Management Of Bronchiolitis Research Articles

Impact of Hyaneb in the management of severe acute bronchiolitis in pediatric patients: a single-center retrospective study

Abstract Background To determine the impact of Hyaneb (7% hypertonic saline and 0.1% hyaluronic acid) on severe acute bronchiolitis management in pediatric patients. The aim of this study is to evaluate the possible benefits and safety of Hyaneb in managing severe acute bronchiolitis. Methods This retrospective observational study was conducted in a tertiary healthcare center. The investigation included patients aged < 2 years who were admitted to the pediatric intensive care unit (PICU) of the Clínico San Carlos Hospital. Patients were excluded if they had a radiological diagnosis of pneumothorax on admission, infection by other microorganisms, bronchiolitis for > 5 days, need for respiratory or hemodynamic support with extracorporeal techniques, or known allergies or intolerance to any Hyaneb compounds. We evaluated the potential benefit and safety of using Hyaneb in severe acute bronchiolitis between 2019 and 2020 by comparing two groups of patients: one that received Hyaneb and the other that did not. Results A total of 49 children were included in the study, and 51.7% received Hyaneb. The median age was 1 month (interquartile range [IQR] 1.5–2.0), and the median weight was 4.7 ± 1.3 kg. Patient history included premature birth in 10% of the sample population. The results were not significant for the length of stay in the PICU and the respiratory support score (p = 0.114 and p = 0.06, respectively). However, there was a significant difference (p = 0.047) in the use of adrenaline rescue between the groups. These data were no longer significant when adjusted for age, Wood Downes scale, and weight (p = 0.056). Conclusions Using nebulized Hyaneb seems safe in patients less than a month old and weighing less than 5 kg. A reduction in PICU stay or respiratory support length could not be confirmed.

Practice in bronchiolitis management in Polish hospitals—a multicenter retrospective cohort study

Bronchiolitis is one of the main reasons for the hospitalization of young children. Based on updated recommendations, only supportive therapy is recommended for treatment. In Poland, many children that are hospitalized with bronchiolitis undergo a treatment that is not supported by current research. The study aimed to assess clinicians’ adherence to the guidelines. This was a multicenter retrospective study of hospitalized infants with bronchiolitis; a cohort study design was utilized. Data were collected in four Pediatric Departments in Poland. All infants aged less than 24 months that had been hospitalized for their first and subsequent episodes of acute bronchiolitis from January 1, 2021, to December 31, 2022, were included. The exclusion criterion was an age over 24 months. A total of 629 infants with a median age of 8.5 months were included in this study. The medical interventions and treatments varied between the four hospitals. Laboratory blood tests were run for almost all children (99.5%), and the percentage of children for which a chest X-ray was performed ranged from 1.3% to 44%. The other measures were the use of intravenous hydration (51.3%-93.3%), use of hypertonic saline nebulization (1.3%-43.6%), use of normal saline nebulization (10%-95.1%), use of oxygen (7.3%-42%), use of beta-mimetics (19.1%-89.4%), use of nebulized steroids (8%-76.9%), use of systemic steroids (0.9%-42%), use of nebulized adrenaline (0%-8.1%), and use of antibiotics (12%-21.8%).Conclusions: In total, 70% of infants who were hospitalized in four hospitals in Poland underwent examinations and treatment methods that are not supported by current guidelines and evidence-based research. This study shows that non-recommended medications are overused in bronchiolitis treatment, and there is a need to take action to implement the guidelines into healthcare providers’ work.What is Known:• Bronchiolitis is a lower respiratory tract viral infection and is one of the main reasons for hospitalization among young children.• Only supportive therapy is recommended in the guidelines.• Bronchodilators, nebulized adrenaline, nebulized or systemic steroids, and antibiotics are not recommended.What is New:• Non-recommended medications are overused in bronchiolitis treatment in Poland.• Up to 70% of hospitalized children in the studied centers underwent treatment that is not supported by guidelines.

Saline nebulizers in treatment of bronchiolitis

ABSTRACT Introduction: This study was conducted to assess the response to treatment and compare the effects of nebulized normal saline 0.9% and hypertonic saline 3% in the management of acute bronchiolitis, a condition associated with multiple complications in pediatric patients. Materials and Methods: In this clinical trial, a total of 60 children diagnosed with viral bronchiolitis in the autumn and winter of 2018 at Ali Asghar Children’s Hospital’s emergency department were enrolled. The cohort consisted of 30 children in the control group treated with normal saline 0.9% nebulization and 30 in the treatment group treated with 3% hypertonic saline nebulization. Demographic variables, symptom onset duration, and initial heart and respiratory rates were recorded. Disease severity was assessed using the Respiratory Distress Assessment Index (RDAI). Data were analyzed using SPSS software. Results: Following treatment, both groups exhibited significant improvements in vital signs (respiratory rate, heart rate, and oxygen saturation) and RDAI scores (P value < 0.001). However, there was no statistically significant difference in the degree of improvement in vital signs and RDAI scores between the two treatment groups (P value > 0.05). The mean hospital stay duration did not significantly differ between the groups (P value = 0.16). Conclusion: Nebulized hypertonic saline and normal saline both effectively ameliorated symptoms in children with bronchiolitis. The absence of a significant difference between these treatments suggests that either can be recommended for use in the pediatric population experiencing acute bronchiolitis symptoms.

Clinical practice guidelines for the management of bronchiolitis in children (2024 version)

Clinical practice guidelines for the management of bronchiolitis in children (2024 version)

Management of RSV Bronchiolitis in Outpatient Setting

AbstractSeasonal respiratory syncytial virus (RSV) lower respiratory infections (RSV-LRI) and bronchiolitis in children remain a high burden to medical facilities. Studies evaluating the practical approach in outpatient settings are scarce. We conducted a survey to provide an insight into management in pediatric offices in Germany. Invitations for participation in an online survey were sent to 623 providers of pediatric primary care via email. Recipients were randomly chosen from national databanks based on zip codes. The response rate was 16,2%, n=92 (14,7%) questionnaires were fully answered and analyzed. 93,5% (n=86) are board certified pediatricians. In outpatient setting, every second patient with suspected or confirmed RSV-LRI is presented three times or more. 40,7% of our participants refer less than 10% of all patients to hospital, 83,7% refer less than one third (<30%). 33,7% of all participants never perform virological testing in suspected cases of RSV-LRI. More than 50% of all participants prescribe bronchodilators, hypertonic saline inhalation is prescribed by 17,4%. Antibiotics are prescribed in less than 10% of all cases of RSV-LRI. About 3/4 ask for a clearer, more conclusive guideline regarding prophylaxis. The diagnostic approach varies significantly. Although not recommended in international guidelines, bronchodilators are still frequently used. Considering emerging options for passive immunization, broader inclusion criteria into immunization regimes are requested by the participants. More conclusive guidelines and recommendations could further improve the management of outpatient RSV-LRI in children.

Sustainability assessment of a quality improvement initiative on the management of bronchiolitis

BackgroundA bronchiolitis integrated care pathway (BICP) achieved an 87% reduction in the use of medications in our regional health service (RHS) during the 2019–2020 season.AimThis study aimed to assess the...

Acute Bronchiolitis: The Less, the Better?

Acute bronchiolitis is a viral infection of the lower respiratory tract affecting infants aged under 12 months, variably presenting with respiratory distress, diffuse crackles and inflammatory wheezing. The main causative agent is Respiratory Syncytial Virus (RSV). The diagnosis is clinical and treatment mainly supportive. Despite the availability of more than 30 international guidelines, consistent management recommendations are lacking and considerable variability in patients' care persists among different providers. To review and describe current knowledge about epidemiology, physiopathology, clinic, diagnosis and management of acute bronchiolitis, with particular emphasis on updated evidence and future perspectives in terms of treatment and prevention. We searched Cochrane for systematic reviews and PubMed for scientific articles published in the last 10 years, using a combination of the following search terms: "bronchiolitis", "respiratory syncytial virus", "epidemiology", "risk factors", "severity", "diagnosis", "clinic", "diagnostic imaging", "management", "asthma", "wheezing", "bronchodilator", "steroids", "hypertonic saline", "oxygen", "blood gas analysis", "HHHFNC", "rehydration", "enteral feeding", "parenteral hydration", "prevention", "vaccine" and "COVID-19 or SARS-CoV2". We accordingly performed a deep and extensive selection of the most updated and considerable literature on the matter, summarizing the most significant evidence concerning all aspects of acute bronchiolitis (epidemiology, clinic, diagnosis, management and prevention). Furthermore, we examined references and available guidelines from UK, USA, Canada, Italy and Spain. Results are extensively discussed below. Although acute bronchiolitis has been a widely known disease for decades, its therapeutic approach remained unchanged and essentially limited to respiratory and metabolic support. Despite the abundance of studies, there is no significant evidence concerning therapeutic alternatives (e.g. steroids, inhaled hypertonic solution), which are therefore not recommended. According to most recent data, "acute bronchiolitis" definition encompasses a plethora of different clinical entities related to each subject's genetic and immune predisposition. Therefore, future research should focus on the precise characterization of such subcategories in order to individualize therapeutic management and ensure the most appropriate evidence-based care.

Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting.

Systematically review the management of infants with severe bronchiolitis in a paediatric intensive care unit (PICU) setting with a focus on high-risk infants to identify gaps in evidence-based knowledge. This systematic review utilised Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) to examine the literature on the PICU management of bronchiolitis in infants <24 months old. Three databases, Embase, PubMed and Medline, were searched and higher levels of evidence I, II and III were included. There were 455 papers reviewed and 26 met the inclusion criteria. Furthermore, 19 of these studied respiratory interventions such as positive airway pressure and oxygen delivery. The remaining 7 examined: erythropoietin, caffeine, dexamethasone, protein supplementation, ribavirin, respiratory syncytial virus immune globulin, or diuretic therapy. Of the 26 studies, 20 excluded infants with high-risk conditions. Therapies showing favourable outcomes included Heliox, prophylactic dexamethasone pre-extubation, protein supplementation, and diuretic use. Clinical trials for bronchiolitis management frequently exclude high-risk children. Innovative study design in the future may improve access to clinical trials for the management of bronchiolitis in high-risk infants in a PICU setting. Clinical trials for bronchiolitis management frequently exclude high-risk children. We review the evidence base for the management of an under-investigated patient demographic in the setting of acute bronchiolitis. Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting.

Toma de decisiones para el manejo ambulatorio de la bronquiolitis según fisioterapeutas docentes de la Universidad del Gran Rosario

IntroductionClinical practice guidelines recommend against performing respiratory physiotherapy in children with bronchiolitis. It is unknown which interventions physiotherapists use in routine practice, and what factors influence their decisions. The aim was to characterize decision-making in outpatient management of bronchiolitis according to teaching physiotherapists from the University of Gran Rosario. Material and methodsA Delphi technique-based survey was conducted with physiotherapy teachers in 2 stages. The first stage involved a questionnaire with open-ended questions. The second stage was developed from the results of the first, consisting of closed-ended questions. A majority criterion was established among physiotherapists≥60%. ResultsA considerable variability was observed in the interventions considered for the management of bronchiolitis. Over 60% of professionals expressed full agreement that their interventions are based on their knowledge of basic sciences, scientific evidence, clinical evaluation, and academic training. Also, over 60% stated full agreement that the application of interventions depends on clinical aspects of the child, their socioeconomic context, and their family's commitment to treatment. ConclusionsThe clinical intervention process as informed by physiotherapists differs from clinical practice guidelines recommendations. Multiple factors seem to condition, according to the statements of consulted physiotherapists, decision-making in the outpatient management of bronchiolitis.

Acute viral bronchiolitis in infants: A narrative literature review

Severe acute bronchiolitis is mostly caused by the respiratory syncytial virus (RSV) and is the main cause of hospitalization in children under one year old. Although it has a low mortality rate, it has a high morbidity rate, requiring early diagnosis through a detailed clinical history and physical examination. A narrative review of fourteen articles found in the PubMED/MEDLINE, SciELO and BVS electronic databases was therefore carried out, with the aim of reviewing the most up-to-date literature on the subject. Currently, the monoclonal antibody Palivizumab is the main agent used to prevent bronchiolitis and is available for patients at high risk of developing the serious disease. In addition, the Abryso vaccine was recently approved by the National Health Surveillance Agency (Anvisa) and will be administered to pregnant women in the last trimester of pregnancy, with the aim of preventing the disease in newborns. Finally, it was found that the appropriate management of acute viral bronchiolitis consists of supportive measures such as hydration, nutritional support and oxygenation when necessary, while the use of corticosteroids and bronchodilators has not been shown to reduce the length of hospital stay or the natural course of the disease.

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.

Comparing Treatment with Nebulized 3% Hypertonic Saline Versus Nebulized 0.9% Saline In Patients With Acute Bronchiolitis: A Double-Blind Randomized Controlled Trial

Objective: To establish the therapeutic role of nebulized hypertonic saline solution in the management of acute bronchiolitis in terms of primary and secondary outcomes. Methods: This randomized control trial was conducted in the Pediatric department of Holy Family Hospital, Rawalpindi for 8 months from September 2021 to April 2022 after ethical approval. A total of 65 cases of acute bronchiolitis were enrolled who were divided into two groups. The intervention group was nebulized with 3 ml of 3% hypertonic saline 6 hourly while the control group was nebulized with 0.9% saline 6 hourly during hospital stay in addition to the standard treatment. Children in both groups were monitored in terms of clinical severity score, feeding, hydration status, length of hospital stay, duration of oxygen supplementation, development of any adverse effect, and outcome (length of hospital stay and clinical severity score) was observed. Data was collected on a predesigned proforma, and SPSS version 21 was used to analyze the data. Results: Two groups were comparable for age, gender, and baseline characteristics including clinical severity score. Length of hospital stay was significantly less in the hypertonic saline group 75.53 ±43 .87 versus 45.92 ± 12.19 (p-value 0.000). Similarly, in patients requiring oxygen, treatment with hypertonic saline significantly reduced the duration of nebulization, 27.21 ±26.20 versus 10.67± 7.91 (p-value 0.03). However clinical severity score between the two groups was not different, 5.42 ± 2.88 in the saline group and 4.50 ± 2.88 p value 0.921. Conclusion: Nebulization with hypertonic saline reduces oxygen requirement and benefits in reducing the length of hospital stay. Keywords: Bronchiolitis, Hypertonic saline (HS), Normal saline (NS)

Respiratory syncytial virus subtypes in children with bronchiolitis: does it correlate with clinical severity?

BackgroundIn this retrospective study, we aimed to evaluate the factors associated with the severity of respiratory syncytial virus (RSV) bronchiolitis in children aged under 2 years who were admitted to the Children’s Hospital of Hebei between June 2018 and January 2019.MethodsSputum samples positive for RSV via multiplex PCR were subtyped using real-time PCR. Data collected included risk factors for disease severity, demographics, microbiology, and outcomes.ResultsOf the 82 children with RSV bronchiolitis, 79 were treated and discharged with improvement, while 3 died. All three patients had underlying medical conditions, including complex congenital heart disease and severe combined immunodeficiency. Further, disease severity was associated with preexisting underlying disease, fever duration, and bacterial co-infection, but not with the RSV subtype.ConclusionsOur findings suggest that an appropriate therapeutic regimen should include the detection of bacterial co-infections and the identification of underlying diseases for the effective management of severe RSV bronchiolitis.

Inpatient Rsv-Management 2016-2022: Epidemiology and Adherence to A Bronchiolitis Treatment Standard at a German University Children's Hospital.

This study analyzes the RSV season 2021/2022 in a referral children's hospital, compares the epidemiology and illness severity with RSV-infected inpatients from 2016 to 2020 and audits the adherence to our internal therapy standard for RSV bronchiolitis. Inpatients with rtPCR-confirmed RSV infection (Jan. 2016 to Jan. 2022). The audit comprises 306 RSV inpatients, on average 50 hospitalizations per year; in 03/2020, a rapid RSV Season-Offset was observed. In the winter season 2020/2021, no patient with RSV was hospitalized. Beginning in July, we noticed a rapid increase of RSV-admissions (most cases in Sept./Oct, duration until Dec. 2021; n=53). In 2021-2022, a significant larger share needed PICU admission (9.4% vs 3.2%, p=0.040). Adherence to the internal guidance was low; only 11.8% (n=36) of all patients received supportive treatment without inhalative or systemic medications, 37% of all patients received antibiotics. This audit confirms the strong impact of public preventive measures directed against SARS-CoV-2 transmission on RSV epidemiology. Few weeks after easing public COVID-19 restrictions (summer 2021), RSV inpatient cases rapidly increased, lasting until Dec. 2021. The audit of bronchiolitis management revealed surprisingly low adherence to the internal guidance, despite a face-to-face educational session with the attending pediatricians in Oct. 2021. Low adherence resulted in an unnecessary exposure of RSV patients to systemic medications of questionable benefit including antibiotics.

Saudi Initiative of Bronchiolitis Diagnosis, Management, and Prevention 2024 updated consensus on the prevention of respiratory syncytial virus.

Respiratory syncytial virus (RSV) is the major cause of bronchiolitis among children under 5 years of age worldwide, accounting for a prevalence of 25%-88% in Saudi Arabia. Although no effective treatment for the virus exists, passive immunoprophylaxis reduced RSV hospitalizations in high-risk children. With recent advances in immunization, the Saudi Initiative of Bronchiolitis Diagnosis, Management, and Prevention panel screened recent relevant international guidelines, locally published data, and expert consensus to update guidelines for RSV prevention, taking into consideration the resources, timing, varying health profiles, and RSV burden in Saudi Arabia. The panel updated its recommendations to include immunization of infants, mothers, and older adults. Practical guidelines were prepared to facilitate the administration of the short-acting and newly developed long-acting RSV monoclonal antibodies (mAb) during the regular follow-ups of high-risk infants in specialized clinics. In addition, long-acting mAb was highlighted as all-infant protection in the routine immunization calendar.

Management of Acute Bronchiolitis in Spoke Hospitals in Northern Italy: Analysis and Outcome.

Bronchiolitis is an acute viral infection of the lower respiratory tract that affects infants and young children. Respiratory syncytial virus (RSV) is the most common causative agent; however, other viruses can be involved in this disease. We retrospectively reviewed the clinical features of infants aged less than 12 months hospitalized for acute bronchiolitis in our Pediatric Units of Chivasso, Cirié, and Ivrea in Piedmont, Northern Italy, over two consecutive bronchiolitis seasons (September 2021-March 2022 and September 2022-March 2023). Patient-, disease-, and treatment-related variables were analyzed. The probability of therapeutic success (discharge home) was 96% for all patients (93% for RSV vs. 98% for non-RSV patients, p > 0.05). Among 192 patients, 42 infants (22%) underwent high-flow oxygen support (HFNC), and only 8 (4%) needed to be transferred to our hub referral hospital. Factors associated with hub hospital transfer were the age under 1 month and the failure of HFNC. The wide and increasing use of HFNC in pediatric inpatients improved the management of bronchiolitis in Spoke hospitals, reducing transfer to a hub hospital provided with Intensive Care Units.

A brief focus on 2022 Italian guidelines on the management of bronchiolitis in infants

The intersociety consensus document “UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants” aimed to update the previously published clinical practice guidelines on the prevention and treatment of bronchiolitis in newborns and infants. Moreover, due to the tremendous disagreement among the clinical practice guidelines and approaches to viral bronchiolitis, the new intersociety consensus document also aimed to unify diagnostic and therapeutic criteria, reinforce the current recommendations, and integrate the most recent advances for optimal care of viral bronchiolitis. The document addresses care in both hospitals and primary care.

Clinical course and complications of RSV versus non-RSV bronchiolitis in hospitalised children

Introduction and objective: Bronchiolitis in young children often requires hospitalisation. It is mostly caused by respiratory syncytial virus (RSV) and aetiological factors may be associated with clinical presentation and prognosis. We aimed to compare the epidemiology, clinical features, severity and management of RSV and non-RSV bronchiolitis. Materials and methods: This cross-sectional retrospective study included hospitalised children under 2 years of age. Children with a positive rapid antigen diagnostic test and/or molecular study were included in the RSV group, while those with a negative result were classified as non-RSV bronchiolitis. We compared patient history, clinical presentation, disease severity including passive oxygen therapy, intensive care unit transfer, death, length of hospital stay, presence of complications, oxygen saturation &lt;92%, acidosis, hypercapnia and treatment used. Results: The study included 524 patients (median age 2 months): 462 (88%) RSV and 62 (12%) non-RSV cases. A 7-fold increase in the number of cases was observed between 2010–2011 and 2017–2018. A univariate regression model showed lower odds of family history of atopy (odds ratio, OR = 0.46), higher odds of cough (OR = 4.74), apathy (OR = 2.61), feeding difficulties (OR = 2.03) and vomiting (OR = 3.34) in the RSV group. RSV patients required oxygen therapy (OR = 3.78) and antibiotics (OR = 2.82) more frequently, received inhaled steroid therapy for longer (9 vs. 8 days) and had a higher likelihood of complications (OR = 4.24). A multivariate model showed statistical significance for cough (OR = 6.22), oxygen therapy (OR = 4.43) and complications (OR = 15.95). Conclusions: We observed an increasing trend in bronchiolitis hospitalisations, including RSV bronchiolitis, which was associated with a more severe disease course. No significant clinical features were identified to replace laboratory tests.

An Update of Bronchiolitis - A Review

Bronchiolitis is one of the most common respiratory infections in children under 2 years of age predominantly caused by Respiratory syncytial virus and other viruses like influenza, Para influenza, and Adenovirus. Rhinovirus, etc. Most children have mild symptoms however bronchiolitis has also been well linked to severe morbidities and mortalities. Even though bronchiolitis has been well recognized for many years, there are still very few therapeutic strategies available beyond supportive management. There are many controversies about therapeutic management in bronchiolitis published in standard guidelines and research in this area. Management can be divided into pharmacological and supportive therapy. Evidence suggests that the current management of bronchiolitis is purely supportive consisting of oxygen supplementation, frequent suctioning, and maintaining good hydration and nutrition. Regarding pharmacological therapy, neither bronchodilators nor corticosteroids have significant efficacy in the treatment of bronchiolitis. However, some studies suggest that adrenaline and nebulizer 3% saline showed some benefit only in terms of outcome. The current recommendation also supports the use of Palivizumab as prophylaxis in certain groups of infants and young children.

Management of bronchiolitis in infants in primary care settings: What to do and what not to do.

Management of bronchiolitis in infants in primary care settings: What to do and what not to do.