Acute Bronchiolitis In Infants Research Articles

Luteolin-7-O-glucoside promotes macrophage release of IFN-β by maintaining mitochondrial function and corrects the disorder of glucose metabolism during RSV infection

Respiratory syncytial virus (RSV) pneumonia is the main cause of acute bronchiolitis in infants. Luteolin-7-O-glucoside (LUT-7G) is a natural flavonoid, which exists in a variety of plants and has the potential to treat viral pneumonia. We established RSV pneumonia mouse models and RSV-infected cell models. Clodronate liposomes were used to deplete macrophages. We used HE staining and immunohistochemistry to determine inflammatory damage and virus replication. We detected the expression levels of inflammatory factors and IFN-β through qPCR and ELISA. JC-1 kit was used for detecting the cell mitochondrial Membrane potential (MMP). ROS, SOD, and MDA kits were used for detecting intracellular oxidative stress damage. Metabolites of TCA in lung tissue and serum of mice were detected by GC-MS. Pharmacodynamic studies have shown that intervention with LUT-7G can alleviate lung tissue damage caused by RSV infection, inhibit RSV replication, and downregulate TNF-α, IL-1β, and IL-6 mRNA expression. LUT-7G upregulated the IFN-β content and the expression of IFN-β, ISG15, and OAS1 mRNA. In vitro, LUT-7G inhibited RSV-induced cell death, reversed the RSV-induced decrease of MMP and decreased intracellular oxidative stress. Target metabonomics showed that RSV infection upregulated the levels of glycolysis and TCA metabolites in lung tissue and serum, while LUT-7G could improve the disorder of glucose metabolism. The results indicate that LUT-7G can promote the release of IFN-β in the lung, alleviate inflammatory damage, and inhibit RSV replication during RSV infection. These effects may be achieved by protecting the mitochondrial function of alveolar macrophages and correcting the disorder of glucose metabolism.

Prevalence of Acute Bronchiolitis in Infants: About 167 Cases Seen in Pediatric Consultation at the Reference Health Center of the Commune I of Bamako (Mali)

Introduction: Bronchiolitis is a common respiratory disease in pediatrics. Its acute onset manifestations are most often observed in infants under 24 months of age, but at this age the respiratory system remains immature. The main pathogen of acute bronchiolitis in infants is respiratory syncytial virus (RSV). Materials and method: This is a descriptive and prospective study of the acute bronchiolitis in infants aged 0 to 24 months received at the pediatric consultation of the Reference Health Center of the Commune I of Bamako de Mars 2019 to February 2020. Results: In 12 months, 167 cases of acute bronchiolitis were seen at the pediatric consultation. The prevalence of bronchiolitis was 1.85%, the average age of infants was 8 months, and the boy/girl sex ratio was 1.6. The month of September represented the peak (31.1%). Infants aged 1 to 10 months accounted for 60% of hospitalizations. Mortality was 5.4%. Conclusion: bronchiolitis is a common pediatric consultation pathology, it remains worrying for parents with a more or less negligible mortality rate.

Inhaled nitric oxide in acute bronchiolitis: A systematic review and meta-analysis.

Until date there is lack of effective therapies in acute bronchiolitis in infants. The aim was to analyze inhaled nitric oxide efficacy in acute bronchiolitis. Systematic review and meta-analysis of randomized controlled trials. Pediatric specialized healthcare. All infants (age less than 2 years) having acute bronchiolitis, which requires emergency room visit or hospitalization. Inhaled nitric oxide. Need for intensive care unit admission. Secondary outcomes were length of hospital stay and adverse events. Risk ratios (RR) and mean differences with 95% confidence intervals (CI) calculated by random-effects DerSimonian and Laird inverse variance method. Peto Odds ratios were used for rare outcomes. Evidence certainty assessed according to GRADE. 186 studies were screened and three included for analysis. Two had low risk of bias and one had some concerns. Three studies (166 infants) analyzed length of hospital stay and the duration was -11.3 h (CI: -26.8 to +4.2 h) shorter in the nitric oxide group. Evidence certainty was ranked as low. Overall adverse event rates were similar (3 studies, 166 infants, RR: 0.94, CI: 0.70-1.26), but treatment related harms were more common in nitric oxide group (2 studies, 98 infants, OR: 3.86, CI: 1.04-14.40). Evidence certainty in both was rated as low. Low certainty evidence suggests that inhaled nitric oxide does not reduce length of hospital stay but may have higher rate of treatment associated harms. Future studies with larger sample sizes are needed to better estimate both the efficacy and adverse events.

Nasal CPAP in the Pediatric Ward to Reduce PICU Admissions for Severe Bronchiolitis?

In treating acute bronchiolitis in infants, the decision to use continuous positive airway pressure (CPAP) often involves infant referral from the pediatric ward to the pediatric intensive care unit (PICU). We present our experience of CPAP use in a general pediatric ward, aiming to reduce the pressure on the PICU in recent outbreaks of bronchiolitis. Clinical data of patients less than 12 months of age and admitted for bronchiolitis from 1 October 2021 to 31 March 2023 were retrospectively collected. Of 82 infants admitted for bronchiolitis, 16 (19%) were treated with nasal CPAP (nCPAP group); of the remaining 66, 21 (26%) were treated with a low-flow nasal cannula (LFNC) only, 1 (1%) was also treated a with high-flow nasal cannula (HFNC), 12 (15%) were treated with an HFNC only, and 41 (50%) were treated without oxygen support (no-nCPAP group). Overall, coinfection with RSV and SARS-CoV-2 was observed in three patients and SARS-CoV-2 infection was observed in two patients. None of them required any type of oxygen support. Only 3/16 (19%) infants in the nCPAP group were referred to the PICU due to worsening clinical conditions despite nCPAP support. In our experience of treating epidemic bronchiolitis, nCPAP can be safely managed in a general pediatric ward, thus reducing the burden of admissions to the PICU. Training and regular updating of the pediatric staff, careful monitoring of the patient, and close cooperation with the PICU were instrumental for our team.

Nebulised hypertonic saline solution for acute bronchiolitis in infants.

Nebulised hypertonic saline solution for acute bronchiolitis in infants.

Evaluation of the Clinical Features of Bronchiolitis in Paediatric Patients and Exploration of the Risk Factors

Background: In general, bronchiolitis presents as a progressive viral respiratory illness in children younger than 2 years of age, most commonly between 2-6 months. Objective: The study was conducted to assess the clinical presentations of acute bronchiolitis in infants and young children and to evaluate the individual characteristics and environmental factors which can increase the risk of severe disease and hospitalization. Methodology: This descriptive study was conducted in the department of Paediatrics, Khwaja Yunus Ali Medical College and Hospital, Enayetpur, Sirajganj. A total of 70 patients were included in the study, who were admitted to the hospital with a clinical and radiological diagnosis of acute bronchiolitis and were followed up in the Paediatric department during January, 2021 to December, 2021. Data collection was done by using a questionnaire form and by physical examination. The information for the questionnaire was provided by the childrens’ mothers. The SPSS software was used for data analysis. Results: According to the results of the study, 39(55.7%) children were infants, aged between 2-6 months, 21(30.0%) were between 7-12 months and 10(14.3%) children of more than 12 months of age. Boys (47, 67.1%) were affected more commonly than girls (23, 32.9%) in a ratio of 2:1. Some 60 (85.7%) of the children had siblings and 46 (65.7%) children lived in crowded environment at home. Many (25, 35.7%) parents of the children were cigarette smokers and 37(52.9%) children were given formula feeds. There was previous history of hospitalization among 14(20.0%) cases and 5(7.1%) children were pre-term. The most common clinical presentations of bronchiolitis were cough among 61(87.1%) cases, wheeze in 56(80.0%), respiratory distress in 49(70.0%) and feeding difficulty in 28(40.0%) children. Conclusion: The risk factors for bronchiolitis were young age (2-6 months), presence of a sibling, a history of hospital admission, crowding and paternal smoking at home and formula feeding. The most common clinical presentations were cough, wheeze and respiratory distress. J Monno Med Coll June 2022;8(2): 48-52

Clinical application of a lung sound analysis in infants with respiratory syncytial virus acute bronchiolitis.

Objective investigation of the characteristics of acute bronchiolitis in infants is important for its diagnosis and treatment. Lung sound data of 50 patients diagnosed with respiratory syncytial virus (RSV) acute bronchiolitis (m:f = 29:21, median of age 7 months), 20 patients with RSV acute respiratory tract infections without acute bronchiolitis (m:f = 10:10, 5 months) and 38 age-matched control infants (m:f = 23:15, 8 months) were analyzed using a conventional method and compared. Furthermore, the relationships between lung sound parameters and clinical symptoms (clinical score, length of hospital stay and SpO2 level) in the bronchiolitis and the non-bronchiolitis patients were examined. Results of lung sound analysis showed that the inspiratory sound power of patients with RSV respiratory tract infections was low and the expiratory sound power was high compared with those of the controls. When the patients with RSV respiratory tract infections were divided into the bronchiolitis and non-bronchiolitis groups, the expiratory/inspiratory ratio of the bronchiolitis patients was greater than that of the non-bronchiolitis patients. There was no difference in the clinical symptoms, clinical score and length of hospital stay between the bronchiolitis and non-bronchiolitis patients, except for the SpO2 level on admission. Lung sound analysis confirmed that patients with RSV acute bronchiolitis present with marked airway narrowing. Considering these results as a characteristic of acute bronchiolitis, it would be meaningful to reflect it in the improvement of diagnosis, treatment and subsequent management.

Comparative Fecal Microbiota Analysis of Infants With Acute Bronchiolitis Caused or Not Caused by Respiratory Syncytial Virus.

Bronchiolitis due to respiratory syncytial virus (RSV) or non-RSV agents is a health-menacing lower respiratory tract (LRT) disease of infants. Whereas RSV causes more severe disease than other viral agents may, genus-dominant fecal microbiota profiles have been identified in US hospitalized infants with bronchiolitis. We investigated the fecal microbiota composition of infants admitted to an Italian hospital with acute RSV (25/37 [67.6%]; group I) or non-RSV (12/37 [32.4%]; group II) bronchiolitis, and the relationship of fecal microbiota characteristics with the clinical characteristics of infants. Group I and group II infants differed significantly (24/25 [96.0%] versus 5/12 [41.7%]; P = 0.001) regarding 90% oxygen saturation (SpO2), which is an increased respiratory effort hallmark. Accordingly, impaired feeding in infants from group I was significantly more frequent than in infants from group II (19/25 [76.0%] versus 4/12 [33.3%]; P = 0.04). Conversely, the median (IQR) length of stay was not significantly different between the two groups (seven [3–14] for group I versus five [5–10] for group II; P = 0.11). The 16S ribosomal RNA V3–V4 region amplification of infants’ fecal samples resulted in 299 annotated amplicon sequence variants. Based on alpha- and beta-diversity microbiota downstream analyses, group I and group II infants had similar bacterial communities in their samples. Additionally, comparing infants having <90% SpO2 (n = 29) with infants having ≥90% SpO2 (n = 8) showed that well-known dominant genera (Bacteroides, Bifidobacterium, Escherichia/Shigella, and Enterobacter/Veillonella) were differently, but not significantly (P = 0.44, P = 0.71, P = 0.98, and P = 0.41, respectively) abundant between the two subgroups. Overall, we showed that, regardless of RSV or non-RSV bronchiolitis etiology, no fecal microbiota-composing bacteria could be associated with the severity of acute bronchiolitis in infants. Larger and longitudinally conducted studies will be necessary to confirm these findings.

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 &lt;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.

Requirement of respiratory support in acute bronchiolitis in infants is linked to endothelial and neutrophil activation.

Evidence shows that activation of pulmonary vascular endothelium and neutrophils are involved in the pathophysiology of acute bronchiolitis. We hypothesized that levels of markers of endothelial activation and leukocyte counts are associated with requirement and duration of respiratory support. Thirty-four infants with bronchiolitis and eight controls were included. Nasopharyngeal swabs and blood samples were taken at admission. Serum levels of Angiopoietin (Ang)-1, Ang-2, sP-selectin, sE-selectin, vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1), and leukocyte counts were measured. For univariate analysis, bronchiolitis cases were grouped into two groups, namely those not requiring and those requiring any form of respiratory support. To control for known risk factors for poor outcome (i.e., age, prematurity, and congenital heart disease), and for days post symptom onset, linear regression analysis was performed with duration of any type of respiratory support in days. Ang-2 levels, Ang-2/Ang-1 ratios, sE-selectin levels, immature neutrophil count, and neutrophil/lymphocyte ratio (NLR) were higher in acute bronchiolitis versus controls. Ang-2, and NLR levels were significantly higher, and lymphocyte counts significantly lower, in infants that required respiratory support versus those that did not. Ang-2 levels (β: .32, 95% confidence interval [CI]: 0.19-1.19) and NLR (β: .68, 95% CI: 0.17-1.19) were positive predictors for the duration of respiratory support. Markers of endothelial and neutrophil activation are associated with respiratory support for acute bronchiolitis. Admission Ang-2 levels and NLR may be promising markers to determine requirement of respiratory support and deserve further study.

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.

Magnesium sulphate nebulization in acute bronchiolitis in infants: a randomized controlled trial

Background: Acute bronchiolitis is a disorder of the lower respiratory tract that occurs mostly in between 1 month to 24 months. There are limited numbers of studies on magnesium sulphate nebulization in acute bronchiolitis. There is a desperate need for a standard treatment which can reduce the morbidity and mortality in acute bronchiolitis. The goal was to study the efficacy of magnesium sulphate nebulization in infants with acute bronchiolitis.Methods: It was a prospective open labelled randomized controlled study. Children in age group of 2-12 months admitted with clinical diagnosis of acute bronchiolitis in paediatric emergency ward, GMSH-16, Chandigarh. Study group patients were treated with 40 mg/kg magnesium sulphate nebulization diluted with 2-3 ml normal saline in addition to supportive treatment as oxygen and IV fluids, three doses of medication were given at 1 hour interval and it was not repeated after three doses. Control group patients were treated with oxygen therapy, IV fluids, symptomatic treatment for fever and supportive care.Results: Respiratory distress assessment instrument score and length of hospital stay was significantly lesser in study group as compared to control group. SpO2 was significantly more in study group as compared to control group.Conclusions: Magnesium sulphate nebulization is effective in improving respiratory distress and oxygen saturation, it also reduces duration of hospital stay in infants with mild to moderate bronchiolitis.

Impact of Anaemia on the Severity of Acute Bronchiolitis in Infants

&#x0D; &#x0D; &#x0D; &#x0D; Introduction: Although anaemia is a predisposing factor in the occurrence of lower respiratory tract infections, there is limited data about the relationship between anaemia and acute bronchiolitis in infants. The aim of this study is to determine whether anaemia is an independent clinical condition increasing the severity of acute bronchiolitis in infants.&#x0D; Methods: This retrospective study was conducted on 163 infants (101 acute bronchiolitis and age and sex matched 62 controls), aged between one month to two years. According to the clinical severity of the disease, patients were divided as having mild, moderate and severe acute bronchiolitis. Haemoglobin (Hb) level was considered low when below 11 gm/dL, which is less than 2 standard deviation (SD).&#x0D; Results: Median Hb and mean cell haemoglobin concentration (MCHC) levels were significantly lower in acute bronchiolitis patients than controls {10.1 gm/dL (9.6 - 10.6 gm/dL) vs. 11.2 gm/dL (10.6 - 12.1 gm/dL); p &lt; 0.001)}, and {33.6 (32.5 - 34.1 gm/dL) vs. 34 gm/dL (33.1 - 34.5 gm/dL) p = 0.012}. Conversely, median red cell distribution width (RDW) was higher {14.4% (13.5 - 15.6%) vs. 14.1% (13.1-15%)}. When evaluated by logistic regression analysis, the risk of severe bronchiolitis increased 10 times in acute bronchiolitis patients with a Hb value ≤ 10 gm/dL. Also, there was a significant negative correlation between Hb level and bronchiolitis severity (r :- 0.423, p &lt; 0.001). Furthermore, the patients who had Hb value under 9.95 gm/dL had risk of more severe bronchiolitis with 73.7% sensitivity and 83.3% specificity than other patients.&#x0D; Conclusions: Anaemic infants are more susceptible to acute bronchiolits and as the degree of anaemia increases, they are more severely affected.&#x0D; &#x0D; &#x0D; &#x0D;

Disability-adjusted life years for acute bronchiolitis in infants in Colombia.

Introductionacute bronchiolitis is the leading cause of hospitalization in infants worldwide. However, little is known about the real impact of on society in terms of years of life lost due to this condition. The objective of the present study is to determine the Disability-Adjusted Life Years (DALYs) for acute bronchiolitis in infants in Colombia.Methodsdata from the national epidemiological surveillance system were used to estimate DALYs, calculated from the sum of years of life lost and years lived with disability due to acute bronchiolitis in Colombia. A bootstrapped method with 10,000 iterations was used to estimate each statistical parameter using the package DALYs calculator in R.Resultsin 2019, 447,434 years of life (confidence interval 95% 397,647- 512,759) were lost due to acute bronchiolitis in Colombian infants. The estimated rate was 34 DALYs/1000 person-year (95% confidence interval 30-39).Conclusionour paper shows the high burden of disease associated with bronchiolitis in Colombia. Prevention strategies, such as acute bronchiolitis vaccination, to reduce morbidity associated with acute bronchiolitis should be encouraged in our country.

Tackling poverty, treating obesity: a ‘whole system’ approach

Respiratory syncytial virus (RSV) is the major cause of acute bronchiolitis in infants under 2 years old. Necroptosis has been implicated in the outcomes of respiratory virus infections. We report...

TNF-mediated alveolar macrophage necroptosis drives disease pathogenesis during respiratory syncytial virus infection.

Respiratory syncytial virus (RSV) is the major cause of acute bronchiolitis in infants under 2 years old. Necroptosis has been implicated in the outcomes of respiratory virus infections. We report that RSV infection triggers necroptosis in primary mouse macrophages and human monocytes in a RIPK1-, RIPK3- and MLKL-dependent manner. Moreover, necroptosis pathways are harmful to RSV clearance from alveolar macrophages. Additionally, Ripk3−/− mice were protected from RSV-induced weight loss and presented with reduced viral loads in the lungs.Alveolar macrophage depletion also protected mice from weight loss and decreased lung RSV virus load. Importantly, alveolar macrophage depletion abolished the upregulation of Ripk3 and Mlkl gene expression induced by RSV infection in the lung tissue.Autocrine tumor necrosis factor (TNF)-mediated RSV-triggered macrophage necroptosis and necroptosis pathways were also involved in TNF secretion even when macrophages were committed to cell death, which can worsen lung injury during RSV infection. In line, Tnfr1−/− mice had a marked decrease in Ripk3 and Mlkl gene expression and a sharp reduction in the numbers of necrotic alveolar macrophages in the lungs. Finally, we provide evidence that elevated nasal levels of TNF are associated with disease severity in infants with RSV bronchiolitis.We propose that targeting TNF and/or the necroptotic machinery may be valuable therapeutic approaches to reduce the respiratory morbidity caused by RSV infection in young children.

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.

Acute Bronchiolitis in Infants and Allergic Asthma

Acute Bronchiolitis in Infants and Allergic Asthma

Prolonged slow expiration technique improves recovery from acute bronchiolitis in infants: FIBARRIX randomized controlled trial

Objective: To examine the effect of prolonged slow expiration respiratory physiotherapy treatment on the acute bronchiolitis severity scale and O2 saturation at short-time and at medical discharge in infants and the hospital stay. Design: Randomized controlled trial. Setting: Infants’ unit of university hospital. Participants: Infants with acute bronchiolitis (N = 80). Intervention: Infants were randomized into respiratory treatment (RT) with prolonged slow expiration or treatment as usual (control) for one-week period. Main outcome measures: The primary outcomes were Acute Bronchiolitis Severity Scale score and O2 saturation, recorded shortly after each intervention during the stay and at medical discharge, and the hospital stay. Results: The RT had a significantly lower Acute Bronchiolitis Severity Scale 10-minute after the first intervention (mean difference −1.7 points, 95% confidence interval (CI) −3.0 to −0.38), 2 hours after (–2.0 points, 95% CI −3.2 to −0.86) and the last day before medical discharge (−1.3 points, 95% CI −2.1 to 0.51). No changes were detected in O2 saturation. The survival analysis of time at medical discharge showed decrease in the average number of days to achieve an Acute Bronchiolitis Severity Scale of less than 2 points (RT: 2.6 days, 95% CI 2.1–3.1; Control: 4.4 days, 95% CI 3.6–5.1). Conclusion: A prolonged slow expiration physiotherapy reduces Acute Bronchiolitis Severity Scale scores and does not change O2 saturation. Infants in RT group stay less days in hospital than infants in control group and no adverse events were detected.

Nebulised hypertonic saline solution for acute bronchiolitis in infants.

Airway oedema (swelling) and mucus plugging are the principal pathological features in infants with acute viral bronchiolitis. Nebulised hypertonic saline solution (≥ 3%) may reduce these pathological changes and decrease airway obstruction. This is an update of a review first published in 2008, and previously updated in 2010 and 2013. To assess the effects of nebulised hypertonic (≥ 3%) saline solution in infants with acute bronchiolitis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, Embase, CINAHL, LILACS, and Web of Science on 11 August 2017. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 8 April 2017. We included randomised controlled trials and quasi-randomised controlled trials using nebulised hypertonic saline alone or in conjunction with bronchodilators as an active intervention and nebulised 0.9% saline, or standard treatment as a comparator in children under 24 months with acute bronchiolitis. The primary outcome for inpatient trials was length of hospital stay, and the primary outcome for outpatients or emergency department trials was rate of hospitalisation. Two review authors independently performed study selection, data extraction, and assessment of risk of bias in included studies. We conducted random-effects model meta-analyses using Review Manager 5. We used mean difference (MD), risk ratio (RR), and their 95% confidence intervals (CI) as effect size metrics. We identified 26 new trials in this update, of which 9 await classification due to insufficient data for eligibility assessment, and 17 trials (N = 3105) met the inclusion criteria. We included a total of 28 trials involving 4195 infants with acute bronchiolitis, of whom 2222 infants received hypertonic saline.Hospitalised infants treated with nebulised hypertonic saline had a statistically significant shorter mean length of hospital stay compared to those treated with nebulised 0.9% saline (MD -0.41 days, 95% CI -0.75 to -0.07; P = 0.02, I² = 79%; 17 trials; 1867 infants) (GRADE quality of evidence: low). Infants who received hypertonic saline also had statistically significant lower post-inhalation clinical scores than infants who received 0.9% saline in the first three days of treatment (day 1: MD -0.77, 95% CI -1.18 to -0.36, P < 0.001; day 2: MD -1.28, 95% CI -1.91 to -0.65, P < 0.001; day 3: MD -1.43, 95% CI -1.82 to -1.04, P < 0.001) (GRADE quality of evidence: low).Nebulised hypertonic saline reduced the risk of hospitalisation by 14% compared with nebulised 0.9% saline among infants who were outpatients and those treated in the emergency department (RR 0.86, 95% CI 0.76 to 0.98; P = 0.02, I² = 7%; 8 trials; 1723 infants) (GRADE quality of evidence: moderate).Twenty-four trials presented safety data: 13 trials (1363 infants, 703 treated with hypertonic saline) did not report any adverse events, and 11 trials (2360 infants, 1265 treated with hypertonic saline) reported at least one adverse event, most of which were mild and resolved spontaneously. Nebulised hypertonic saline may modestly reduce length of stay among infants hospitalised with acute bronchiolitis and improve clinical severity score. Treatment with nebulised hypertonic saline may also reduce the risk of hospitalisation among outpatients and emergency department patients. However, we assessed the quality of the evidence as low to moderate.