hospital Giovanni XXIII, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Melodie O. Aricò
- grid.415079.e0000 0004 1759 989XDepartment of Pediatrics, G. B. Morgagni - L. Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Giacomo Campodipietro
- grid.6292.f0000 0004 1757 1758School of Pediatrics, University of Bologna, Bologna, Italy
| | - Claudio Marabini
- Department of Pediatrics and Neonatology, Provincial General Hospital, ASUR Marche- Area Vasta 3, Macerata, Italy
| | - Mauro Lizzi
- grid.415245.30000 0001 2231 2265S. Spirito Hospital, Azienda Sanitaria Locale Pescara, Pescara, Italy ,grid.412451.70000 0001 2181 4941School of Pediatrics, University of Chieti, Chieti, Italy
| | - Martina Fornaro
- Department of Pediatrics and Neonatology, Provincial General Hospital, ASUR Marche- Area Vasta 3, Macerata, Italy
| | - Desiree Caselli
- grid.488556.2Pediatric Infectious Diseases, Children’s Hospital Giovanni XXIII, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Enrico Valletta
- grid.415079.e0000 0004 1759 989XDepartment of Pediatrics, G. B. Morgagni - L. Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Maurizio Aricò
- S. Spirito Hospital, Azienda Sanitaria Locale Pescara, Pescara, Italy.
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6
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Manti S, Staiano A, Orfeo L, Midulla F, Marseglia GL, Ghizzi C, Zampogna S, Carnielli VP, Favilli S, Ruggieri M, Perri D, Di Mauro G, Gattinara GC, D'Avino A, Becherucci P, Prete A, Zampino G, Lanari M, Biban P, Manzoni P, Esposito S, Corsello G, Baraldi E. UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants. Ital J Pediatr 2023; 49:19. [PMID: 36765418 PMCID: PMC9912214 DOI: 10.1186/s13052-022-01392-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 02/12/2023] Open
Abstract
Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document aims to update the consensus document published in 2014 to provide guidance on the current best practices for managing bronchiolitis in infants. The document addresses care in both hospitals and primary care. The diagnosis of bronchiolitis is based on the clinical history and physical examination. The mainstays of management are largely supportive, consisting of fluid management and respiratory support. Evidence suggests no benefit with the use of salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of effective treatment, the reduction of morbidity must rely on preventive measures. De-implementation of non-evidence-based interventions is a major goal, and educational interventions for clinicians should be carried out to promote high-value care of infants with bronchiolitis. Well-prepared implementation strategies to standardize care and improve the quality of care are needed to promote adherence to guidelines and discourage non-evidence-based attitudes. In parallel, parents' education will help reduce patient pressure and contribute to inappropriate prescriptions. Infants with pre-existing risk factors (i.e., prematurity, bronchopulmonary dysplasia, congenital heart diseases, immunodeficiency, neuromuscular diseases, cystic fibrosis, Down syndrome) present a significant risk of severe bronchiolitis and should be carefully assessed. This revised document, based on international and national scientific evidence, reinforces the current recommendations and integrates the recent advances for optimal care and prevention of acute bronchiolitis.
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Affiliation(s)
| | - Annamaria Staiano
- SIP "Società Italiana di Pediatria", University "Federico II", Naples, Italy
| | - Luigi Orfeo
- SIN "Società Italiana di Neonatologia", Hospital San Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Fabio Midulla
- SIMRI "Società Italiana per le Malattie Respiratorie Infantili", University of Rome "La Sapienza", Rome, Italy
| | - Gian Luigi Marseglia
- SIAIP "Società Italiana di Allergologia e Immunologia Pediatrica", Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Ghizzi
- AMIETIP "Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica", Major Hospital Polyclinic: Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Bologna, Italy
| | - Stefania Zampogna
- SIMEUP "Società Italiana di Medicina di Emergenza ed Urgenza Pediatrica", Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Virgilio Paolo Carnielli
- SIMP "Società Italiana di Medicina Perinatale", University Hospital of Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Silvia Favilli
- SICP "Società Italiana di Cardiologia Pediatrica", University Hospital Meyer, Firenze, Italy
| | - Martino Ruggieri
- SINP "Società Italiana di Neurologia Pediatrica", University of Catania, Catania, Italy
| | - Domenico Perri
- SIPO "Società Italiana Pediatria Ospedaliera", San Giuseppe Moscati Hospital, Aversa, Italy
| | - Giuseppe Di Mauro
- SIPPS "Società Italiana di Pediatria Preventiva e Sociale", Local Health Authority Caserta, Caserta, Italy
| | - Guido Castelli Gattinara
- SITIP "Società Italiana di Infettivologia Pediatrica", Bambino Gesu Pediatric Hospital, Rome, Italy
| | - Antonio D'Avino
- FIMP "Federazione Italiana Medici Pediatri", Local Health Authority Naples 1 Centre, Naples, Italy
| | - Paolo Becherucci
- SICuPP "Società Italiana delle Cure Primarie Pediatriche", Florence City Council, Florence, Italy
| | - Arcangelo Prete
- AIEOP "Società Italiana di Ematologia e Oncologia Pediatrica", IRCCS University Hospital of Bologna, Bologna, Italy
| | - Giuseppe Zampino
- SIMGePeD "Società Italiana Malattie Genetiche Pediatriche e Disabilità Congenite", University Hospital Agostino Gemelli, Rome, Italy
| | | | - Paolo Biban
- University Hospital of Verona, Verona, Italy
| | - Paolo Manzoni
- Ospedale Degli Infermi, Biella, Italy
- University of Turin, Turin, Italy
| | | | | | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padova, Padova, Italy.
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7
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Bronchiolitis therapies and misadventures. Paediatr Respir Rev 2022:S1526-0542(22)00066-5. [PMID: 36280580 DOI: 10.1016/j.prrv.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022]
Abstract
Viral bronchiolitis, which is most commonly caused by an infection with the respiratory syncytial virus (RSV), can lead to respiratory difficulties in young children which may require hospitalization. Despite years of research and medical trials, the mainstay of bronchiolitis treatment remains supportive only. This review provides an overview of the history of different treatments for bronchiolitis, including those that failed, as well as new therapies that are under study. Future studies for the treatment of bronchiolitis should consider different age-groups, important subgroups (i.e., those with a prior history of wheezing, those with a family history of asthma and those with non-RSV viral etiologies) whose response to treatment may differ from that of the composite group.
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8
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Shein SL, Yehya N. Trials and Tribulations in Bronchiolitis. J Pediatr 2022; 244:8-10. [PMID: 35240136 DOI: 10.1016/j.jpeds.2022.02.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Steven L Shein
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Nadir Yehya
- Division of Pediatric Critical Care, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania.
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9
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Sagar H, Dhal S. Managing bronchiolitis in pediatric patients: Current evidence. INDIAN JOURNAL OF RESPIRATORY CARE 2022. [DOI: 10.4103/ijrc.ijrc_153_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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