Acute Bronchiolitis In Children Research Articles

Presión positiva continua en las vías respiratorias (CPAP) para la bronquiolitis aguda en niños: una revisión Cochrane

Presión positiva continua en las vías respiratorias (CPAP) para la bronquiolitis aguda en niños: una revisión Cochrane

CHANGES IN THE STATE OF IMMUNITY AT THE CELLULAR LEVEL IN PATIENTS WITH BRONCHIOLITIS

Acute bronchiolitis in children is considered one of the serious medical problems, since they occupy one of the leading places among the causes of childhood diseases. Despite numerous studies, the problem of acute bronchiolitis in frequently ill children remains unresolved, which is associated with delayed diagnosis, the peculiarities of the manifestation of clinical symptoms and laboratory data. The aim of the research is to study changes in immunity at the cellular level in patients with bronchiolitis. Materials and methods of research: to establish the relationship with immunity indicators at the cellular level, 62 patients with acute bronchiolitis were examined, divided into 2 groups: Group I - 31 patients with acute bronchiolitis in episodically ill children, group II - 31 patients with acute bronchiolitis in those who are often ill. Our study allows us to better understand the pathogenetic role of the immune status at the cellular level in the development of acute bronchiolitis in episodically ill and frequently ill children, for use in clinical practice and the development of more effective methods for predicting, diagnosing, and treating the disease

Association of iron deficiency anemia with acute bronchiolitis in children below 2 years of age

Background: Bronchiolitis is the leading cause of respiratory distress in small children and one of the main causes of hospitalization in children <2 years of age. Anemia is also identified as a risk factor for lower respiratory tract infection. Iron deficiency is considered the most common cause of anemia in developing countries. As anemia is highly prevalent in children of our country, this study was undertaken to evaluate whether iron deficiency anemia is associated with acute bronchiolitis. Method: This Cross-Sectional Analytical study was carried out in the Department of Paediatrics, Sir Salimullah Medical College Mitford Hospital (SSMCMH), Dhaka, during the period of December 2021 to November 2022 after obtaining ethical approval to explore the association between iron deficiency anemia and bronchiolitis. Hemoglobin level, RBC indices, TWBC count, serum iron, TIBC level, Transferrin saturation, and PBF were investigated and compared in all children with bronchiolitis and control. For this purpose, a total number of 71 patients were enrolled in the study and among them, 35 children with bronchiolitis were considered as cases, and 36 healthy children without bronchiolitis were considered as control, who were matched with age. After taking written informed consent from parents/legal guardians, a detailed history and thorough clinical examination and laboratory investigations were carried out on each child. Data were recorded in separate case record form and analyzed by SPSS version 23.0. Results: The mean age was found 12.1±6.7 months in cases and 14.1±6.9 months in controls. Male participants (47, 66.2%) were the predominant group in the study and female participants were (24, 33.8%). Exclusive breastfeeding was found in 10 (28.6%) cases and 25 (71.4%) controls. There was a statistically significant difference in Hb (gm/dl), MCV (fl), S.Iron (µg/dl), Transferrin Saturation (%) and RDW-CV (%) between cases and controls (p<0.05). Among 35 cases, 25 (67.6%) had Iron Deficiency Anemia and statistical difference between the case and control was significant (p=0.001) with an odds ratio of 5.0. Conclusion: Iron deficiency anemia has a significant association with bronchiolitis. A larger and more extensive study was recommended.

Etiologies of Acute Bronchiolitis in Children at Risk for Asthma, with Emphasis on the Human Rhinovirus Genotyping Protocol.

This research aims to determine acute bronchiolitis' causative virus(es) and establish a viable protocol to classify the Human Rhinovirus (HRV) species. During 2021-2022, we included children 1-24 months of age with acute bronchiolitis at risk for asthma. The nasopharyngeal samples were taken and subjected to a quantitative polymerase chain reaction (qPCR) in a viral panel. For HRV-positive samples, a high-throughput assay was applied, directing the VP4/VP2 and VP3/VP1 regions to confirm species. BLAST searching, phylogenetic analysis, and sequence divergence took place to identify the degree to which these regions were appropriate for identifying and differentiating HRV. HRV ranked second, following RSV, as the etiology of acute bronchiolitis in children. The conclusion of the investigation of all available data in this study distributed sequences into 7 HRV-A, 1 HRV-B, and 7 HRV-C types based on the VP4/VP2 and VP3/VP1 sequences. The nucleotide divergence between the clinical samples and the corresponding reference strains was lower in the VP4/VP2 region than in the VP3/VP1 region. The results demonstrated the potential utility of the VP4/VP2 region and the VP3/VP1 region for differentiating HRV genotypes. Confirmatory outcomes were yielded, indicating how nested and semi-nested PCR can establish practical ways to facilitate HRV sequencing and genotyping.

Severe acute bronchiolitis in children: etiology, therapy, effectiveness of 3% hypertonic saline containing sodium hyaluronate

Introduction. Acute bronchiolitis (АB) is a common infection in children under the age of 2 years. In modern clinical protocols, routine use of the studied drugs is not recommended. The effectiveness of a 3% hypertonic sodium chloride solution (HSCS) at vol.Аim. Тo study the etiology, risk factors, the therapy of acute care in children in intensive care units (ICU), the effectiveness of inhalations with 3% HSCS with hyaluronate sodium (HS) in comparison with therapy without the inclusion of this drug.Materials and methods. The medical documentation of 54 patients with AB from January 2021 to January 2023 who were treated in the ICU was analyzed. An ambispective comparative study of the effectiveness of therapy of 3% HSCS with HS AB was conducted in comparison with historical control.Results. Respiratory syncytial viral (RSV) etiology was established in 50% of patients. The most common risk factor for the disease was the age younger than 3 months (40.7%). The presence of risk factors for severe course of acute respiratory failure had an impact on the average bed-day and on the need for respiratory support (p = 0.04), in addition to which patients often received drug therapy. There were no statistically significant differences in the terms of hospitalization, the duration of respiratory support depending on the appointment of 3% of HSCS with HS (p > 0.05), however, there was an improvement in clinical and functional dynamics estimated by the modified clinical scale of Wood’s asthma by the 2nd day of the disease.Conclusion. AB in ICU patients most often has RSV etiology, developing in the presence of risk factors for severe course. The influence of modern guidelines for the treatment of AB in the ICU remains controversial. The addition of 3% HSCS with HS can improve the flow of AB.

Epidemiology of hospitalization for acute bronchiolitis in children: a systematic review

Bronchiolitis is a sequence of clinical signs and symptoms that include a viral respiratory prodrome followed by wheezing and increased lower respiratory effort. It is the leading cause of hospitalization among infants younger than 2 years of age. Therefore, this paper aimed to assess the epidemiology of hospitalization for acute bronchiolitis in children. Two databases, PubMed and Google Scholar, were searched for studies on bronchiolitis in children published after 2010. Keywords, including epidemiology, children, pediatric, hospitalization, admission, risk factors, and respiratory syncytial virus (RSV), were used in different combinations to obtain the relevant articles. The inclusion criteria for this review were original articles on pediatric bronchiolitis that were written in English, available in full text, and contained clear and complete data. A total of 609 articles were retrieved, of which seven met the inclusion criteria. The included studies involved a total of 4,288 children in 7 countries. The major causative agent for bronchiolitis among hospitalized children was RSV. The main findings analyzed included causative agents, symptoms, hospitalization, management, and complications. Bronchiolitis is mostly caused by RSV. Longer hospital stays were associated with RSV, co-infection, and infants less than 2 months of age.

Continuous positive airway pressure (CPAP) for acute bronchiolitis in children.

Acute bronchiolitis is one of the most frequent causes of emergency department visits and hospitalisation in children up to three years of age. There is no specific treatment for bronchiolitis except for supportive treatment, which includes ensuring adequate hydration and oxygen supplementation. Continuous positive airway pressure (CPAP) aims to widen the lungs' peripheral airways, enabling deflation of overdistended lungs in bronchiolitis. Increased airway pressure also prevents the collapse of poorly supported peripheral small airways during expiration. Observational studies report that CPAP is beneficial for children with acute bronchiolitis. This is an update of a review first published in 2015 and updated in 2019. To assess the efficacy and safety of CPAP compared to no CPAP or sham CPAP in infants and children up to three years of age with acute bronchiolitis. We conducted searches of CENTRAL (2021, Issue 7), which includes the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE (1946 to August 2021), Embase (1974 to August 2021), CINAHL (1981 to August 2021), and LILACS (1982 to August 2021) in August 2021. We also searched the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) for completed and ongoing trials on 26 October 2021. We considered randomised controlled trials (RCTs), quasi-RCTs, cross-over RCTs, and cluster-RCTs evaluating the effect of CPAP in children with acute bronchiolitis. Two review authors independently assessed study eligibility, extracted data using a structured pro forma, analysed data, and performed meta-analyses. We used the Cochrane risk of bias tool to assess risk of bias in the included studies. We created a summary of the findings table employing GRADEpro GDT software. MAIN RESULTS: We included three studies with a total of 122 children (62/60 in intervention/control arms) aged up to 12 months investigating nasal CPAP compared with supportive (or 'standard') therapy. We included one new trial (72 children) in the 2019 update that contributed data to the assessment of respiratory rate and the need for mechanical ventilation for this update. We did not identify any new trials for inclusion in the current update. The included studies were single-centre trials conducted in France, the UK, and India. Two studies were parallel-group RCTs, and one study was a cross-over RCT. The evidence provided by the included studies was of low certainty; we made an assessment of high risk of bias for blinding, incomplete outcome data, and selective reporting, and confidence intervals were wide. The effect of CPAP on the need for mechanical ventilation in children with acute bronchiolitis was uncertain due to risk of bias and imprecision around the effect estimate (risk difference -0.01, 95% confidence interval (CI) -0.09 to 0.08; 3 RCTs, 122 children; low certainty evidence). None of the trials measured time to recovery. Limited, low certainty evidence indicated that CPAP decreased respiratory rate (decreased respiratory rate is better) (mean difference (MD) -3.81, 95% CI -5.78 to -1.84; 2 RCTs, 91 children; low certainty evidence). Only one trial measured change in arterial oxygen saturation (increased oxygen saturation is better), and the results were imprecise (MD -1.70%, 95% CI -3.76 to 0.36; 1 RCT, 19 children; low certainty evidence). The effect of CPAP on change in arterial partial carbon dioxide pressure (pCO₂) (decrease in pCO₂ is better) was imprecise (MD -2.62 mmHg, 95% CI -5.29 to 0.05; 2 RCTs, 50 children;low certainty evidence). Duration of hospital stay was similar in both the CPAP and supportive care groups (MD 0.07 days, 95% CI -0.36 to 0.50; 2 RCTs, 50 children;low certainty evidence). Two studies did not report pneumothorax, but pneumothorax did not occur in one study. No studies reported occurrences of deaths. Several outcomes (change in partial oxygen pressure, hospital admission rate (from the emergency department to hospital), duration of emergency department stay, and need for intensive care unit admission) were not reported in the included studies. The use of CPAP did not reduce the need for mechanical ventilation in children with bronchiolitis, although the evidence was of low certainty. Limited, low certainty evidence suggests that breathing improved (a decreased respiratory rate) in children with bronchiolitis who received CPAP; this finding is unchanged from the 2015 review and 2019 update. Due to the limited available evidence, the effect of CPAP in children with acute bronchiolitis is uncertain for our other outcomes. Larger, adequately powered trials are needed to evaluate the effect of CPAP for children with acute bronchiolitis.

Effect of Hemoglobin Level on the Severity of Acute Bronchiolitis in Children: A Case-Control Study

Introduction: Iron deficiency anemia (IDA) is a significant health problem that is seen in about 40% of children worldwide. It affects a child’s physical and mental development, performance of work and maintenance of their health. Anemia increases the risk of lower respiratory tract infection in children, yet there is not enough evidence that shows the effect of iron deficiency anemia on acute bronchiolitis. Aim: To evaluate the effect of anemia on the severity of acute bronchiolitis in infants. Methodology: A total of 160 infants were included in the study, 100 of whom were having acute bronchiolitis while 60 of them were included as a control group. This contrast analysis was conducted on 3 groups of patients having mild, moderate and severe bronchiolitis. A low haemoglobin level (HB) was below 12 grams/dL. This is considered to be an SD of <2. They ranged from 1 month to 2 years of age. Results: Children having acute bronchiolitis had comparatively lower haemoglobin level and mean cell haemoglobin concentration (MCHC) than in those who were healthy controls. Whereas, the median red cell distribution was higher in patients with acute bronchiolitis. If patients had a haemoglobin level lower than or equal to 10 grams/dL, it is more likely that the bronchiolitis getting worse, that is increasing ten times in patients with acute bronchiolitis. A negative correlation was seen between the severity of bronchiolitis and haemoglobin level. Conclusion: Infants suffering from anemia are more likely to have acute bronchiolitis and the intensity of anemia increases the severity of bronchiolitis. In infants, early identification and treatment of iron deficiency anemia may reduce the incidence and severity of acute bronchiolitis.

Prognostic Value of Cardiac Biomarkers in Children with Acute Bronchiolitis

Introduction: Determining the severity of acute bronchiolitis in children is important for the clinical management of the disease. Therefore, we aimed to reveal their prognostic importance by examining cardiac markers in our patients with acute bronchiolitis. Materials and Methods: We conducted a single-center retrospective, observational study with children with acute bronchiolitis between 1 month and 2 years of age, between December 2020 and December 2021, who were covid-19 PCR test negative and had no covid-19 contact. We scanned demographic, clinical and laboratory parameters from medical records. Results: A total of 45 (44% female) children with acute bronchiolitis, a median (IQR) age of 5 (5) months were included in the study. There were 7 (16%) mild bronchiolitis, 23 (51%) moderate and 15 (33%) severe bronchiolitis patients. The cutoff point of Nt-proBNP to be ≥1025 ng/L to predict severe bronchiolitis with a sensitivity of 71% and a specificity of 80 % at admission in children with acute bronchiolitis. Conclusion: We think that the threshold value for Nt-proBNP in the study can be used to identify patients with severe bronchiolitis in the early period and to reduce mortality and morbidity by earlier intervention.

Etiologies of Hospitalized Acute Bronchiolitis in Children 2 Years of Age and Younger: A 3 Years' Study During a Pertussis Epidemic.

Objective: In recent years, the incidence of Bordetella pertussis infection in infants and young children has been increasing. Multiple studies have suggested that B. pertussis may be one of the pathogens of bronchiolitis in infants and young children. However, the prevalence and clinic characteristic of B. pertussis in bronchiolitis is controversial. This prospective descriptive study evaluated the prevalence and clinical manifestations of infants and young children hospitalized for bronchiolitis with B. pertussis.Methods: Children hospitalized with bronchiolitis were eligible for a prospective study for 36 months from January 1, 2017, to December 31, 2019. Besides B. pertussis, 10 common respiratory viruses and Mycoplasma pneumoniae (MP) were confirmed by laboratory tests. Medical records of patients were reviewed for demographic, clinical characteristics, and laboratory examination.Results: A total of 1,092 patients with bronchiolitis were admitted. B. pertussis was detected in 78/1,092 (7.1%) patients. Of the 78 patients with B. pertussis bronchiolitis, coinfections occurred in 45 (57.7%) patients, most frequently with human rhinovirus (28/78, 35.9%), followed by MP (9/78, 11.4%), and human bocavirus (6/78, 7.7%). The peak incidence of B. pertussis infection was in May. A high leukocyte count could help distinguish B. pertussis–associated acute bronchiolitis from other acute bronchiolitis etiologies. After excluding coinfections, children with B. pertussis–only bronchiolitis exhibited a milder clinical presentation than those with RSV-only infection; also, children with MP-only and other pathogen infections revealed similar severity. The morbidity of B. pertussis was common (31/78, 39.7%) in infants with bronchiolitis under 3 months.Conclusion: In summary, B. pertussis is one of the pathogens in children with bronchiolitis, and coinfection of B. pertussis with other viruses is common in bronchiolitis. B. pertussis should be considered when patients hospitalized with bronchiolitis present a longer course and have an elevated leukocyte count. Patients with B. pertussis–associated bronchiolitis present a milder clinical presentation.

Recurrent Wheezing and Asthma After Respiratory Syncytial Virus Bronchiolitis.

Background: Respiratory syncytial virus (RSV) is the most common pathogen of acute bronchiolitis in children, which sometimes triggers the development of recurrent wheezing and increases the risk of childhood asthma.Methods: We enrolled 425 children who were diagnosed with RSV-infected bronchiolitis at the department of pulmonology, Children's Hospital Zhejiang University School of Medicine in 2011. Long-term follow-up was performed to explore the consequence of bronchiolitis on subsequent recurrent wheezing and asthma.Results: Of 425 patients, 266 cases completed the entire follow-up, the mean age of onset was 4.9 (3.3) months, and the male-to-female ratio was 2.5. The mean birth weight of all patients was 3.22 (0.63) kg, and the number of patients who had a history of cesarean section was 148. According to the outcome of follow-up, 36 were in the recurrent wheezing (RW) group, 65 were in the asthma (AS) group, and the remaining 165 were in the completely recovered (CR) group. The age of onset was older and the birth weights were higher in the AS group than those in the CR group (P < 0.05). And the higher proportion of cesarean sections was higher in the RW group than that in the CR group (P < 0.05). Furthermore, we found a remarkable increasing of serum IgE in the AS groups than that in the CR group (P < 0.01). Multiple logistic regression analysis showed that the cesarean section was the risk factor for the development of recurrent wheezing and the higher birth weight was the risk factor for the development of asthma.Conclusion: RSV bronchiolitis might increase the incidence of recurrent wheezing and asthma. Allergic constitution was an important prerequisite for the occurrence of asthma, and related risk factor such as cesarean section can only increase recurrent wheezing to a certain extent within a certain period of time. And we also find higher birth weight and older onset age for those who develop asthma, which should be verified in the future.

High-flow oxygen nasal cannula for treating acute bronchiolitis in infants: A systematic review and meta-analysis.

Oxygen therapy through a high-flow nasal cannula is thought to improve the work of breathing and the comfort of patients with acute bronchiolitis. It is widely used in hospital wards and critical care of pediatric patients. However, there is uncertainty on the magnitude of the effect on critical and important outcomes in these patients. The objective of this review is to evaluate the available evidence on the use of oxygen administered through high-flow cannula versus low-flow oxygen for the treatment of acute bronchiolitis in children under two years of age. We carried out a systematic review and a meta-analysis following the PRISMA standards for reporting. The search was carried out in electronic databases by two researchers independently. The evidence was summarized using the GRADE methodology. Six randomized and non-randomized clinical trials were included, including 1867 individuals younger than 24 months of age with acute bronchiolitis in pediatric emergency, hospitalization, and intensive care services. Mortality was not reported in the included studies. Treatment failure occurred in 108/933 in the high flow group and 233/934 in the low flow group (relative risk: 0.46; 95% confidence interval: 0.35 to 0.62), which shows 11.7% less treatment failure (95% confidence interval between 7.9% and 14.5% less) in the high flow group with a number needed to treat of 7.5 (95% confidence interval 6 to 10) with moderate certainty in the evidence. The use of humidified and heated oxygen with high flow compared to oxygen at low flow is probably associated with decreased treatment failure in children younger than two years with acute bronchiolitis. There is uncertainty about the effect on hospitalization days and clinical progression.

Ambulatory chest physiotherapy in mild-to-moderate acute bronchiolitis in children under two years of age- A randomized control trial.

Objective:The aim of this study was to compare the role of a chest physiotherapy (CP) intervention to no intervention on the respiratory status of children under two years of age, with mild-to-moderate bronchiolitis.Methods:Out of 80 eligible children observed in the Emergency Room, 45 children completed the study with 28 randomized to the intervention group and 17 to the control group. The intervention protocol, applied in an ambulatory setting, consisted of combined techniques of passive prolonged slow expiration, rhinopharyngeal clearance and provoked cough. The control group was assessed with no chest physiotherapy intervention. The efficacy of chest physiotherapy was assessed using the Kristjansson Respiratory Score at the admission and discharge of the visit to the Emergency Room and during clinical visits at day 7 and day 15.Results:There was a significant improvement in the Kristjansson Respiratory Score in the intervention group compared to the control group at day 15 [1.2 (1.5) versus 0.3 (0.5); -value, in the control and intervention groups, respectively], with a mean difference (95% CI) of ( to ).Conclusion:Chest physiotherapy had a positive impact on the respiratory status of children with mild-to-moderate bronchiolitis.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT04260919.

Short-term association among meteorological variation, outdoor air pollution and acute bronchiolitis in children in a subtropical setting

ObjectivesTo examine the association among acute bronchiolitis-related hospitalisation in children, meteorological variation and outdoor air pollution.MethodsWe obtained the daily counts of acute bronchiolitis-related admission of children≤2 years old from all...

The relationship between immature platelet fraction and severity of acute bronchiolitis.

Acute bronchiolitis is one of the most common reasons for hospitalization in infants. Although patients with acute bronchiolitis generally have a good prognosis, death can also occur. In this study, we evaluate the immature platelet fraction (IPF) as an indicator of the severity of acute bronchiolitis. In our study, 179 patients diagnosed with acute bronchiolitis were divided into three groups as mild (n: 48; 26.8%), moderate (n: 104; 58.10%) and severe (n: 27; 15.1%) bronchiolitis. There were 80 healthy children in the control group. The diagnostic capacity of IPF and hematological parameters (platelet distribution width (PDW), mean platelet volume (MPV), white blood cell count (WBC), and platelet count (PLT)) values to predict severity of acute bronchiolitis was evaluated using receiver operating characteristic (ROC) curves and their respective areas under the curves (AUCs) calculated with 95% confidence intervals. The IPF value of patients with acute bronchiolitis was significantly higher than the healthy group (p < 0.001). In addition, a positive correlation was observed between clinical severity of bronchiolitis and IPF. The ROC curve analysis indicated that the IPF cut-off point for predicting severity of acute bronchiolitis was > 3.2% (Sensitivity of 84%, specificity of 97%). We found that the AUCs for IPF, MPV, PDW, WBC and PLT were statistically significant for bronchiolitis relative to the healthy control group. The parameter with the greatest AUC value was IPF. The IPF may present for diagnosing and evaluating the clinical severity of acute bronchiolitis in children.

Magnesium sulphate for treating acute bronchiolitis in children up to two years of age.

Acute bronchiolitis is a significant burden on children, their families and healthcare facilities. It mostly affects children younger than two years of age. Treatment involves adequate hydration, humidified oxygen supplementation, and nebulisation of medications, such as salbutamol, epinephrine, and hypertonic saline. The effectiveness of magnesium sulphate for acute bronchiolitis is unclear. To assess the effects of magnesium sulphate in acute bronchiolitis in children up to two years of age. We searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, and two trials registries to 30 April 2020. We contacted trial authors to identify additional studies. We searched conference proceedings and reference lists of retrieved articles. Unpublished and published studies were eligible for inclusion. Randomised controlled trials (RCTs) and quasi-RCTs, comparing magnesium sulphate, alone or with another treatment, with placebo or another treatment, in children up to two years old with acute bronchiolitis. Primary outcomes were time to recovery, mortality, and adverse events. Secondary outcomes were duration of hospital stay, clinical severity score at 0 to 24 hours and 25 to 48 hours after treatment, pulmonary function test, hospital readmission within 30 days, duration of mechanical ventilation, and duration of intensive care unit stay. We used standard methodological procedures expected by Cochrane. We used GRADE methods to assess the certainty of the evidence. We included four RCTs (564 children). One study received funding from a hospital and one from a university; two studies did not report funding sources. Comparator interventions differed among all four trials. Studies were conducted in Qatar, Turkey, Iran, and India. We assessed two studies to be at an overall low risk of bias, and two to be at unclear risk of bias, overall. The certainty of the evidence for all outcomes and comparisons was very low except for one: hospital re-admission rate within 30 days of discharge for magnesium sulphate versus placebo. None of the studies measured time to recovery, duration of mechanical ventilation, duration of intensive care unit stay, or pulmonary function. There were no events of mortality or adverse effects for magnesium sulphate compared with placebo (1 RCT, 160 children). The effects of magnesium sulphate on clinical severity are uncertain (at 0 to 24 hours: mean difference (MD) on the Wang score 0.13, 95% confidence interval (CI) -0.28 to 0.54; and at 25 to 48 hours: MD on the Wang score -0.42, 95% CI -0.84 to -0.00). Magnesium sulphate may increase hospital re-admission rate within 30 days of discharge (risk ratio (RR) 3.16, 95% CI 1.20 to 8.27; 158 children; low-certainty evidence). None of our primary outcomes were measured for magnesium sulphate compared with hypertonic saline (1 RCT, 220 children). Effects were uncertain on the duration of hospital stay in days (MD 0.00, 95% CI -0.28 to 0.28), and on clinical severity on the Respiratory Distress Assessment Instrument (RDAI) score at 25 to 48 hours (MD 0.10, 95% CI -0.39 to 0.59). There were no events of mortality or adverse effects for magnesium sulphate, with or without salbutamol, compared with salbutamol (1 RCT, 57 children). Effects on the duration of hospital stay were uncertain (magnesium sulphate: 24 hours (95% CI 25.8 to 47.4), magnesium sulphate + salbutamol: 20 hours (95% CI 15.3 to 39.0), and salbutamol: 24 hours (95% CI 23.4 to 76.9)). None of our primary outcomes were measured for magnesium sulphate + epinephrine compared with no treatment or normal saline + epinephrine (1 RCT,120 children). Effects were uncertain for the duration of hospital stay in hours (MD -0.40, 95% CI -3.94 to 3.14), and for RDAI scores (0 to 24 hours: MD -0.20, 95% CI -1.06 to 0.66; and 25 to 48 hours: MD -0.90, 95% CI -1.75 to -0.05). There is insufficient evidence to establish the efficacy and safety of magnesium sulphate for treating children up to two years of age with acute bronchiolitis. No evidence was available for time to recovery, duration of mechanical ventilation and intensive care unit stay, or pulmonary function. There was no information about adverse events for some comparisons. Well-designed RCTs to assess the effects of magnesium sulphate for children with acute bronchiolitis are needed. Important outcomes, such as time to recovery and adverse events should be measured.

Early Impact of Social Distancing in Response to Coronavirus Disease 2019 on Hospitalizations for Acute Bronchiolitis in Infants in Brazil.

BackgroundInterventions to tackle the COVID-19 pandemic may affect the burden of other respiratory diseases. Considering the repercussion of these unique social experiences in infant’s health, this study aims to assess the early impact of social distancing due to the COVID-19 pandemic in hospital admissions for acute bronchiolitis.MethodsData from hospitalizations of acute bronchiolitis in infants under one year were obtained from the Department of Informatics of the Brazilian Public Health database (DATASUS) for the period between 2016 and 2020. These data were also analyzed by macro-regions of Brazil (North, Northeast, Southeast, South and Midwest). To evaluate the effect of social distancing strategy on the incidence of acute bronchiolitis, the absolute and relative reduction was calculated by analyzing the yearly subsets of 2016vs2020, 2017vs2020, 2018vs2020, and 2019vs2020.ResultsThere was a significant reduction in all comparisons, ranging from -78% [IRR 0.22 (0.20 to 0.24)] in 2016vs2020 at -85% [IRR 0.15 (0.13 to 0.16)] in 2019vs2020, for the data from Brazil. For analyzes by macro-regions, the reduction varied from -58% [IRR 0.41 (0.37 to 0.45)] in the Midwest in 2016vs2020 to -93% [IRR 0.07 (0.06 to 0.08)] in the South in 2019vs2020.ConclusionsThere was a significant reduction in hospitalization for acute bronchiolitis in children under one year old, in Brazil, of the order of more than 70% for most analysis. Our data suggest an important impact of social distance on reducing the transmission of viruses related to acute bronchiolitis. Such knowledge may guide strategies for prevention of viruses spread.

Epidemiology and Outcome of Acute Bronchiolitis in Children in the Tobruk Area, Libya

Bronchiolitis is inflammation of the bronchioles, usually caused by an acute viral illness. It is the most common lower respiratory tract infection in children younger than 2 years.The aim of this study is to analyze the hospital incidence of acute bronchiolitis in children aged 2 months up to 2 years, to assess the relation, the severity of the disease to age, gender, season, family history of atopy, and to assess the treatment and outcome. The retrospective study collected the data from the admission records of patients. 198 admissions for acute bronchiolitis represented 14.6% of hospital admission rates. Most in ages between 2-6 months 128 (64.6%). Female: Male ratio 1.1:1, female patients 102 (51.5%). The history of Atopy in the family was positive in 136 (68.7%) of patients. The disease was not severe as only 27 (13.6%) were admitted to PICU, and only 3 (1.6%) of them needed mechanical ventilation, in addition to there being no mortalities. Most cases were in winter 81 (40.9%) (P-value 0.02). All patients received Salbutamol nebulizer, 47 (23.7%) received hydrocortisone injection (IV), and 45 (22.7%) received Ipratropium bromide nebulizer. Acute Bronchiolitis is an important cause of admissions in infants, especially under the age of 6 months.

Acute bronchiolitis in children

Bronchiolitis is the most common respiratory disease in children below 2 years of age. Primarily, the disease is caused by viral infection (respiratory syncytial virus), mainly in the month from November to April. Climate and environment both influence the season and severity of bronchiolitis. Forty percent infants are affected in 1st year of life. Diagnosis of the bronchiolitis is mainly clinical though various definitions have been suggested by different groups. Laboratory investigations including reverse transcription polymerase chain reaction, chest X-ray, and others do not contribute in diagnosing the disease. There is no effective treatment available and mortality is also low with bronchiolitis.

TREATMENT OF ACUTE BRONCHIOLITIS IN CHILDREN IN CONDITIONS OF THE PEDIATRIC DISTRICT

The data of the prospective study is presented. In conditions of the pediatric district, the population prevalence rate of acute bronchiolitis in children under two years was calculated to be 107 per 1000 cases. Two groups of children with mild and moderate bronchiolitis were examined: 52 patients were randomized to receive 3% or 0.9% sodium chloride solution; children of the comparison group from the adjacent section of the same polyclinic received antibiotics (15 children) and inhalation of berodual with saline (21 children). The evaluation of the severity of the course, the effectiveness of treatment, indications for the hospitalization were executed with the use of pulse oximetry and the Kristjansson scale. The clinical effectiveness of the use of hypertonic (3%) sodium chloride solution in the form of inhalations with the help of a compressor nebulizer as an adequate, safe and economical means of monotherapy in the mild and moderate course of acute bronchiolitis in children on an outpatient basis has been established