Respiratory Syncitial Virus Bronchiolitis Research Articles

Demographic, Clinical and Hematological Profile of Children with Bronchiolitis: A Comparative Study between Respiratory Synctial Virus [RSV] and [Non RSV] Groups.

Acute bronchiolitis is one of major disease affecting the lower airways in infants and children with Respiratory Syncitial Virus (RSV) being most common causative organism accounting for 50%-80% of bronchiolitis cases. To analyse the demographic characteristics, clinical features and haematological profile of children with Bronchiolitis. To compare the findings of demographic characteristics, clinical features and haematological profile between RSV and Non -RSV bronchiolitis. This is a prospective study, conducted in a teritiary care center for 1 year period from Jan 2015 to Dec 2015. The demographic characteristics, clinical features and haematological profile of children aged between 1 month to 3 years who fulfilled the inclusion criteria were noted in predesigned proforma, nasopharyngeal swab was sent for RSV analysis and then the findings of the parameters were compared between the two groups of RSV bronchiolitis and Non RSV bronchiolitis. Among 80 cases with 40 in each group, children below the age of 1year were affected more in RSV group, with male preponderance. Among the clinical features except that 89.7% of RSV cases had wheeze that was statistically significant with no difference in other features. Investigations showed no much difference in both the groups. Percentage of Non RSV subjects who received nebulisation with bronchodilators, steroid and antibiotic therapy were higher than RSV subjects. The hospital stay was significantly higher in RSV cases and none of the study participants met with mortality. Children with RSV bronchiolitis had prolonged hospital stay compared to Non RSV group. Need for nebulisation with bronchodilators, steroids and antibiotic therapy was more in Non RSV group.

PO-0565 Four Years Cohort Of Late Preterm Infants From A Terciary Spanish Hospital: Risk Factors For Respiratory Syncitial Virus Infections

Background and aims Respiratory Syncitial Virus (RSV) causes respiratory infections that may be severe, especially in one of the highest risk populations: Premature infants. Palivizumab has proven safe and efficacious in reducing hospitalisation rate for RSV induced bronchiolitis in preterm neonates. This study aimed to evaluate in a Spanish cohort of late preterm infants the incidence and risk factors of hospitalisation for RSV bronchiolitis. Update the indication of RSV prophylaxis. Methods Descriptive study. A cohort of late preterm infants born in a Spanish third level hospital (2010–2014) was enrolled. Medical records were reviewed. Risk factors for RSV infections were reviewed. Recommendations for inmunoprophylaxis issued by the Spanish Society of Neonatology 2010 were followed. Results 887 late preterm infants were enrolled. 4,1% were hospitalised for RSV bronchiolitis, median age was 5 months old. According to the gestational age: 16% were 34 weekers (one RSV prophylaxis), 45% 35 weekers (three RSV prophylaxis), and 38% 36 weekers (one RSV prophylaxis). The risk factors for RSV hospitalisation: 56% were born in RSV season, 48% had school age siblings, 54% were male gender. Anyone was exposed to passive cigarette smoke. 16% were admitted to ICU. All the hospitalised infants required oxygen at any time. No deaths were reported. Conclusions Hospitalisation rate for RSV bronchiolitis in late preterm infants of our cohort was higher than the estimated one in overall population. RSV prophylaxis was not routinely scheduled to late preterm infants according to the Guidelines issued by the Spanish Society of Neonatology. Its risk scoring tool for prophylaxis can be used to identify infants at higher risk.

Analysis of the local and systemic inflammatory response in hospitalized infants with respiratory syncitial virus bronchiolitis

BackgroundRespiratory syncytial virus acute bronchiolitis (RSV-AB) is a major cause of hospital admission among our infants. The immune and inflammatory mechanisms involved in the RSV-AB and factors influencing severity have not been clearly established, although an imbalanced Th1 and Th2 response seems to be crucial. ObjectivesTo assess the local and systemic inflammatory response in RSV-AB. To find a possible marker of clinical severity and/or oxygen requirements. Patients and methodsLevels of nine cytokines were measured in nasopharyngeal aspirate (NPA) and peripheral blood (PB) of 45 infants with RSV-AB and 27 peer controls, including IFNγ, TNFα, VEGF, interleukins 4, 6 and 10, and chemokines (IL-8 and macrophage inflammatory proteins 1-α and 1-β). ResultsThe levels of the analyzed cytokines and chemokines were significantly higher in the NPA of RSV-AB group, with a decrease in IL-4/IFNγ ratio. IL-6 and MIP-1β levels in NPA were directly correlated to oxygen therapy. PB showed an increase in IL-8 and a decrease in MIP-1α and MIP-1β in the RSV-AB group (only MIP-1β associated to the need for oxygen therapy). No correlation was found between cytokines and chemokines levels in NPA and PB. ConclusionsThis study shows that RSV triggers an inflammatory response fundamentally at the respiratory level, with scant systemic repercussion. This local response is characterized by an increase in Th1 and Th2 cytokines, although with a relative predominance of Th1. The determination upon patient admission of IL-6 and MIP-1β levels in NPA, and of MIP-1β in PB could help predict severe forms and the need for oxygenotherapy.

1829 Severe Forms of Osteogenesis Imper.Fecta (OI) In Infants and the Role of Respiratory Syncitial Virus (RSV) Immunoprophylaxis with Palivizumab

Background and AimsRespiratory illnesses could be serious, even life threatening among infants with severe forms of osteogenesis imperfecta (OI). Respiratory syncitial virus (RSV) bronchiolitis could deteriorate the respiratory status of...

Endotracheal DNase for atelectasis in ventilated neonates

Management of atelectasis and lung collapse in ventilated neonates remains a common challenge in the neonatal intensive care unit. Recombinant human DNase (rhDNase) is an established treatment of atelectasis in cystic fibrosis and its use is also reported in the management of asthma, respiratory syncitial virus bronchiolitis and bronchiectasis to liquefy sputum and aid its clearance from the lungs. We report the use of rhDNase in a subgroup of ventilated neonates with severe end-stage respiratory failure and atelectasis. Three of the four patients showed clinical improvement. A previously undiagnosed lung anomaly was subsequently identified in the fourth patient. Future randomized studies could examine any potential benefits of this emerging therapy.

Pediatric obstructive sleep apnea: A potential late consequence of respiratory syncitial virus bronchiolitis

To examine the hypothesis that children who suffered from severe respiratory syncitial virus (RSV) bronchiolitis during infancy may be at higher risk for obstructive sleep apnea (OSA) later in childhood. Survey of Kosair Children's Hospital medical records allowed for identification of potential candidates for the study. Twenty-one randomly selected children (mean age +/- SD: 5.2 +/- 1.5 years) with a history of verified RSV-induced bronchiolitis during their first year of life underwent overnight sleep study (NPSG). Children recruited from the general population with no history of RSV bronchiolitis served as a control group. After matching for age, gender, ethnicity, gestational age at birth, body mass index (BMI) z scores, household cigarette smoking, history of asthma and allergies, 63 control subjects (mean age +/- SD: 5.1 +/- 0.7 years) were also studied. Children who had RSV bronchiolitis as infants had significantly higher obstructive apnea/hypopnea index compared to controls (2.3 +/- 1.9 vs. 0.6 +/- 0.8 /hr total sleep time (TST); P < 0.05). In addition, significantly higher respiratory arousal indices were apparent among children with previous RSV bronchiolitis compared to controls (1.3 +/- 1.0 vs. 0.1 +/- 0.2 /hr TST; P < 0.05). There were no significant differences between the groups in the lowest SpO(2), ETCO(2), and sleep indices. RSV bronchiolitis may contribute to the pathophysiology of OSA in vulnerable children.

IL-17F His(161)Arg but not IL-8 A(???251)T is associated with the development of respiratory syncitial virus bronchiolitis in the Japanese population

IL-17F His(161)Arg but not IL-8 A(???251)T is associated with the development of respiratory syncitial virus bronchiolitis in the Japanese population

La vaccination rotavirus en France : position du groupe francophone d'hépatologie, gastroentérologie et nutrition pédiatriques

The rotavirus is the major cause of infantile gastroenteritis worldwide. In Europe and in industrialized countries, rotavirus infections bring out considerable economic expenses. In France, the burden of health expenses is particularly marked during winter period, the peak of rotavirus infections coinciding with that of the respiratory syncitial virus bronchiolitis, this specificity results in an increase of nosocomial infections during this period and a saturation of beds in paediatric hospitals. Vaccination likely represents the only efficacious adapted response to rotavirus infections. Two vaccines have recently been developed and licensed in France. The development of these two vaccines has followed two different strategies. Despite their differences, these vaccines are both safe and efficient in protecting young infants against severe rotavirus acute gastroenteritis. French Health Authorities decided to postpone rotavirus vaccination for at least two years. According scientific and economic data, the French Speaking Group of Gastroenterology Hepatology and Nutrition disagrees with this decision and states that rotavirus vaccination is universally recommended for healthy infants under six months.

Lipopolysaccharide hyporesponsiveness as a risk factor for intensive care unit hospitalization in infants with respiratory syncitial virus bronchiolitis

Factors such as genetic heterogeneity in the immune response contribute to respiratory syncytial virus (RSV) bronchiolitis severity. Such heterogeneity may manifest by an aberrant proliferation of phytohaemagglutinin (PHA)-stimulated peripheral blood mononuclear cells (PBMC) in response to lipopolysaccharide (LPS). The proliferation of PBMC was analysed in 52 infants: 21 ambulatory infants with mild RSV bronchiolitis (group I), 26 hospitalized infants with RSV bronchiolitis on ward (group II) and five intensive care unit (ICU) hospitalized infants (group III). Proliferation was analysed in response to negative control, PHA (LPS) and LPS/PHA. The TLR4 mutations were genotyped using reverse-transcriptase-polymerase chain reaction. The optical density (OD) post-LPS/PHA of group II (1.27 +/- 0.63) was significantly higher than group II (0.65 +/- 0.38, P = 0.005) or group I (0.63 +/- 0.33, P = 0.003), suggesting hyporesponsiveness to the LPS attenuation effect. None of the ICU hospitalized infants demonstrated OD readings post-LPS/PHA under the 0.75 threshold as opposed to group I (67% under 0.75) and group II (69%) (P < 0.05). The responses to negative-control, LPS and PHA stimulation alone were similar across groups. The presence of TLR4 mutations (Asp299Gly and Thr399Ile) were associated with severe RSV bronchiolitis and were significantly over-represented in groups II and III. These findings suggest that impairments of PBMC function manifested by hyporesponsiveness to LPS as well as the presence of TLR4 mutations are associated with an increased risk for more severe RSV bronchiolitis in previously healthy infants. A certain threshold of LPS hyporesponsiveness may have a very high negative predictive value for ICU hospitalization, even better than the determination of known TLR4 mutations for this purpose.

The accuracy of tonicity balance formulas in predicting changes in plasma sodium in ventilated infants with respiratory syncitial virus bronchiolitis

The accuracy of tonicity balance formulas in predicting changes in plasma sodium in ventilated infants with respiratory syncitial virus bronchiolitis

Presence of IgE in Nasal Secretions of Infants with Respiratory Syncitial Virus induced Bronchiolitis. † 724

There is presently controversy as to whether Respiratory Syncitial Virus(RSV) induced bronchiolitis has an atopic association. We investigated this with the following aim: to determine the presence of Immunoglobulin E (IgE) in the airway of infants with acute RSV bronchiolitis, and to assess correlation with recognised demographic associations of atopy. RSV -ve bronchiolitics were used as controls. Method: Nasal samples(NS) were obtained from infants during the acute phase (AP) and convalescent phase (CP) of an episode of bronchiolitis. IgE was investigated using an ultrasensitive enzyme linked immunosorbent assay(ELISA). Results: Out of 95 AP samples 63(65%) showed detectable levels of IgE; expressed in pg/mg of albumin the range was 30 - 19,300 with median of 1050. This response was detectable in 55 of 80 who were RSV +ve and in 8 of 15 who were RSV -ve. In the CP samples only 16(27%) out of 54 tested showed the presence IgE. 15 of these were from infants who were RSV +ve at admission. The IgE/albumin ratio was available from both phases in 25 infants; in 7 of these there was a rise between the two phases, but in 13 a decrease. In 5 it was equivocal. There was no significant difference in detection or in the levels of IgE/albumin between the RSV +ve and -ve infants either in the AP or CP. No correlation with sex, age, maternal or family history of atopy was noted. Conclusion: IgE is detectable in the NS of bronchiolitics using an ultrasensitive ELISA. This response appears to be transient and is present in the RSV +ve and -ve infants. The magnitude of the response, its transience, and the lack of correlation with recognised associations of atopy are not consistent with the hypothesis that RSV bronchiolitis has an atopic association.