Feeding in the first six months of life is associated with the probability of having bronchiolitis: a cohort study in Spain

Clinical Profile and Outcome of Bronchiolitis in Children With 1-24 Months of Age

Introduction Bronchiolitis poses a significant challenge in pediatric critical care. It is an acute illness affecting the lower respiratory tract in children under the age of two. The most common cause of bronchiolitis is the seasonal respiratory syncytial virus, with influenza and adenovirus also notable contributors. It is characterized by various clinical symptoms and indicators, such as an upper respiratory prodrome, increased respiratory effort, and wheezing in younger children under two years old. This study primarily examines the clinical profile, risk factors, severity, and outcomes of bronchiolitis in children under two years, excluding the neonatal age group.  Materials and methods Children under two years of age who presented with upper respiratory symptoms and their first episode of wheezing were evaluated. Those with pre-existing systemic conditions such as cardiac, respiratory, or immunodeficiency disorders were excluded. A detailed history was gathered using a questionnaire, and risk factors were analyzed. The severity of the condition was measured using the Wood-Downes-Ferres score. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The relationship between risk factors, severity, and outcomes was examined using the chi-squared test. A two-sided probability of p<0.05 was considered statistically significant for all tests. Results Among 54 children aged 1-24 months with bronchiolitis, the average age was 10.18 months, with a standard deviation of 4.8 months. The severity of the condition was greater in younger children (1-12 months) and tended to decrease with age. Bronchiolitis was more common in males (33 cases) than females (21 cases). Approximately 50 children (92.6%) exhibited signs of respiratory distress, and 45 children (83.3%) showed cough as an initial symptom. Severity was notably higher in children with a history of irritability, which was statistically significant (chi-squared value: 8.169; p-value: 0.017). Only 16 children (29.65%) had a history of poor feeding. Bronchiolitis was more prevalent among infants with a birth weight under 1500 grams (63%). Non-exclusive breastfeeding and early bottle feeding were significant risk factors for bronchiolitis and its severity (chi-squared values: 18.794; p-value: 0.000 and 7.795; p-value: 0.020, respectively). Only two children (3.7%) had been exposed to passive smoke, and the severity was slightly higher in these cases. There was also a statistically significant association between socioeconomic status and bronchiolitis (chi-squared value: 11.917; p-value: 0.018). Conclusion This study aims to raise awareness among parents and clinicians about the high-risk age group for bronchiolitis, its typical presentations, and predictors of severity. It underscores the impact of both biological and environmental risk factors, such as bottle feeding, non-exclusive breastfeeding, and socioeconomic status, on the severity of the condition.

Exposure to family and domestic violence in the prenatal period is associated with an increased risk of hospitalization for bronchiolitis in children under 2 years

BACKGROUND

Existing research has acknowledged a correlation between stress in pregnancy and poorer respiratory health in offspring. However, research focusing on stress caused by family and domestic violence in the prenatal period is missing.

METHODS

A retrospective cohort study included children born 1987-2010 who were identified as being exposed to FDV in the prenatal period (n = 1477) from two sources: WA Police Information Management System and WA Hospital Morbidity Data Collection (HMDC) and a non-exposed comparison group (n = 41 996). Hospitalization for bronchiolitis was identified in HMDC. Cox regression was used to estimate the adjusted and unadjusted hazard ratio and 95% confidence interval for bronchiolitis hospitalizations contact.

RESULTS

Children exposed to FDV had a 70% (HR 1.70, 95% CI: 1.49-1.94) increased risk of hospitalization for bronchiolitis than non-exposed counterparts by age two. Children exposed to FDV had a longer average hospital stay for bronchiolitis than non-exposed children (4.0 days vs. 3.8 days, P < 0.001).

CONCLUSIONS

Prenatal exposure to FDV is associated with bronchiolitis hospitalization in children <2 years. Along with other risk factors, clinicians should give consideration to maternal stress factors, including experiencing FDV as a potential contributor to bronchiolitis.

Setting up the first human milk bank in Uganda: a success story from Nsambya hospital

Background

The World Health Organization (WHO) strongly recommends the use of donor human milk (DHM) for low birth weight infants when mother's own milk is unavailable or insufficient. However, the use of DHM requires the availability of human milk banks (HMBs), the majority of which are in middle and high-income countries. Developing countries offer multiple opportunities and challenges regarding the establishment and operationalization of HMBs. This study describes the experience in setting up the HMB in Uganda at St. Francis Hospital Nsambya.

Methods

The establishment of the first HMB in Uganda followed a step-wise approach using the PATH's Resource Toolkit for Establishing and Integrating Human Milk Banks. The steps included: performing a facility readiness assessment, implementing quality control measures, forming and training a committee for the Baby Friendly Hospital Initiative, establishing a monitoring and evaluation system, developing a communication strategy, engaging with the Ministry of Health, providing staff training by a Human Milk Bank consultant, and maintaining regular coordination by a dedicated technical team.

Results

A total of 170 donors have been screened and of these 140 have donated milk with a mean age of 26 years since the establishment of the bank in November 2021. A total of 108 admitted neonates have received the milk; majority (88%) are preterm infants with a mean gestational age of 34 weeks. A total of 90 liters have been collected and 76 distributed. The challenges in establishment of the Human Milk bank included: lack of guidelines on human milk banking, use of unpasteurized milk, lack of communication strategy, lack of clear model infrastructure and lactation training. We addressed the challenges: by drafting guidelines, set up a human milk bank and had training on use donor pasteurized milk, designed communication messages through videos and brochures, visited Pumwani hospital and remodeled the Human Milk Bank according to the model at Pumwani, all the health workers in the human milk bank had a training on Lactation. Assessing the experiences and attitudes of mothers, donors, healthcare providers, and hospital leaders revealed concerns about milk safety and fear about potential attachments or acquired traits through the donated milk to the babies that may receive it. Donors viewed milk donation as a life-saving act, although fears of breast cancer and lumps arose from misconceptions. To address these perspectives, creative media, such as videos and messages, were designed to raise awareness, promote behavioral change, and create demand for the HMB services.

Conclusion

The establishment and integration of HMB services at hospitals in Uganda is feasible.

Exposure to outdoor air pollution and risk of hospitalization for bronchiolitis in an urban environment: A 9-year observational study

BACKGROUND

Outdoor air pollution is supposed to influence the course of bronchiolitis, but the evidence is limited. The present study aimed at evaluating the role of outdoor air pollutants on hospitalization for bronchiolitis.

METHODS

Infants aged ≤12 months referred for bronchiolitis to our Pediatric Emergency Department in Bologna, Italy, from 1 October 2011 to 16 March 2020 (nine epidemic seasons) were retrospectively included. Daily concentrations of benzene (C6 H6 ), nitrogen dioxide (NO2 ), particulate matter ≤2.5 μm (PM2.5 ), and ≤10 μm (PM10 ), and the mean values of individual patient exposure in the week and the 4 weeks before hospital access were calculated. The association between air pollutants exposure and hospitalization was evaluated through logistic regression analysis.

RESULTS

A total of 2902 patients were enrolled (59.9% males; 38.7% hospitalized). Exposure to PM2.5 in the 4 weeks preceding bronchiolitis was identified as the main parameter significantly driving the risk of hospitalization (odds ratio [95% confidence interval]: 1.055 [1.010-1.102]). After stratifying by season, higher values of other outdoor air pollutants were found to significantly affect hospitalization: 4-week exposure to C6 H6 (Season 2011-2012, 4.090 [1.184-14.130]) and PM2.5 (Season 2017-2018, 1.282 [1.032-1.593]), and 1-week exposure to C6 H6 (Season 2012-2013, 6.193 [1.552-24.710]), NO2 (Season 2013-2014, 1.064 [1.009-1.122]), PM2.5 (Season 2013-2014, 1.080 [1.023-1.141]), and PM10 (Season 2018-2019, 1.102 [0.991-1.225]).

CONCLUSION

High levels of PM2.5 , C6 H6 , NO2 , and PM10 may increase the risk of hospitalization in children affected by bronchiolitis. Open-air exposure of infants during rush hours and in the most polluted areas should be avoided.

Case-control study of exclusive breast feeding and severe bronchiolitis in the United States

BACKGROUND

Bronchiolitis is a major cause of infant illness, with few known modifiable risk factors. Breast feeding may reduce risk of severe bronchiolitis, but the association of exclusive vs. partial breast feeding with severe bronchiolitis is unclear.

OBJECTIVE

To estimate the association of exclusive vs. partial breast feeding during ages 0-2.9 months with bronchiolitis hospitalisation during infancy.

METHODS

We conducted a case-control study as a secondary analysis of two prospective US cohorts in the Multicenter Airway Research Collaboration. Cases were enrolled in a 17-centre study of infants hospitalised for bronchiolitis during 2011-2014 (n = 921). Controls were enrolled in a five-centre study of healthy infants during 2013-2014 and 2017 (n = 719). Breast feeding history during ages 0-2.9 months was collected by parent interview. Among breastfed infants, the association of exclusive vs. partial breast feeding with odds of bronchiolitis hospitalisation was estimated using a multivariable logistic regression model adjusted for demographic variables, parental asthma history, and early-life exposures. As a secondary analysis, we estimated the associations of exclusive, predominant, and occasional breast feeding vs. no breast feeding with the odds of bronchiolitis hospitalisation.

RESULTS

Among 1640 infants, the prevalence of exclusive breast feeding was 187/921 (20.3%) among cases and 275/719 (38.3%) among controls. Exclusive vs. partial breast feeding was associated with 48% reduced odds of bronchiolitis hospitalisation (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.39, 0.69). In the secondary analysis, exclusive vs. no breast feeding was associated with 58% reduced odds of bronchiolitis hospitalisation (OR 0.42, 95% CI 0.23, 0.77), whereas predominant breast feeding (OR 0.77, 95% CI 0.37, 1.57) and occasional breast feeding (OR 0.98, 95% CI 0.57, 1.69) were not associated with meaningfully reduced odds of bronchiolitis hospitalisation.

CONCLUSION

Exclusive breast feeding had a strong protective association against bronchiolitis hospitalisation.

Impact of breastfeeding on the incidence and severity of respiratory syncytial virus (RSV)-associated acute lower respiratory infections in infants: a systematic review highlighting the global relevance of primary prevention

BACKGROUND

Respiratory syncytial virus (RSV) is the principal cause of acute lower respiratory infections (ALRI) among infants worldwide, and an important cause of morbidity, hospitalisation and mortality. While infants are universally exposed to RSV, most mortality occurs among normal term infants from low-income and middle-income countries. Breastfeeding has been suggested to have a protective effect against RSV infection. This study aims to determine the association of breastfeeding on the frequency and severity of RSV-associated ALRI among infants.

METHODS

A systematic review was conducted using keywords and Medical Subject Headings on MEDLINE, PubMed, Google Scholar, EMBASE, MedRxiv and Cochrane Central Register of Controlled Trials. Full-text articles published in English from 2000 to 2021 that studied exclusively or partially breastfed infants who developed RSV-associated ALRI <12 months of age were included. Covidence software-based evidence extraction and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines were followed. Quality of evidence was analysed using UK National Service Framework grading and the risk-of-bias assessment using Robvis.

RESULTS

Among 1368 studies screened, 217 qualified full-text review and 198 were excluded based on pre-agreed criteria. Nineteen articles published from 12 countries that included 16 787 infants from 31 countries (of which 8 middle-income) were retained for analysis. Results indicate that non-breastfeeding practices pose a significant risk for severe RSV-associated ALRI and hospitalisation. Exclusive breastfeeding for >4-6 months significantly lowered hospitalisation, length of stay, supplemental oxygen demand and admission to intensive care units.

CONCLUSION

In the context of no effective or standardised treatment for established RSV-associated ALRI, available evidence suggest that breastfeeding is associated with lower frequency and severity of RSV-associated ALRI, based on observational studies of variable grades of evidence and risk-of-bias. With both exclusive and partial breastfeeding benefiting infants who develop RSV-associated ALRI, breastfeeding should be promoted globally as an adjunct primary prevention; in addition to emerging immunoprophylaxis and maternal immunisation strategies.

Exclusive Breastfeeding and Childhood Morbidity: A Narrative Review

Globally, diarrheal diseases and acute respiratory infections are the leading causes of morbidity and mortality in children under 5 years old. The benefits of exclusive breastfeeding in reducing the risk of gastrointestinal and respiratory infections are well documented. Optimal breastfeeding may potentially save the lives of about 800,000 children in low-income settings. Despite the evidence, around 63% of infants from birth to 6 months are not exclusively breastfed worldwide. We searched the literature published between 2010 and 2022 in Medline, Embase, and Scopus on the association between exclusive breastfeeding and infectious diseases. We selected and reviewed 70 relevant studies. Our findings expand and confirm the positive association between exclusive breastfeeding and reduced risk of a number of gastrointestinal, respiratory, and other infections in 60 out of 70 studies observed in both low- and high-income settings. Several studies analyzing exclusive breastfeeding duration reported that a longer exclusive breastfeeding duration is protective against many infectious diseases. This review also reported a lack of standardized definition for measuring exclusive breastfeeding in many studies. Overall, the results highlight the benefits of exclusive breastfeeding in many studies and suggests reporting exclusive breastfeeding in future studies using a consistent definition to enable better monitoring of exclusive breastfeeding rates.

Breastfeeding performance index and associated factors among children aged 0-6 months in Ethiopia: Analysis of the 2019 Ethiopia Mini Demographic and Health Survey

Background

Infants under the age of 6 months are commonly affected by malnutrition globally. The higher the breastfeeding performance index (BPI), the greater the advantage of breastfeeding will be. However, there is a lack of literature in the context of Ethiopia. Therefore, this study is aimed at investigating the magnitude and determinants of the breastfeeding performance index score among mothers of children under the age of 6 months in Ethiopia.

Methods

This study was conducted using the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) dataset. A stratified, two-stage cluster sampling technique was used in the study. The survey data were weighted using the “svy” function in STATA version 16. Descriptive statistics, bivariable and multivariable logistic regression were employed in the analysis. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported. The results were considered statistically significant if the p-value was < 0.05. The goodness of fit of the model was checked using the Hosmer–Lemeshow test.

Results

A total of 4,273 mothers with children under the age of 6 months were included in the analysis. Our analysis revealed that the prevalence of low breastfeeding performance index was 79.05% (95% CI: 78.01, 81.59). A unit increase in child age (AOR = 11.56; 95% CI: 6.97, 19.17), the richest wealth quintile (AOR = 2.76; 95% CI: 1.18, 6.5), a higher level of education (AOR = 5.41; 95% CI: 2.08, 14.05), being married or living with partner (AOR = 2.73; 95% CI: 1.18, 6.27), being women from Somali (AOR = 5.11; 95% CI: 2.08, 12.56), Afar (AOR = 3.03; 95% CI: 1.16, 7.91), Oromia (AOR = 1.88; 95% CI: 1.03, 3.41), Diredawa city administration (AOR = 2.89; 95% CI: 1.04, 8.07), and antenatal care (ANC) visit (AOR = 2.05; 95% CI: 1.31, 3.19) were positively associated with the low breastfeeding performance index.

Conclusion

The prevalence of the low breastfeeding performance index was found to be high. Hence, the findings of the study suggest the need to target interventions aimed at improving breastfeeding performance toward mothers with higher socioeconomic and demographic status and educational status. Antenatal care clients are among the targets of the intervention.

Parents Reaching Out to Parents: An Appreciative, Qualitative Evaluation of Stakeholder Experiences of the Parent Champions in the Community Project

Background: Bronchiolitis is a seasonal, global acute lower respiratory tract infection caused by respiratory syncytial virus (RSV) and is a leading cause of hospital admission in young children. A peer-led (parents to parents) intervention was implemented to empower parents of children at risk of bronchiolitis and reduce hospital admissions. This paper reported the evaluation that aimed to gain the perspectives and experiences of five key stakeholder groups. Methods: A qualitative remote interview-based design, informed by Appreciative Inquiry was used. Thematic analysis was used. Results: Sixty-five stakeholders participated: parents (n = 43; mothers, n = 42), Parent Champions (n = 9), Children’s Centre Managers (n = 8), Children’s Centre Group Leaders (n = 11), and Core Team (n = 4). An overarching theme ‘Parents reaching out to parents’ was supported by five sub-themes (Raising awareness and sharing knowledge; Creating connection, trust, and confidence; Flourishing in their role as a Parent Champion; Rising to the challenges; and Knowledge is power, prevention is key: the government needs to know this.) Conclusions: Parent-to-parent peer support via the Parent Champions was perceived positively by parents who wanted to learn and improve the lives and health of their children. Parent Champions were successful in delivering information. Considering the socioeconomic burden of bronchiolitis to services and families, the potential for an upstream, relatively low cost, high-reach innovative intervention, as evidenced in this project, seems a valuable opportunity for improving children’s respiratory health.

Exclusive Breastfeeding and Vitamin D Supplementation: A Positive Synergistic Effect on Prevention of Childhood Infections?

Human milk is the best food for infants. Breastfeeding has been associated with a reduced risk of viral and bacterial infections. Breast milk contains the perfect amount of nutrients needed to promote infant growth, except for vitamin D. Vitamin D is crucial for calcium metabolism and bone health, and it also has extra-skeletal actions, involving innate and adaptive immunity. As exclusive breastfeeding is a risk factor for vitamin D deficiency, infants should be supplemented with vitamin D at least during the first year. The promotion of breastfeeding and vitamin D supplementation represents an important objective of public health.

Clinical assessment and management of children with bronchiolitis

Bronchiolitis is a common seasonal viral illness in babies and children aged under two years. Its significance has increased in the light of a predicted surge in respiratory illness in children this winter and the continuing effect of the coronavirus disease 2019 (COVID-19) pandemic on parental anxiety and cross-infection. Children's nurses will have a central role in delivering high-quality care and support to children and families during this time. To support children's nurses to prepare for a surge, this article summarises the pathophysiology of bronchiolitis, risk factors, transmission, diagnosis and clinical management of children with the illness, including recent national policy changes. It also considers the potential effect of the COVID-19 pandemic on the healthcare system, children and families.