Clinical Diagnosis Of Bronchiolitis Research Articles

Management and outcomes of bronchiolitis in Italy and Latin America: a multi-center, prospective, observational study

We aimed to describe differences in the epidemiology, management, and outcomes existing between centers located in countries which differ by geographical location and economic status during to post-pandemic bronchiolitis seasons. This was a prospective observational cohort study performed in two academic centers in Latin America (LA) and three in Italy. All consecutive children with a clinical diagnosis of bronchiolitis were included, following the same data collection form. Nine hundred forty-three patients have been enrolled: 275 from the two Latin American Centers (San Jose, 215; Buenos Aires, 60), and 668 from Italy (Rome, 178; Milano, 163; Bologna, 251; Catania, 76). Children in LA had more frequently comorbidities, and only rarely received palivizumab. A higher number of patients in LA had been hospitalized in a ward (64% versus 23.9%, p < 0.001) or in a PICU (16% versus 6.2%, p < 0.001), and children in LA required overall more often respiratory support, from low flow oxygen to invasive mechanical ventilation, except for CPAP which was more used in Italy. There was no significant difference in prescription rates for antibiotics, but a significantly higher number of patients treated with systemic steroids in Italy.Conclusions: We found significant differences in the care for children with bronchiolitis in Italy and LA. Reasons behind such differences are unclear and would require further investigations to optimize and homogenize practice all over the world.What is Known:• Bronchiolitis is among the commest cause of morbidity and mortality in infants all over the world.What is New:• There are significant differences on how clinicians care for bronchiolitis in different centers and continents. Differences in care can be principally due to different local practices than differences in patients severity/presentations.• Understanding these differences should be a priority to optime and standardize bronchiolitis care globally.

High-flow nasal cannula therapy for infants with bronchiolitis.

Bronchiolitis is a common lower respiratory tract illness, usually of viral aetiology, affecting infants younger than 24 months of age and is the most common cause of hospitalisation of infants. It causes airway inflammation, mucus production and mucous plugging, resulting in airway obstruction. Effective pharmacotherapy is lacking and bronchiolitis is a major cause of morbidity and mortality. Conventional treatment consists of supportive therapy in the form of fluids, supplemental oxygen, and respiratory support. Traditionally, oxygen delivery is as a dry gas at 100% concentration via low-flow nasal prongs. However, the use of heated, humidified, high-flow nasal cannula (HFNC) therapy enables delivery of higher inspired gas flows of an air/oxygen blend, at 2 to 3 L/kg per minute up to 60 L/min in children. It can provide some level of continuous positive airway pressure (CPAP) to improve ventilation in a minimally invasive manner. This may reduce the need for invasive respiratory support, thus potentially lowering costs, with clinical advantages and fewer adverse effects. To assess the effects of HFNC therapy compared with conventional respiratory support in the treatment of infants with bronchiolitis. We searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS, and Web of Science (from June 2013 to December 2022). In addition, we consulted ongoing trial registers and experts in the field to identify ongoing studies, checked reference lists of relevant articles, and searched for conference abstracts. Date restrictions were imposed such that we only searched for studies published after the original version of this review. We included randomised controlled trials (RCTs) or quasi-RCTs that assessed the effects of HFNC (delivering oxygen or oxygen/room air blend at flow rates greater than 4 L/minute) compared to conventional treatment in infants (< 24 months) with a clinical diagnosis of bronchiolitis. Two review authors independently used a standard template to assess trials for inclusion and extract data on study characteristics, risk of bias elements, and outcomes. We contacted trial authors to request missing data. Outcome measures included the need for invasive respiratory support and time until discharge, clinical severity measures, oxygen saturation, duration of oxygen therapy, and adverse events. In this update we included 15 new RCTs (2794 participants), bringing the total number of RCTs to 16 (2813 participants). Of the 16 studies, 11 compared high-flow to low-flow, and five compared high-flow to CPAP. These studies included infants less than 24 months of age as stated in our selection criteria. There were no significant differences in sex. We found that when comparing high-flow to low-flow oxygen therapy for infants with bronchiolitis there may be a reduction in the total length of hospital stay (mean difference (MD) -0.65 days, 95% confidence interval (CI) -1.23 to -0.06; P < 0.00001, I2 = 89%; 7 studies, 1951 participants; low-certainty evidence). There may also be a reduction in the duration of oxygen therapy (MD -0.59 days, 95% CI -1 to -0.18; P < 0.00001, I2 = 86%; 7 studies, 2132 participants; low-certainty evidence). We also found that there was probably an improvement in respiratory rate at one and 24 hours, and heart rate at one, four to six, and 24 hours in those receiving high-flow oxygen therapy when compared to pre-intervention baselines. There was also probably a reduced risk of treatment escalation in those receiving high-flow when compared to low-flow oxygen therapy (risk ratio (RR) 0.55, 95% CI 0.39 to 0.79; P = 0.001, I2 = 43%; 8 studies, 2215 participants; moderate-certainty evidence). We found no difference in the incidence of adverse events (RR 1.2, 95% CI 0.38 to 3.74; P = 0.76, I2 = 26%; 4 studies, 1789 participants; low-certainty evidence) between the two groups. The lack of comparable outcomes in studies comparing high-flow and CPAP, as well as the small numbers of participants, limited our ability to perform meta-analysis on this group. High-flow nasal cannula therapy may have some benefits over low-flow oxygen for infants with bronchiolitis in terms of a greater improvement in respiratory and heart rates, as well as a modest reduction in the length of hospital stay and duration of oxygen therapy, with a reduced incidence of treatment escalation. There does not appear to be a difference in the number of adverse events. Further studies comparing high-flow nasal cannula therapy and CPAP are required to demonstrate the efficacy of one modality over the other. A standardised clinical definition of bronchiolitis, as well as the use of a validated clinical severity score, would allow for greater and more accurate comparison between studies.

Evaluating the efficacy of corticosteroids and bronchodilators in the management of paediatric bronchiolitis

Background: Bronchiolitis, a standard lower tract infection in young children, poses significant challenges in terms of diagnosis and management. Corticosteroids and bronchodilators are often prescribed to manage this condition, despite limited evidence supporting their efficacy. This study aimed to judge the effectiveness of corticosteroids and bronchodilators within the management of paediatric bronchiolitis. Objective: to see the clinical efficacy of corticosteroids and bronchodilators in improving respiratory symptoms and reducing hospitalization rates among paediatric patients with bronchiolitis. Study Settings and Sample Size: This study was conducted at different centres including Department of Paediatrics, Social Security MNCH Hospital, Dera Ghazi Khan, Punjab and Sahara Medical College Narowal, Punjab in the period from October, 2022 to March, 2023 enrolling 300 children aged 1 month to 2 years with a clinical diagnosis of bronchiolitis. Methods: Participants were randomly assigned to at least one of three treatment groups: corticosteroids (n=100), bronchodilators (n=100), or placebo (n=100). the first outcome was improvement within the Respiratory Distress Assessment Instrument (RDAI) score. Secondary outcomes included hospitalization rates, length of hospital stay, and adverse events. Results: Children within the corticosteroid group experienced a significantly greater improvement in RDAI scores compared to the placebo group (p&lt;0.001).

Bronchiolitis and its Different Ways of Management in Raparin Teaching Hospital, Erbil-Iraq

Background: Despite the prevalence, global impact, financial burden, and mortality and morbidity related to bronchiolitis, clinical management still seems to be difficult.&#x0D; Objective: To describe the diversity medical treatment options used to manage bronchiolitis and conclude the safest and most effective way to treat it in order to help the development of an evidence based treatment protocol at Raparin teaching hospital.&#x0D; Patients and Methods: This current study design was randomized controlled trial, in which total of 125 children presented with bronchiolitis enrolled in our study, we divided them into five groups (A, B, C, D and E), each of 25 cases. All the groups received supportive treatment in the form of oxygen and intravenous (IV) fluid in addition to specific treatment except group A subjects who received supportive treatment only. The treatments were The study was conducted at the inpatient wards of Raparin teaching hospital in Erbil city-Iraq, from the period of 1st January to 1st August 2022. The infants and children’s age was ranging from 1 to 60 months with clinical diagnosis of bronchiolitis.&#x0D; Results: There was non-significant statistical association between treatment groups and presence of wheeze after treatment (p:0.538), while statistically significant association between various treatment modalities (groups) and cough after treatment (p:0.006) in the same way the association was significant with accessory muscle use after treatment (p:0.037). &#x0D; Conclusion: Generally patients in groups B (inhaled bronchodilator) and D (inhaled bronchodilator and intravenous steroids) had better response rates in terms of cough, accessory muscle use, respiratory rate (tachypnea), time to resolution of fever and coryza, duration of IV fluid therapy, oxygen therapy and hospital stay. Which conclude using of inhaled bronchodilator and IV steroid

Bronchiolitis and its Different Ways of Management in Raparin Teaching Hospital, Erbil-Iraq

Background: Despite the prevalence, global impact, financial burden, and mortality and morbidity related to bronchiolitis, clinical management still seems to be difficult. Objective: To describe the diversity medical treatment options used to manage bronchiolitis and conclude the safest and most effective way to treat it in order to help the development of an evidence based treatment protocol at Raparin teaching hospital. Patients and Methods: This current study design was randomized controlled trial, in which total of 125 children presented with bronchiolitis enrolled in our study, we divided them into five groups (A, B, C, D and E), each of 25 cases. All the groups received supportive treatment in the form of oxygen and intravenous (IV) fluid in addition to specific treatment except group A subjects who received supportive treatment only. The treatments were The study was conducted at the inpatient wards of Raparin teaching hospital in Erbil city-Iraq, from the period of 1st January to 1st August 2022. The infants and children’s age was ranging from 1 to 60 months with clinical diagnosis of bronchiolitis. Results: There was non-significant statistical association between treatment groups and presence of wheeze after treatment (p:0.538), while statistically significant association between various treatment modalities (groups) and cough after treatment (p:0.006) in the same way the association was significant with accessory muscle use after treatment (p:0.037). Conclusion: Generally patients in groups B (inhaled bronchodilator) and D (inhaled bronchodilator and intravenous steroids) had better response rates in terms of cough, accessory muscle use, respiratory rate (tachypnea), time to resolution of fever and coryza, duration of IV fluid therapy, oxygen therapy and hospital stay. Which conclude using of inhaled bronchodilator and IV steroid Keywords: Bronchiolitis, Wheeze, Treatment, Randomized clinical trial, Iraq

Epidemiology, Microbiology and Severity of Bronchiolitis in the First Post-Lockdown Cold Season in Three Different Geographical Areas in Italy: A Prospective, Observational Study.

The aim of this study was to understand the epidemiology, disease severity, and microbiology of bronchiolitis in Italy during the 2021–2022 cold season, outside of lockdowns. Before COVID-19, the usual bronchiolitis season in Italy would begin in November and end in April, peaking in February. We performed a prospective observational study in four referral pediatric centers located in different geographical areas in Italy (two in the north, one in the center and one in the south). From 1 July 2021 to 31 January 2022, we collected all new clinical diagnoses of bronchiolitis in children younger than two years of age recording demographic, clinical and microbiological data. A total of 657 children with a clinical diagnosis of bronchiolitis were enrolled; 56% children were admitted and 5.9% required PICU admission. The first cases were detected during the summer, peaking in November 2021 and declining into December 2021 with only a few cases detected in January 2022. RSV was the commonest etiological agent, while SARS-CoV-2 was rarely detected and only since the end of December 2021. Disease severity was similar in children with RSV vs. non-RSV bronchiolitis, and in those with a single infectious agent detected compared with children with co-infections. The 2021–2022 bronchiolitis season in Italy started and peaked earlier than the usual pre-pandemic seasons, but had a shorter duration. Importantly, the current bronchiolitis season was not more severe when data were compared with Italian published data, and SARS-CoV-2 was rarely a cause of bronchiolitis in children younger than 24 months of age.

Pragmatic Randomized Trial of Corticosteroids and Inhaled Epinephrine for Bronchiolitis in Children in Intensive Care

To determine whether the combination of systemic corticosteroids and nebulized epinephrine, compared with standard care, reduces the duration of positive pressure support in children with bronchiolitis admitted to intensive care. We performed a pragmatic, multicenter, open-label, randomized trial between July 2013 and November 2019 in children younger than 18months old with a clinical diagnosis of bronchiolitis. The intervention group received the equivalent of 13mg/kg prednisolone over 3days, then 1mg/kg daily for 3days, plus 0.05mL/kg of nebulized 1% epinephrine made up to 6ml with 0.9% saline via jet nebulizer and mask using oxygen at 12l/min every 30minutes for 5 doses, then 1-4 hourly for 3days, then as required for 3days. The primary outcome was clinician-managed duration of positive pressure support in intensive care defined as high-flow nasal-prong oxygen, nasopharyngeal continuous positive airway pressure, or mechanical ventilation. In total, 210 children received positive pressure support. In the corticosteroid-epinephrine group, 107 children received positive pressure support for a geometric mean of 26 (95% CI, 22-32) hours compared with 40 (95% CI 34-47) hours in 103 controls, adjusted ratio 0.66 (95% CI 0.51-0.84), P=.001. In the intervention group, 41 (38%) children experienced at least 1 adverse event, compared with 39 (38%) in the control group. In children with severe bronchiolitis, the duration of clinician-managed pressure support was reduced by regular treatment with systemic corticosteroids and inhaled epinephrine compared with standard care. Australian Clinical Trials Research Network: ACTRN12613000316707.

Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis.

Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis.

Severe bronchiolitis profiles and risk of asthma development in Finnish children

Recent studies support the existence of several entities under the clinical diagnosis of bronchiolitis. Among infants with severe bronchiolitis, distinct profiles have been differentially associated with development of recurrent wheezing by age 3 years. However, their associations with actual asthma remain unclear. Our aim was to study the association between severe bronchiolitis profiles identified by using a clustering approach and childhood asthma. Among 408 children (aged <2 years) hospitalized with bronchiolitis in Finland (in 2008-2010), latent class analysis identified 3 bronchiolitis profiles: profile A(47%), characterized by history of wheezing and/or eczema, wheezing during acute illness, and rhinovirus infection; profile BC (38%), characterized by severe illness and respiratory syncytial virus infection; and profile D (15%), characterized by the least severely ill children, including mostly children without wheezing and with rhinovirus infection. The children were followed by questionnaire 4 years later (86% [n= 348]) and through a nationwide social insurance database 7 years later (99% [n= 403]). Current asthma at the 4- and 7-year follow-ups was defined by regular use (according to parental report and medical records) or purchase (according to the social insurance database) of asthma control medication. Compared with risk of current asthma associated with profile BC, we observed increased risk of current asthma associated with profile Aboth at the 4-year follow-up (age- and sex-adjusted odds ratio= 2.42 [95% CI= 1.23-4.75]) and at the 7-year follow-up (age- and sex-adjusted odds ratio= 3.14 [95% CI= 1.33-7.42]). No significant difference in asthma risk was observed between profile D and profile BC. These longitudinal results provide further support for an association between a distinct severe bronchiolitis profile (characterized by a history of wheezing and/or eczema and rhinovirus infection) and risk of development childhood asthma.

Use of bilevel positive pressure ventilation in patients with bronchiolitis.

This study aims at describing the use of bilevel positive airway pressure (BiPAP) in infants with severe bronchiolitis. The use of BiPAP in infants with bronchiolitis may be associated with a worst outcome. A single-center retrospective study performed from October 2013 to April 2016. All infants from 1 day to 6 months of age admitted in the pediatric intensive care unit (PICU) were included if they had a clinical diagnosis of bronchiolitis and if they required any type of noninvasive ventilation (NIV), including high flow nasal cannula, continuous positive airway pressure and BiPAP at admission in PICU. There was no local written protocol regarding the ventilator management during the study. Overall, 252 infants (median age 45 (26-72) days) were included in the study and 110 infants (44%) were supported by BiPAP at admission. More infants were born preterm in the group of patients supported by BiPAP at admission. No complication related to NIV occurred. Patients in the BiPAP group had a longer duration of noninvasive support as well as a longer PICU length of stay. However, hospital length of stay did not differ according to the type of respiratory support at admission. The use of BiPAP was not associated with endotracheal intubation, however it was associated with increased PICU length of stay and increased duration of NIV.

6 Factors associated with treatment failure of high flow nasal cannula (HFNC) among children with bronchiolitis: a single centre retrospective study

Abstract Background Bronchiolitis is the most common viral lower respiratory tract infection in children under two years of age and is the leading cause of hospital admission for children under the age of one year. Respiratory support for bronchiolitis with high flow nasal cannula (HFNC) is increasingly being used outside of critical care areas and in community hospitals. It is important to understand the patient factors associated with HFNC treatment failure in order to identify which patients are at higher risk for requiring escalation of respiratory support and transfer to a pediatric critical care centre. Objectives The primary objective of this study was to evaluate the patient characteristics that are associated with HFNC treatment failure in bronchiolitis. Design/Methods We completed a retrospective review of patients under 24 months of age with a clinical diagnosis of bronchiolitis admitted to a single tertiary level children’s hospital for supportive management with HFNC between January 2014 and December 2018. Patients who were mechanically ventilated or on non-invasive positive pressure ventilation prior to the initiation of HFNC during their hospital stay were excluded. HFNC treatment failure was the primary endpoint of the study, with treatment failure defined as escalation to non-invasive positive pressure or invasive mechanical ventilation. Multivariable logistic regression analysis was used to identify the patient demographic, clinical, and biochemical parameters associated with HFNC failure. Results Four hundred and thirty-five patient charts were identified, of which 208 patients met inclusion criteria for the study. Of these patients, 61 (29%) were classified as HFNC treatment failures. The likelihood of failing HFNC support was reduced with older age (OR 0.89; 95% CI 0.81, 0.97; p= 0.011) and greater time spent on HFNC (OR 0.94; 95% CI 0.92, 0.96; p&amp;lt;0.001). Patients with a Modified Tal score greater than 5 at 4 hours of HFNC treatment had a greater likelihood of failing HFNC support (OR 2.81; 95% CI 1.04, 7.64; p= 0.042). Conclusion This was the first study to examine predictors of HFNC failure among Canadian children with bronchiolitis. We found that patient age, time spent on HFNC, and severity of bronchiolitis as defined using a Modified Tal score were associated with HFNC failure. These patient factors should be considered when initiating HFNC for bronchiolitis, and may identify patients at risk for escalation of respiratory support, warranting earlier referral to pediatric critical care centres.

Risk Factors Associated With Bronchiolitis in Puerto Rican Children.

The objective of this study was to identify frequency, severity, and risk factors associated with bronchiolitis in Puerto Rican children. A cross-sectional was study performed at 4 emergency departments of Puerto Rico's metropolitan area, between June 2014 and May 2015. We included children younger than 24 months, with a clinical diagnosis of bronchiolitis, who were born and living in Puerto Rico at the time of recruitment. A physician-administered questionnaire inquiring about the patient's medical, family, and social history and a bronchiolitis severity assessment were performed. Daily weather conditions were monitored, and aeroallergens were collected with an air sample and precision weather station within the metropolitan area to evaluate environmental factors. We included 600 patients for 12 months. More than 50% of the recruited patients had a previous episode of bronchiolitis, of which 40% had been hospitalized. Older age (odds ratio [OR], 18.3; 95% confidence interval [CI], 9.2-36.5), male sex (OR, 1.6; 95% CI, 1.1-2.4), history of asthma (OR, 8.9; 95% CI, 3.6-22), allergic rhinitis (OR, 3.6; 95% CI, 1.8-7.4), and smoke exposure by a caretaker (OR, 2.3; 95% CI, 1.2-4.4) were predictors of bronchiolitis episodes. Bronchiolitis episodes were associated with higher severity score (P = 0.040), increased number of atopic factors (P < 0.001), and higher number of hospitalizations (P < 0.001). This study identifies Puerto Rican children who may present a severe clinical course of disease without traditional risk factors. Atopy-related factors are associated with frequency and severity of bronchiolitis. Puerto Rican children present risk factors related to atopy earlier in life, some of which may be modified to prevent the subsequent development of asthma.

Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis

Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis

Adherence to national paediatric bronchiolitis management guidelines and impact on emergency department resource utilization

To evaluate the association between the use of nonrecommended pharmacology (salbutamol and corticosteroids) per national bronchiolitis guidelines, either during the index visit or at discharge, and system utilization measures (frequency of return visits [RTED] and on paediatric emergency department [PED] length of stay [LOS]). We conducted a retrospective case control study of 185 infants (≤12 months old) who presented to the PED between December 2014 and April 2017 and discharged home with a clinical diagnosis of bronchiolitis. Inclusion criteria included ≥ 1 viral prodromal symptom and ≥ 1 physical exam finding of respiratory distress. Cases were defined as infants who had ≥ 1 RTED within 7 days of their index visit and controls were matched for age and acuity but without RTED. Logistic regression analysis and multivariable linear regression were used to assess the odds of RTED and PED LOS associated with nonadherence to pharmaceutical recommendations per AAP and CPS bronchiolitis guidelines. Use of nonrecommended pharmacology per national bronchiolitis guidelines was documented among 39% of the 185 study participants. Adjusting for acuity of index visit, age, severe tachypnea, oxygen desaturation, and dehydration, use of nonrecommended pharmacology was not associated with RTED (odds ratio [OR]: 0.98, 95% confidence interval [CI]: 0.47 to 2.03). Use of salbutamol and corticosteroids, however, were each independently associated with increased PED LOS (58.3 minutes [P=0.01] and 116.7 minutes [P<0.001], respectively). Nonadherence to the pharmaceutical recommendations of national bronchiolitis guidelines was not associated with RTED but salbutamol and corticosteroid use increased PED LOS.

Respiratory Syncityal Virus A and B: three bronchiolitis seasons in a third level hospital in Italy

BackgroundRespiratory syncytial virus (RSV) is the main cause of hospitalization for bronchiolitis among infants. RSV is classified into two subtypes, A and B, whose predominance alternates during different epidemic seasons. The clinical impact of viral factors is controversial and many evidences suggest a critical role for the immune host response. Premature children are at the highest risk for severe RSV infection. The main aim of this study is to identify the different RSV subtypes circulating in the last three epidemic seasons and to evaluate whether any of them was associated with poor prognosis in term and preterm infants.MethodsWe performed a retrospective analysis of medical records for all patients aged less than one year which were hospitalized during the winter season between November 2015 and April 2018 with clinical diagnosis of bronchiolitis and nasopharyngeal aspirates positive for RSV.ResultsWe enrolled 422 children, of which 50 were born preterm. During the analysis period, we observed a significant increase in the rates of oxygen supplementation and admission to intensive care unit. The evidence shows an alternating pattern in the prevalence of RSV subtypes among term born; in each epidemic season, the prevalent serotype is the cause of the majority of the cases requiring intensive care. Conversely, RSV-A is always prevalent in preterm children and caused most of the cases requiring intensive care.ConclusionsDuring the 3 seasons analyzed, we observed an alternating prevalence of RSV A and B. While there are no differences in severity between RSV A and B in term population, RSV-A is prevalent and causes most of the severe cases in the premature group. Furthermore, an increase in RSV-related oxygen therapy and PICU admission has been documented not only in the premature population. Considering the absence of appropriate therapeutic strategies, our work emphasizes the importance of implementing prophylaxis measures against RSV and highlights the urgent need to gain knowledge about immune response to the virus, also in premature children.

Prematurity, a significant predictor for worse outcome in viral bronchiolitis: a comparative study in infancy

BackgroundThe rate of admissions to hospital with bronchiolitis has increased over the past years. The reasons for this are likely to be multifactorial including improved survival of preterm infants.AimTo assess the severity of viral bronchiolitis in preterm compared to term infants admitted at a tertiary hospital in Cairo, Egypt, based on the outcome.Patients and methodsThis prospective study was conducted throughout a 3-year period from September 2011 to October 2014. It included 153 infants, 74 healthy preterm, and 79 healthy term infants admitted with clinical diagnosis of bronchiolitis at a tertiary hospital in Cairo, Egypt. Bronchiolitis severity score (BSS) was recorded, and nasopharyngeal swabs were obtained from each patient at the time of presentation. Viruses were identified using reverse transcription polymerase chain reaction (RT-PCR). The clinical course and patient’s outcome were recorded.ResultsThis study recorded a significantly more severe BSS for preterm compared to term infants. The preterm group had an increased mean length of hospital stay and oxygen therapy and was more likely to need intensive care unit admission and mechanical ventilation (MV) compared to the term group. The mean (± SD) BSS for infections with h-MPV, RSV, and para-influenza 3 was more significantly severe in preterm compared to term infants. Bacterial co-infection was significantly correlated with severity scoring in both groups.ConclusionPrematurity significantly affects the severity of bronchiolitis, and this underscores the importance of early categorization as a high-risk group on their first visit. The physician should be aware that their illness runs a more severe course, even if they have no underlying disorders.

The role of nebulized hypertonic saline in the management of acute bronchiolitis

Background Acute bronchiolitis is the most frequent lower respiratory tract infection in infants and the most frequent cause of hospitalization in this age group. It places enormous strains on pediatric inpatient services and pediatric ICUs, and despite the growing understanding of its pathogenesis, currently available therapies have failed to show consistent benefit, and supportive care remains the mainstay of bronchiolitis therapy. It is suggested that hypertonic saline nebulization may be useful in making secretions less viscous and promoting their excretion, thereby resulting in clinical improvement, and over the past decade, a growing number of randomized trials have suggested that early and repeated doses of nebulized 3% hypertonic saline improve clinical outcomes in hospitalized children compared with 0.9% normal saline. Objectives The current study aimed to study the safety and efficacy of nebulized 3% hypertonic saline in hospitalized infants with a clinical diagnosis of bronchiolitis. Patients and methods This double-blind, randomized controlled trial was conducted on 110 infants who were admitted to Alexandria University Children’s Hospital with a clinical diagnosis of acute bronchiolitis. The diagnosis of bronchiolitis was based on clinical evaluation. Patients were randomly allocated into two groups: one group received nebulized 3% hypertonic saline with 2.5-mg salbutamol at intervals of 4 h, whereas the second group received nebulized 0.9% normal saline with 2.5-mg salbutamol at intervals of 4 h. Results There was no significant difference in the clinical severity score between the two studied groups in all days of admission, except for mild improvement on the second and third days of admission, yet it was not sufficient enough to make the patients eligible for discharge. Furthermore, there was no significant difference in length of hospital stay among infants who received hypertonic saline. Complications of nebulized hypertonic saline, namely, vomiting, agitation, exacerbation of cough, cyanosis, and apnea, were similar to normal saline. Conclusion The use of nebulized 3% hypertonic saline in hospitalized infants with bronchiolitis is considered safe, but when compared with 0.9% normal saline, it did not improve the clinical severity score nor shorten the length of hospital stay in hospitalized infants with bronchiolitis.

Interventions to Reduce Over-Utilized Tests and Treatments in Bronchiolitis.

The American Academy of Pediatrics published bronchiolitis clinical practice guidelines in 2014 recommending against the routine use of bronchodilators, chest radiographs, or respiratory viral testing in children with a clinical diagnosis of bronchiolitis. Our aim in this project was to align care with the American Academy of Pediatrics clinical practice guidelines by decreasing the overuse of these interventions. This study included patients who were admitted to a non-ICU setting with a primary or secondary diagnosis of bronchiolitis. The team used a multidisciplinary kickoff event to understand the problem and develop interventions, including sharing provider-specific data and asking providers to sign a pledge to reduce use. We used a novel, real-time data dashboard to collect and analyze data. Special cause variation on control charts indicated improvement for all outcomes for inpatients during the intervention season. Pre- and postanalyses in which we compared baseline to intervention values for all admitted patients and patients who were discharged from the emergency department or urgent care revealed a significant reduction in the ordering of chest radiographs (from 22.7% to 13.6%; P ≤ .001), respiratory viral testing (from 12.5% to 9.8%; P = .001), and bronchodilators (from 17.5% to 10.3%; P = .001) without changes in balancing measures (eg, hospital readmission within 7 days [1.7% (preanalysis) and 1.0% (postanalysis); P = .21]) for bronchiolitis. This multidisciplinary improvement initiative resulted in a significant reduction in use for bronchiolitis care at our institution. Our approach, which included a novel, real-time data dashboard and interventions such as individual providers pledging to reduce use, may have the potential to reduce overuse in other settings and diseases.

Comparison of nebulized Salbutamol versus Adrenaline in the treatment of wheeze associated respiratory tract infection

Background: Wheezing related to respiratory infections is common in infancy and early child hood. In 1-3% of all infants these infections are severe enough to require hospitalization. Most episodes of wheezing in early life are of viral origin and form a heterogeneous group with different outcomes. The objectives of this study were to assess the efficacy of bronchodilators in wheeze associated respiratory infection and to comparing the efficacy of a nebulized nonspecific adrenergic agonist -1 adrenaline with a nebulized beta-2 specific agonist salbutamol for the treatment of the wheeze associated respiratory tract infection.Methods: The study was conducted in children reporting to the Pediatric Department Government General Hospital in Kakinada. The study period was 6 months from January to June 2014. Children between the ages of two months to two years attending the hospital with the clinical diagnosis of bronchiolitis were enrolled. Results: 30 children were enrolled. 22 (73.3) were in age group of 2 months to 1 year and 8 (26.7%) were in age group of 1-2 years. There is no added advantage of decreasing the respiratory rates, wheezing and retractions of one over the other groups.Conclusions: It can be inferred that bronchodilators, both nebulized adrenalin and salbutamol are useful in relieving symptoms and improving oxygenation in wheezy infants with clinical diagnosis of WRTI. No drug is said to be better over the other.

Nasal Continuous Positive Airway Pressure in Bronchiolitis: A Randomized Controlled Trial

ObjectiveTo evaluate the efficacy of nasal continuous positive airway pressure (nCPAP) in decreasing respiratory distress in bronchiolitis.DesignRandomized controlled trial.SettingTertiary-care hospital in New Delhi, India.Participants72 infants (age < 1y) hospitalized with a clinical diagnosis of bronchiolitis were randomized to receive standard care, or nCPAP in addition to standard care, in the first hour after admission. 23 parents refused to give consent for participation. 2 infants did not tolerate nCPAP.InterventionThe outcome was assessed after 60 minutes. If nCPAP was not tolerated or the distress increased, the infant was switched to standard care. Analysis was done on intention-to-treat basis.Main outcome measuresChange in respiratory rate, Silverman-Anderson score and a Modified Pediatric Society of New Zealand Severity Score.Results14 out of 32 in nCPAP group and 5 out of 35 in standard care group had change in respiratory rate ≥10 (P=0.008). The mean (SD) change in respiratory rate[8.0 (5.8) vs 5.1 (4.0), P=0.02] in Silverman-Anderson score [0.78 (0.87) vs 0.39 (0.73), P=0.029] and in Modified Pediatric Society of New Zealand Severity Score [2.5 (3.01) vs. 1.08 (1.3), P=0.012] were significantly different in the nCPAP and standard care groups, respectively.ConclusionnCPAP helped reduce respiratory distress significantly compared to standard care.