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PubMed1989

Childhood asthma following hospitalization with acute viral bronchiolitis in infancy.

A prospective follow-up of 48 infants hospitalized with respiratory syncytial virus bronchiolitis in the first year of life revealed that 44 of these infants had symptoms suggestive of asthma in the 5 years following their initial illness (cumulative prevalence 92%). Symptoms became less frequent and less troublesome during the follow-up period. Thirty-five of these children visited the laboratory for clinical examination, pulmonary function testing, and histamine challenge. Twenty-five children were believed to have clinical evidence of asthma at the time of the laboratory visit (point prevalence 71%). Five children were unable to perform pulmonary function tests; 25 of the remaining 30 (67%) had a positive histamine challenge test. No relationship could be demonstrated between a clinical diagnosis of asthma, a family history of atopy, and the results of histamine challenge testing. These results question the relationship between the results of bronchial provocation tests and clinical asthma in this age group.

Acute Disease↗
PubMed2004

[Nosocomial viral infections in a pediatric service: example of rotaviral gastroenteritis and respiratory syncytial viral bronchiolitis].

UNLABELLED: Nosocomial infections are a preoccupation in a pediatric hospital mainly during the winter with bronchiolitis and gastroenteritis epidemics. We have examined the risk factors of nosocomial infections. MATERIAL AND METHODS: A prospective study was conducted between November, 1999 and March, 2000 in the infants units of the Le Havre hospital. We systematically listed the admissions and contacted the family after their discharge by phone. A geographic information system was implemented to display the epidemiological data; this software is able to illustrate the sectors at risk. RESULTS: During the study, 687 infants were hospitalized of whom 458 for bronchiolitis and community-acquired gastroenteritis. Mean age was 5.4 months old. No nosocomial bronchiolitis occurred. Prevalence of nosocomial gastroenteritis was 10% (68 cases including nine after discharge). Infants with nosocomial infection were younger than those with community-acquired infection (6.6 months vs. 11.2 months, P < 0.01). The mean length of stay was longer in nosocomial infection (7.7 vs. 4.1 days, P < 0.05). Among the infants with bronchiolitis, 16% have developed nosocomial intestinal infections (RR = 2.65, IC: 1.59-4.4; P < 0.01). The geographic analysis pointed the area with nosocomial risk (bedroom without water, nearness of nurse office and games room). CONCLUSION: Geographic information system is a part of the quality control system and may have some interaction effect on final decision making. Incidence of nosocomial infections showed the need for a prevention strategy in a pediatric hospital.

Age Distribution↗
PubMed2000

Feeding efficiency and respiratory integration in infants with acute viral bronchiolitis.

OBJECTIVE: To examine the effects of bronchiolitis on feeding efficiency and respiratory integration. STUDY DESIGN: We studied 21 infants with bronchiolitis and 21 bottle-fed healthy infants who formed a comparison group. Repeat evaluations of half the bronchiolitis group were performed during recovery. During each feeding study we measured the duration and frequency of sucking, the frequency of single and multiple swallows, the respiratory rate, the postswallow respiratory direction, and the suck and swallow volumes. RESULTS: The infants with bronchiolitis devoted significantly less time to sucking than their healthy peers (P <.05), and the mean suck volume was reduced. Although the frequency of swallowing was slightly higher, the volume of milk consumed per swallow was almost half the amount consumed by the comparison group (P <.01). Coordination of breathing with swallowing was also less effective (P <.01). CONCLUSION: Although most aspects of feeding are less efficient during periods of respiratory illness, others are preserved or recover rapidly. Coordination of breathing during feeding is also significantly impaired.

Acute Disease↗
PubMed2002

A hypothesis: antenatal sensitisation to respiratory syncytial virus in viral bronchiolitis.

AIM: To investigate the possibility of antenatal sensitisation to respiratory syncytial virus (RSV). METHODS: A total of 36 cord blood specimens were obtained from newborn infants; serum IgA was measured to exclude maternal blood contamination. Cord peripheral blood mononuclear cells were separated and cultured in the presence of either uninfected negative control cells or cells containing ultraviolet (UV) inactivated RSV. Proliferation was assessed by tritiated thymidine incorporation. Supernatant cytokine concentrations were measured using ELISA. RESULTS: Significantly higher proliferative response rates to UV inactivated RSV were shown in those infants exposed in utero to the RSV epidemic after 22 weeks gestation. UV inactivated RSV stimulation induced significantly higher interferon gamma production from specimens with a positive proliferative response (sensitised) than from those with a negative response (not sensitised). CONCLUSIONS: Antenatal sensitisation to RSV occurs in one third of infants exposed to an RSV epidemic at the appropriate time of gestation. This sensitisation is associated with increased interferon gamma production, suggesting a type 1 memory response. We hypothesise that priming of fetal T cells to RSV results in a reduced severity of subsequent RSV disease in these individuals and that this will explain much of the clinical diversity of RSV disease.

Bronchiolitis, Viral↗
PubMed2003

Current treatment for acute viral bronchiolitis in infants.

This paper provides an update and critical review of available data on the treatment of acute viral bronchiolitis in previously healthy infants, with special focus on new or promising therapies. The main potential benefits of medical assistance in these patients reside in the careful monitoring of their clinical status, the maintenance of adequate hydration and oxygenation, the preservation of the airway opened and cleared of secretions and the option to perform parental education. There is no convincing evidence that any other form of therapy will reliably provide beneficial effects in infants with bronchiolitis and currently, any treatment beyond supportive care should be prescribed on a case-by-case basis with watchful appraisal of its effects. Therapies such as ribavirin, IFN, vitamin A, antibiotics, mist therapy or anticholinergics, have not demonstrated any measurable clinical effect. Several studies and meta-analyses with beta(2)-agonists and corticosteroids have failed to show any benefit of significant extent, however, physicians keep favouring their use. Presently, adrenaline has received rather consistent support from clinical trials but it is not yet widely prescribed. There are other therapeutic strategies, for instance, heliox, hypertonic saline, noninvasive ventilation, physical therapy techniques, thickened feeds or palivizumab that have shown promising potential benefits, but evidence supporting its use is still limited and further studies should be warranted. In the meantime, infants with acute viral bronchiolitis should be treated following evidence-based clinical practice guidelines, keeping the patient central in the process and being sensitive to social, cultural and familiar influences on their treatment strategy.

Acute Disease↗
PubMed1996

Surfactant abnormalities in infants with severe viral bronchiolitis.

To determine whether abnormalities of pulmonary surfactant occur in infants with acute viral bronchiolitis, surfactant indices were measured in lung lavage fluid from 12 infants with severe bronchiolitis and eight infants without lung disease. Compared with controls, the bronchiolitis group showed deficiency of surfactant protein A (1.02 v 14.4 micrograms/ml) and disaturated phosphatidylcholine (35 v 1060 micrograms/ml) which resolved as the disease improved. Surfactant functional activity was also impaired (minimum surface tension 22 v 17 mN/m). These findings indicate that surfactant abnormalities occur in bronchiolitis, and may represent one of the pathophysiological mechanisms causing airway obstruction.

Acute Disease↗
PubMed2006

Respiratory dysfunction and proinflammatory chemokines in the pneumonia virus of mice (PVM) model of viral bronchiolitis.

We explore relationships linking clinical symptoms, respiratory dysfunction, and local production of proinflammatory chemokines in the pneumonia virus of mice (PVM) model of viral bronchiolitis. With a reduced inoculum of this natural rodent pathogen, we observe virus clearance by day 9, while clinical symptoms and respiratory dysfunction persist through days 14 and 17 postinoculation, respectively. Via microarray and ELISA, we identify expression profiles of proinflammatory mediators MIP-1alpha, MCP-1, and MIP-2 that correlate with persistent respiratory dysfunction. MIP-1alpha is localized in bronchial epithelium, which is also the major site of PVM replication. Interferon-gamma was detected in lung tissue, but at levels that do not correlate with respiratory dysfunction. Taken together, we present a modification of our pneumovirus infection model that results in improved survival and data that stand in support of a connection between local production of specific mediators and persistent respiratory dysfunction in the setting of acute viral bronchiolitis.

Animals↗
PubMed2003

Randomized, double-blind, placebo-controlled trial of oral albuterol in infants with mild-to-moderate acute viral bronchiolitis.

OBJECTIVE: To determine whether oral albuterol is effective in reducing symptomatology of acute viral bronchiolitis in infants with mild-to-moderate illness. STUDY DESIGN: In a randomized, double-blind trial, previously well infants were randomized upon discharge from the emergency department to receive either albuterol (0.1 mg/kg/dose) three times per day or placebo three times per day for 7 days. Daily standardized telephone interviews were conducted for as long as 14 days. The primary outcome was the time to resolution of illness. Secondary outcomes included time to normal feeding, normal sleeping, quiet breathing, resolved cough, and coryza. RESULTS: We studied 129 infants (albuterol, n = 64; placebo, n = 65). Baseline characteristics were similar between groups. The overall mean age was 5.3 months, 60% were male, and 49 of 61 tested infants were positive for respiratory syncytial virus. The median (95% confidence interval) time to resolution of illness (days) was similar: albuterol, 9.0 (8-13); placebo, 8.0 (7-9); P =.3) (log-rank test). There were no significant group differences in any secondary outcome. Health care revisit and admission rates were similar between groups. CONCLUSIONS: No significant group differences in either primary or secondary outcomes in infants treated with oral albuterol versus placebo were found. The widespread use of oral albuterol in this patient group is not recommended.

Acute Disease↗
PubMed2004

Repair of incarcerated inguinal hernia in an infant with acute viral bronchiolitis.

PURPOSE: To describe the anesthetic concerns and management options in an infant with acute viral bronchiolitis who required emergency surgery. CLINICAL FEATURES: A 12-week-old infant presented to the emergency department with an incarcerated right inguinal hernia. The history was complicated by concurrent acute bronchiolitis. As the hernia was irreducible, emergency surgery was required. General endotracheal anesthesia, following a rapid sequence induction, was supplemented with a caudal epidural block. Inhaled salbutamol and suctioning for thick tracheal secretions were required and were found to be clinically useful. The baby made a good postoperative recovery. CONCLUSIONS: A variety of techniques may be used to anesthetize the infant with concurrent acute bronchiolitis. In this case a good outcome was achieved with combined general and regional anesthesia, together with the use of inhaled salbutamol.

Acute Disease↗
PubMedDate not supplied

[Association between ventilation index and time on mechanical ventilation in infants with acute viral bronchiolitis].

OBJECTIVE: To evaluate the association between time on mechanical ventilation and anthropometric, clinical and pulmonary function variables, measured early, in infants on invasive mechanical ventilation with acute respiratory failure due to viral bronchiolitis, and the temporal progression of variables with significant correlations. METHODS: Twenty-nine infants admitted to the pediatric intensive care unit of UNICAMP university hospital were studied. Acute viral bronchiolitis was defined according to clinical and radiological criteria. Children with chronic diseases and those that were hemodynamically unstable were excluded. All measurements were taken after 24 to 72 hours' mechanical ventilation, using volumetric capnography and blood gas analysis. Mechanical ventilation time was divided into: < or = 7 days and > 7 days. Association between time on mechanical ventilation and the variables analyzed was determined by Spearman's Correlation Coefficient (r(s)). RESULTS: Time on mechanical ventilation showed a significant positive correlation with PaCO(2) (rs = 0.45, p = 0.01) and ventilation index (rs = 0.51, p = 0.005), and a negative correlation with pH (rs = -0.40, p = 0.03). Ventilation indices of 37, measured between day one and day five, was associated with a progressively increased risk of more than 7 days on mechanical ventilation (OR = 4.2 on the first day to 15.71 on the fourth day). CONCLUSIONS: Ventilation index, PaCO(2) and pH, measured early, were associated with prolonged mechanical ventilation, reflecting the severity of ventilatory disturbance and the need for support.

Acute Disease↗
PubMed1990

Acute viral bronchiolitis in infancy: epidemiology and management.

Acute bronchiolitis due to viral agents (RSV, parainfluenza, influenza, adenovirus) is a relatively frequent disease of infancy. Seasonal epidemic pattern have been recognized, and nosocomial infections in pediatric wards occur. Until age 2 years most children have experienced some form of airway disease attributable to RSV. Some patients require hospital treatment; about 15% of our patients had to be transferred to the intensive care unit. Bronchiolitis seems to be frequently the first manifestation of asthma and we found higher IgG antibody titers to viruses causing bronchiolitis in children with asthma than in controls. Retrospective analysis of the charts of 147 cases of bronchiolitis revealed considerable uncertainty regarding therapeutic concepts. Mainstays of conservative therapy include oxygen, adequate hydration (often IV), and sometimes bronchodilators (based on the clinical impression of effectiveness in the individual patient). Mist therapy and secretolytic agents remain popular, although no clinical effect has been demonstrated. Attention should be directed toward the relief of upper airway obstruction caused by swelling, secretions, and nasogastric tubes. Oxygen administration in infants with coexisting chronic airway disease (e.g., BPD) and bronchiolitis may cause CO2 retention. Bronchodilators can cause hypoxia and increase bronchial compressibility by reducing smooth muscle tone. However, in severe cases a trial under pulse oximetry control seems worthwhile. Steroids seem to bring no clinical improvement, except in infants with protracted wheezing after bronchiolitis and patients with preexisting BPD.

Asthma↗