Bronchiolitis In Children Research Articles

Disease and age-related inequalities in paediatric research, funding and communication: Lessons from the COVID-19 pandemic.

COVID‐19 has already caused millions of infections, thousands of deaths and countless indirect and poorly estimated consequences on other diseases and the global economy. All ages are potentially susceptible, but the virus has had a lower direct impact on children, with fewer severe cases and low mortality rates. However, the reasons for this are still unclear and we cannot rule out children’s role in transmitting the disease. The serious impact that restrictive measures have had on children’s lives have not been fully considered. Because children are less affected by COVID‐19, the scientific community, health agencies and governments have not focused much attention on them during this pandemic.

Low hemoglobin as a risk factor in influencing severity of bronchiolitis

Bronchiolitis is the major cause of hospitalisation in children under 2 years of age. It has peak incidence between 2 months to 6 months. There is an increase in severity of bronchiolitis in children with anemia. Our study is undertaken to prove that low hemoglobin is an independent risk factor for bronchiolitis Methods: This study is a prospective study conducted in a tertiary care hospital. Children admitted with bronchiolitis in the age group of 2 months to 2 years were included in study group. Total of 91 children were enrolled in the study. Duration of study was one year. Hemoglobin levels of the children were correlated with the severity by BROSJOD scoring of bronchiolitis. Results: The study showed that hemoglobin levels were low in children of severe group by BROSJOD scoring. Mean hemoglobin level of 9.7 ± 1.4 is found in children of severe group, mean hemoglobin of 10.2 ± 1.2 is found in moderate group and mean hemoglobin of 11.0 ± 0.8 is found in mild group. Conclusion: The study concluded that hemoglobin would influence the severity of bronchiolitis and could be an in independent risk factor in influencing the severity.

Bronchiolitis: treatment and management in an urgent out of hours care setting

Justine Dexter and Gerri Mortimore explore ways to manage the common lung infection bronchiolitis in small children Bronchiolitis is an acute inflammation of the bronchioles that predominately affects children but is most common in the first 12 months of life. Viral bronchiolitis is the principal cause of admission in England and Wales, with numbers exceeding 30 000 annually. Occurrence is seasonal, in winter months incidence is typically at epidemic proportions for approximately six weeks. Bronchiolitis presents initially with coryza and a persistent cough; as the infection progresses, tachypnoea, chest recession, or both, may be present alongside wheeze or crackles. The assessment of an unwell child is challenging and as an advanced nurse practitioner, working in an out of hours service, the importance to prevent further deterioration should focus on spotting the sick child at an early stage. Therefore, an initial assessment should be undertaken, prior to taking a history and examination, to ensure patient safety. Bronchiolitis is usually a self-limiting illness, that requires supportive management only with treatment directed at fluid input. However, management approaches to bronchiolitis continue to be a subject of substantial debate with vast differences in practice exhibited in the UK, and beyond. with a lack of consensus regarding management. Therefore, the appropriate management of children presenting with bronchiolitis is challenging and can be overwhelming. Nurses must be aware of the pathophysiology, presentation, diagnosis, and management of children presenting to an out of hours service with bronchiolitis, to manage patients safely.

Imiquimod suppresses respiratory syncytial virus (RSV) replication via PKA pathway and reduces RSV induced-inflammation and viral load in mice lungs

Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract disease and bronchiolitis in children, as well as an important cause of morbidity and mortality in elderly and immunocompromised individuals. However, there is no safe and efficacious RSV vaccine or antiviral treatment. Toll Like Receptors (TLR) are important molecular mediators linking innate and adaptive immunity, and their stimulation by cognate agonists has been explored as antiviral agents. Imiquimod is known as a TLR7 agonist, but additionally acts as an antagonist for adenosine receptors. In this study, we demonstrate that imiquimod, but not resiquimod, has direct anti-RSV activity via PKA pathway in HEp-2 and A549 cells, independently of an innate response. Imiquimod restricts RSV infection after viral entry into the host cell, interfering with viral RNA and protein synthesis. Probably as a consequence of these anti-RSV properties, imiquimod displays cytokine modulating activity in RSV infected epithelial cells. Moreover, in a murine model of RSV infection, imiquimod treatment improves the course of acute disease, evidenced by decreased weight loss, reduced RSV lung titers, and attenuated airway inflammation. Consequently, imiquimod represents a promising therapeutic alternative against RSV infection and may inform the development of novel therapeutic targets to control RSV pathogenesis.

Comparative efficacy of nebulization with 3% hypertonic saline and 0.9% normal saline in the management of acute bronchiolitis

Background: There is a dearth of therapeutic modalities for the management of bronchiolitis in children. Objective: The objective of the study was to compare the improvement in clinical severity scores and the length of hospital stay (LOS) among children with bronchiolitis nebulized with either 3% hypertonic saline (HS) or 0.9% normal saline (NS). Materials and Methods: A total of 360 hospitalized patients of age 1–24 months, diagnosed as a case of acute bronchiolitis of moderate severity, were randomized to receive either 4 ml of 3% HS (Group A) or 4 ml of 0.9% NS (Group B) along with 1.5 mg of epinephrine in each arm, at 4 hourly intervals till the patients were ready for discharge. Appropriate statistical analysis was carried out using the collected data. Results: All the baseline characteristics were similar in both the groups. There was a significant (p=0.0011) reduction of 13 h (12.2%), i.e., from 4 days 23 h in Group B (NS) to 4 days 10 h in Group A in the mean LOS and significant difference (p=0.0001) in the clinical severity score was noted from the 2nd day onward in Group A as compared to Group B. No adverse events were observed or reported by the treating medical team or the patients’ caregiver in both the study groups. Conclusion: Nebulization with 3% HS is superior to 0.9% NS nebulization in infants with clinically diagnosed acute bronchiolitis.

Systemic Corticosteroids for Bronchiolitis in Children Aged Less than Two Years: A Systematic Review

Introduction: Bronchiolitis is the main cause of lower respiratory tract infection during the first year of life. This systematic review aimed to assess the effectiveness of systemic corticosteroids in the treatment of bronchiolitis in children aged less than two years during their first hospitalization.Methods: This systematic review was conducted via searching in databases such as PubMed, Scopus, Web of Science, and Cochrane Library until August 2019. Randomized clinical trials regarding the effects of systemic corticosteroids on children with bronchiolitis aged less than two years were evaluated in the retrieved studies. The quality of the studies was assessed based on the Jadad scale. Result: Three studies were included in this systematic review. In two studies, dexamethasone versus placebo were used, and in one study, prednisolone was applied. In one study, use of dexamethasone versus placebo resulted in the faster resolution of respiratory distress, shorter duration of respiratory distress syndrome, reduced oxygen therapy time, and reduced length of hospital stay. In another study, children receiving treatment with dexamethasone had no significant difference in the clinical score, respiratory rate, and pulmonary function compared to the control group. In another study, use of prednisolone within two weeks led to the partial improvement of rhinitis, wheezing, breathing problems, nocturnal respiratory symptoms, and coughing. However, no significant difference was observed between the prednisolone treatment and control groups after 12 months.Conclusion: Despite the improvements in respiratory symptoms, evidence is scarce regarding the effectiveness of systemic corticosteroids in the treatment of bronchiolitis in children aged less than two years. Therefore, well-designed randomized clinical trials on large sample sizes are required in this regard.

Lymphocytic interstitial pneumonia and follicular bronchiolitis in children: A registry‐based case series

Pediatric lymphocytic interstitial pneumonia (LIP) and follicular bronchiolitis (FB) are poorly characterized lymphoproliferative disorders. We present and quantify demographics, radiological and histopathologic patterns, treatments and their responses, and outcomes in non-HIV-infected children with LIP and FB. This structured registry-based study included a retrospective chart review, blinded analysis of imaging studies and lung biopsies, genetic testing, and evaluation of treatments and outcomes. Of the 13 patients (eight females) studied, eight had FB, four had combined LIP/FB, and one had isolated LIP; diagnoses were highly concordant between the pathologists. Most patients became symptomatic during the first 2 years of life, with a mean lag time to diagnosis of 4 years. The most common symptoms were coughing and respiratory infections (11 out of 13 each), dyspnea (10 out of 13), and wheezing (eight out of 13). Autoantibodies were found in eight out of 13 patients. In three patients, disease-causing mutations in the COPA gene were identified. CT revealed hilar lymphadenopathy (five out of 12), ground-glass opacity (eight out of 12), consolidation (five out of 12), and cysts (four out of 13). Systemic steroids as intravenous pulses (11 out of 13) or oral intake (10 out of 13) were the main treatments and showed high response rates of 100% and 90%, respectively. Within the mean observation period of 68 months, all children had chronic courses, eight out of 13 hadsevere diseases, two died, and one worsened. Children with LIP/FB have chronic diseases that occurred in early childhood and were commonly associated with immune dysregulation as well as high morbidity and mortality. Early diagnosis and treatment may be crucial to improve the outcome.

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.

Impaired tumor necrosis factor-α secretion by CD4 T cells during respiratory syncytial virus bronchiolitis associated with recurrent wheeze.

BackgroundInfants with severe respiratory syncytial virus (RSV) bronchiolitis have an increased risk of recurrent wheezing and asthma. We aimed to evaluate the relationships between regulatory T cell (Treg) percentage and cytokine production of in vitro‐stimulated CD4+ T cells during acute bronchiolitis and the development of recurrent wheezing in the first 3 years of life.MethodsWe obtained peripheral blood from 166 infants hospitalized with their first episode of RSV‐confirmed bronchiolitis. Granzyme B (GZB) expression, and interleukin‐10, interferon‐γ, tumor necrosis factor‐α (TNF‐α), IL‐4, and IL‐5 production by in vitro anti‐CD3/CD28‐ and anti‐CD3/CD46‐activated CD4+ T cells, and percentage of peripheral Treg (CD4+CD25hiFoxp3hi) cells were measured by flow cytometry. Wheezing was assessed every 6 months. Recurrent wheezing was defined as three or more episodes following the initial RSV bronchiolitis.ResultsSixty‐seven percent (n = 111) of children had wheezing after their initial RSV infection, with 30% having recurrent wheezing. The percentage of peripheral Treg (CD4+CD25hiFoxp3hi) cells was not significantly different between the wheezing groups. Decreased TNF‐α production from anti‐CD3/CD28− and anti‐CD3/CD46− activated CD4+ T cells was observed in the recurrent wheezers, compared with nonwheezers (p = .048 and .03, respectively). There were no significant differences in the GZB+ CD4+ T cells and production of other inflammatory cytokines between these groups.ConclusionsWe demonstrated lower TNF‐α production by in vitro stimulated CD4+ T cells during severe RSV bronchiolitis in children that subsequently developed recurrent wheezing, compared with children with no subsequent wheeze. These findings support the role of CD4+ T cell immunity in the development of subsequent wheezing in these children.

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.

High-flow nasal cannula for acute viral bronchiolitis in children: Worth a high five

High-flow nasal cannula for acute viral bronchiolitis in children: Worth a high five

Efficacy of salbutamol in the treatment of infants with bronchiolitis: A meta-analysis of 13 studies.

Background:To systematically evaluate the clinical efficacy of salbutamol treatment in infants with bronchiolitis.Methods:A systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the use of salbutamol in infants with bronchiolitis was performed. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of RCTs. Data were extracted and meta-analyzed using STATA version 12.0 (StataCorp, College Station, TX).Results:Thirteen RCTs, including a total of 977 participants, were assessed in the present meta-analysis. Results indicated that salbutamol therapy for bronchiolitis in infants led to an increase in respiratory rate (weighted mean difference [WMD] 2.26 [95% confidence interval {CI} 0.36–4.16]) and higher heart rate (WMD 12.15 [95% CI 9.24–15.07]). However, as a selective β2-agonist, salbutamol did not improve the clinical severity score of infants with bronchiolitis (WMD –0.11 [95% CI –0.26 to 0.03]), length of hospital stay (WMD 0.12 [95% CI –0.32 to 0.56]), or oxygen saturation (WMD 0.20 [95% CI –0.35 to 0.75]).Conclusion:Based on the results of this systematic review, the use of salbutamol had no effect on bronchiolitis in children <24 months of age. Moreover, the treatment can also lead to side effects, such as high heart rate. As such, salbutamol should not be recommended for treatment of bronchiolitis in infants.

Review of the effect of air pollution exposure from industrial point sources on asthma-related effects in childhood

We reviewed epidemiologic studies of the association between exposure to air pollution from industries and asthma-related outcomes in childhood. We searched bibliographic databases and reference lists of relevant articles to identify studies examining the association between children's exposure to air pollution from industrial point-sources and asthma-related outcomes, including asthma, asthma-like symptoms, wheezing, and bronchiolitis. We extracted key characteristics of each study and when appropriate we performed a random-effects meta-analysis of results and quantified heterogeneity (I 2). Thirty-six studies were included in this review. Meta-analysis was generally not possible and limited to a few studies because of substantial variation across design characteristics and methodologies. In case-crossover studies using administrative health data, pooled odds ratio (OR) of hospitalization for asthma and bronchiolitis in children <5 years were 1.02 [95% confidence intervals (CI): 0.96, 1.08; I 2 = 56%] and 1.01 (95% CI: 0.97, 1.05; I 2 = 64%) per 10 ppb increase in the daily mean and hourly maximum concentration of sulfur dioxide (SO2), respectively. For PM2.5, pooled ORs were 1.02 (95% CI: 0.93, 1.10; I 2 = 56%) and 1.01 (95% CI: 0.98, 1.03 I 2 = 33%) per 10 μg/m3 increment in the daily mean and hourly maximum concentration. In cross-sectional studies using questionnaires, pooled ORs for the prevalence of asthma and wheezing in relation to residential proximity to industry were 1.98 (95% CI: 0.87, 3.09; I 2 =71%) and 1.33 (95% CI: 0.86, 1.79; I 2= 65%), respectively. In conclusion, this review showed substantial heterogeneity across study designs and methods. Meta-analysis results suggested no evidence of an association for short-term asthma-related effects and an indication for long-term effects, but heterogeneity between results and limitations in terms of design and exposure assessment preclude drawing definite conclusions. Further well-conducted studies making use of a longitudinal design and of refined exposure assessment methods are needed to improve risk estimates.

Clinical and Paraclinical Characteristics of Severe Bronchiolitis in Children From 2 Months to 12 Months at the Children's Hospital 1 in Ho Chi Minh City - Vietnam

Clinical and Paraclinical Characteristics of Severe Bronchiolitis in Children From 2 Months to 12 Months at the Children's Hospital 1 in Ho Chi Minh City - Vietnam

Life-threatening bronchiolitis in children: eight decades of critical care

Life-threatening bronchiolitis in children: eight decades of critical care

Risk factors for severe bronchiolitis among children in the emergency department at Sultan Qaboos University Hospital

Background and Aim: Bronchiolitis is an acute viral lower respiratory tract infection. It is a common disease among children below 2 years old, resulting in frequent presentation to the emergency department and occasionally admission1 . For proper management of such patients, studying the disease spectrum and the risk factors is important2 . The aim of this study was to investigate the demographics and risk factors for severe bronchiolitis in children (0–2 years old), in the emergency department (ED) at Sultan Qaboos University Hospital (SQUH). Methods: We conducted a retrospective cohort study, including children ( < 2 years old), who came to the ED with a presentation suggestive of bronchiolitis. We reviewed the charts for a two-year period (January 2015–December 2016). Demographic and baseline characteristics were gathered from electronic medical records and then analyzed. We categorized patients into severe and non-severe bronchiolitis according to the guidelines set by the New South Wales (NSW) Ministry of Health in Australia in 2012 for the “Acute Management of Bronchiolitis in Infants and Children”3 . Therefore, in our study children who were considered to have severe bronchiolitis had one of the following: unwell appearance, apneas, severe tachypnea (>70 breaths/min), bradypnea ( < 30 breaths/min), moderate to severe grunting, cyanosis, pallor, oxygen saturation < 90% in air (or < 92% in O2), tachycardia (>180 beats/min) and difficulty in feeding (taking less than 50% of normal feed).We investigated the following risk factors to predict severe bronchiolitis: maternal age, birth weight, prematurity ( < 37 weeks of gestational age), age < 12 weeks, congenital heart defects, congenital respiratory diseases, immunodeficiency, and global developmental delay. We described the cohort using descriptive statistics and performed a logistic regression analysis to determine the risk factors for severe bronchiolitis. Results: Of the 235 children with bronchiolitis, 133 had severe bronchiolitis while 102 had the non-severe form of the disease, with a greater percentage of males than females in both groups. The majority of children with severe bronchiolitis were in the age < 3 months group (32%), while the least was in the ≥ 12 months age group (10%). There was a trend toward statistically significant results for the following factors: chronological age < 12 weeks (OR = 2.67, 95% CI = 0.89–2.67), congenital cardiac diseases (OR = 2.12, 95% CI = 0.85–5.30) and congenital respiratory diseases (OR = 1.86, 95% CI = 0.80–4.27).The following factors were associated with severe bronchiolitis using stepwise logistic regression: increased heart rate (OR = 1.046, 95% CI = 1.026 – 1.066), decreased SpO2 (OR = 0.890, 95% CI = 0.827 - 0.957), male gender (OR = 2.248, 95% CI = 1.105 – 4.573), irritability (OR = 2.209, 95% CI = 1.024 – 4.769) and global developmental delay (OR = 3.5, 95% CI = 1.0 – 12.537). Conclusion: Multiple factors were associated with severe bronchiolitis and three were trending toward significant association including the younger age group, presence of congenital heart and respiratory diseases4. Low saturation, tachycardia and irritability were both part of the diagnostic criteria for severity and risk factors which confirms the clinical importance of these factors. Further investigations with a prospective study and a bigger sample size are required to confirm our findings and find other associated factors.

1145. Reducing Antibiotic Use In Children With Respiratory Syncitial Virus-related Bronchiolitis: Implementation of TeamSTEPPS® 2.0 to Improve Pharmacy-Physician Communication in a Community Hospital Antibiotic Stewardship Program

BackgroundOveruse of antibiotics in Respiratory Syncytial virus (RSV) bronchiolitis in children has been reported between 29–80%. Our antibiotic stewardship program (ASP) utilized a validated communication tool using TeamSTEPPS ® 2.0 principles to improve pharmacy-physician communication and improve audit-feedback technique (AFT).MethodsWe trained pharmacists and physicians in TeamSTEPPS ® 2.0 using simulation-based training. The key component of the training was: closed-loop communication and using a scripted pharmacy communication tool. The scripted pharmacy communication tool was modified from the “DESC” script used in TeamSTEPPS ® 2.0, which includes (1) Describing the situation, (2) Expressing concern, (3) providing Solutions, (4) stating Consequences and coming to an agreement. We incorporated this to improve the audit-feedback technique. We aimed to: (1) Reduce overall percentage of antibiotic (abx) use in RSV bronchiolitis by 25%, (2) reduce use of ceftriaxone, (3) reduce average antibiotic days of therapy (DOT).ResultsOur baseline data from 2017–18 RSV season showed a 42% (48/113) use of abx, of which 10% were deemed inappropriate. When compared with the 2018–2019 season, no differences were noted in patient demographics. The median length of stay between the two time periods was similar (2.9 days, IQR 1.9–4.8 days vs. 3.1 days, IQR 2.1–5.1 days, P = 0.17). More patients were admitted to the pediatric intensive care unit (PICU) in the 2018–2019 period: 35/96 (36.4%) as compared with 17/113 (15%) in the previous season. Although similar proportions of patients received abx (42% vs. 41%) in the two groups (Figure 1), average abx DOT, significantly decreased in the 2018–2019 period as compared with 2017–2018 (Figure 2). There was also a decrease in the use of ceftriaxone during the 2018–2019 (Figure 3). All physicians and pharmacists were satisfied with the communication technique and thought that it improved their interaction and understanding of the ASP process.ConclusionThough we did not reduce the overall abx use in RSV bronchiolitis, we did reduce the average abx DOT and use of ceftriaxone in our institution. The use of a validated communication tool to improve prospective AFT was crucial to the success of the ASP program. Disclosures All authors: No reported disclosures.

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

Bronchiolitis affects more than one-third of children less than age 2 years and can cause substantial anxiety for parents, leading them to seek information on how to care for their sick child. The aim of our qualitative study was to explore the information needs and preferences of parents caring for a child with bronchiolitis. We used a qualitative descriptive approach. Participants were recruited by means of purposive sampling from Oct. 1, 2017, to Mar. 15, 2018 from the Stollery Children's Hospital emergency department, a specialized pediatric emergency department in Edmonton. Individual semistructured interviews were conducted. Fifty-three parents were recruited to participate, of whom 30 could not be reached after 4 contact attempts and 8 refused. Thus, 15 parents participated (16 children). Three major themes were identified: 1) parents' information needs about bronchiolitis, 2) parents' preferred information sources and 3) parents' preferred information delivery formats. Participants indicated that they want and require credible, easy-to-understand information about bronchiolitis in a variety of formats, and especially valued information obtained directly from a health care professional or an evidence-based website. This study provides important information about parents' information needs concerning bronchiolitis in children. Identifying the information that parents want and value in relation to acute pediatric illnesses is imperative to developing innovative educational approaches for parents that reflect patient-centred care.

Bronchiolitis in children

Bronchiolitis is the commonest lower respiratory tract infection in infants needing hospital admission. It is caused by the virus mainly the respiratory syncytial virus. The infants typically present with initial upper respiratory symptoms such as rhinitis, nasal congestion and low grade fever which is followed by tachypnea recessions grunting apnoea and cyanosis in severe cases. Young age group, prematurity congenital heart diseases are the major risk factors for the severe disease. Diagnosis of bronchiolitis is mainly depended on clinical features. Clinical assessment of a child suspected with bronchiolitis should include clinical features to diagnoses the bronchiolitis and to assess the severity of the bronchiolitis. There is no definitive management for bronchiolitis. None of the drugs tried in the management of bronhiolitis have shown their efficacy in reducing the length of hospital stay, severity of the illness or improvement in the outcome. The main stay of management is supportive like minimum handling, supplementary oxygen, and care on fluid and nutrition and ventilator support whenever needed.

Is high-flow nasal cannula therapy feasible for managing bronchiolitis in children in the emergency department?

Is high-flow nasal cannula therapy feasible for managing bronchiolitis in children in the emergency department?