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JAMA Network Open Oct 2023
Topics: Humans; Bronchiolitis; Suction
PubMed: 37856128
DOI: 10.1001/jamanetworkopen.2023.39970 -
JAMA Pediatrics Mar 2022Over the last 2 decades, bronchiolitis guidelines and improvement efforts focused on supportive care and reducing unnecessary tests, treatments, and hospitalization....
IMPORTANCE
Over the last 2 decades, bronchiolitis guidelines and improvement efforts focused on supportive care and reducing unnecessary tests, treatments, and hospitalization. There have been limited population-based studies examining hospitalization outcomes over time.
OBJECTIVE
To describe rates and trends in bronchiolitis hospitalization, intensive care unit (ICU) use, mortality, and costs.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used population-based health administrative data from April 1, 2004, to March 31, 2018, to identify bronchiolitis encounters using hospital discharge diagnosis codes in Ontario, Canada. Children younger than 2 years with and without bronchiolitis hospitalization were included. Data were analyzed from January 2020 to July 2021.
MAIN OUTCOMES AND MEASURES
Bronchiolitis hospitalization per 1000 person-years, ICU use per 1000 hospitalizations, mortality per 100 000 person-years, and costs per 1000 person-years adjusted to 2018 Canadian dollars and reported in 2018 US dollars.
RESULTS
Among 2 336 446 included children, 1 199 173 (51.3%) were male. During the study period, 43 993 children (1.9%) younger than 2 years had 48 058 bronchiolitis hospitalizations at 141 hospitals. Bronchiolitis accounted for 48 058 of 360 920 all-cause hospitalizations (13.3%) and 215 654 of 2 566 348 all-cause hospital days (8.4%) in children younger than 2 years. Bronchiolitis hospitalization was stable over time, at 14.0 (95% CI, 13.6-14.4) hospitalizations per 1000 person-years in 2004-2005 and 12.7 (95% CI, 12.2-13.1) hospitalizations per 1000 person-years in 2017-2018 (annual percent change [APC], 0%; 95% CI, -1.6 to 1.6; P = .97). ICU admission increased significantly from 38.1 (95% CI, 32.2-44.8) per 1000 hospitalizations in 2004-2005 to 87.8 (95% CI, 78.3-98.0) per 1000 hospitalizations in 2017-2018 (APC, 7.2%; 95% CI, 5.4-8.9; P < .001). Over the study period, bronchiolitis mortality was 2.8 (95% CI, 2.3-3.4) per 100 000 person-years and remained stable (APC, 1.1%; 95% CI, -8.4 to 11.7; P = .85). Hospitalization costs per 1000 person-years increased from $49 640 (95% CI, $49 617-$49 663) in 2004-2005 to $58 632 (95% CI, $58 608-$58 657) in 2017-2018 (APC, 3.0%; 95% CI, 1.3-4.8; P = .002).
CONCLUSIONS AND RELEVANCE
From 2004 to 2018, bronchiolitis hospitalization and mortality rates remained stable; however, ICU use and costs increased substantially. This represents a major increase in high-intensity hospital care and costs for one of the most common and cumulatively expensive conditions in pediatric hospital care.
Topics: Bronchiolitis; Child; Cohort Studies; Female; Hospitalization; Humans; Intensive Care Units; Male; Ontario
PubMed: 34928313
DOI: 10.1001/jamapediatrics.2021.5177 -
Scandinavian Journal of Trauma,... Apr 2014Acute viral bronchiolitis is one of the most common medical emergency situations in infancy, and physicians caring for acutely ill children will regularly be faced with... (Review)
Review
Acute viral bronchiolitis is one of the most common medical emergency situations in infancy, and physicians caring for acutely ill children will regularly be faced with this condition. In this article we present a summary of the epidemiology, pathophysiology and diagnosis, and focus on guidelines for the treatment of bronchiolitis in infants. The cornerstones of the management of viral bronchiolitis are the administration of oxygen and appropriate fluid therapy, and overall a "minimal handling approach" is recommended. Inhaled adrenaline is commonly used in some countries, but the evidences are sparse. Recently, inhalation with hypertonic saline has been suggested as an optional treatment. When medical treatment fails to stabilize the infants, non-invasive and invasive ventilation may be necessary to prevent and support respiratory failure. It is important that relevant treatment algorithms exist, applicable to all levels of the treatment chain and reflecting local considerations and circumstances.
Topics: Acute Disease; Bronchiolitis; Disease Management; Humans; Infant
PubMed: 24694087
DOI: 10.1186/1757-7241-22-23 -
Archives of Disease in Childhood Jan 1996To test the hypothesis that socioeconomic deprivation is associated with an increased risk of admission with clinically suspected bronchiolitis.
OBJECTIVE
To test the hypothesis that socioeconomic deprivation is associated with an increased risk of admission with clinically suspected bronchiolitis.
DESIGN
Case-control study.
SETTING
Children under 1 year living in Sheffield in 1989-90.
SUBJECTS
307 children resident in Sheffield admitted to Sheffield hospitals with clinically suspected bronchiolitis between 1 October 1989 and 28 February 1990.
METHODS
Children admitted with clinically suspected bronchiolitis were ascertained from laboratory records of nasopharyngeal aspirates cultured for respiratory syncytial virus. Case notes were examined to determine whether these children had required medical intervention and postcode of residence was recorded. Controls were selected from the Sheffield child development study (SCDS) data. Postcodes were converted to electoral wards which were assigned Townsend deprivation index scores. Electoral wards were then categorised by Townsend score into five levels of deprivation. Data on family smoking for cases and controls were extracted from the SCDS.
RESULTS
Of the 307 children admitted with suspected bronchiolitis during the study period, 127 required one or more medical intervention. The risk of admission with clinically suspected bronchiolitis and with bronchiolitis requiring medical intervention rose with increasing level of deprivation score of electoral ward of residence. Children living in electoral wards in the two more deprived groups were more than 1.5 times as likely to be admitted (odds ratio (OR) 1.67, 95% confidence interval (CI) 1.25 to 2.24) or admitted requiring a medical intervention (OR 1.74, 95% CI 1.16 to 2.62) than children living in other parts of the city. Similar results were obtained after exclusion of children living in homes classified as smoky by the health visitor.
CONCLUSION
Residence in an area of social and material deprivation increases the risk of admission with bronchiolitis even after taking account of parental smoking and when only more severe cases were considered.
Topics: Bronchiolitis; Case-Control Studies; England; Hospitalization; Humans; Infant; Infant, Newborn; Poverty Areas; Risk Factors; Socioeconomic Factors
PubMed: 8660048
DOI: 10.1136/adc.74.1.50 -
Respiratory Research Jan 2023Severe bronchiolitis is often associated with subsequent respiratory morbidity, mainly recurrent wheezing and asthma. However, the underlying immune mechanisms remain... (Observational Study)
Observational Study
BACKGROUND
Severe bronchiolitis is often associated with subsequent respiratory morbidity, mainly recurrent wheezing and asthma. However, the underlying immune mechanisms remain unclear. The main goal of this study was to investigate the association of nasal detection of periostin and thymic stromal lymphopoietin (TSLP) during severe bronchiolitis with the development of asthma at 4 years of age.
METHODS
Observational, longitudinal, post-bronchiolitis, hospital-based, follow-up study. Children hospitalized for bronchiolitis between October/2013 and July/2017, currently aged 4 years, included in a previous study to investigate the nasal airway secretion of TSLP and periostin during bronchiolitis, were included. Parents were contacted by telephone, and were invited to a clinical interview based on a structured questionnaire to obtain information on the respiratory evolution. The ISAAC questionnaire for asthma symptoms for 6-7-year-old children, was also employed.
RESULTS
A total of 248 children were included (median age 4.4 years). The mean age at admission for bronchiolitis was 3.1 (IQR: 1.5-6.5) months. Overall, 21% had ever been diagnosed with asthma and 37% had wheezed in the last 12 months. Measurable nasal TSLP was detected at admission in 27(11%) cases and periostin in 157(63%). The detection of nasal TSLP was associated with the subsequent prescription of maintenance asthma treatment (p = 0.04), montelukast (p = 0.01), and the combination montelukast/inhaled glucocorticosteroids (p = 0.03). Admissions for asthma tended to be more frequent in children with TSLP detection (p = 0.07). In the multivariate analysis, adjusting for potential confounders, the detection of TSLP remained independently associated with chronic asthma treatment prescription (aOR:2.724; CI 1.051-7.063, p:0.04) and with current asthma (aOR:3.41; CI 1.20-9.66, p:0.02). Nasal detection of periostin was associated with lower frequency of ever use of short-acting beta2-agonists (SABA) (p = 0.04), lower prevalence of current asthma (p = 0.02), less prescription of maintenance asthma treatment in the past 12 months (p = 0.02, respectively). In the multivariate analysis, periostin was associated with lower risk of asthma at 4 years, independently of the atopic status (aOR:0.511 CI 95% 0.284-0.918, p:0.025).
CONCLUSIONS
Our results show a positive correlation between nasal TSLP detection in severe bronchiolitis and the presence of current asthma, prescription of asthma maintenance treatment and respiratory admissions up to the age of 4 years. By contrast, we found a protective association between nasal periostin detection and current asthma at 4 years, ever diagnosis of asthma, maintenance asthma treatment prescription, and respiratory admissions.
Topics: Child; Child, Preschool; Humans; Infant; Asthma; Bronchiolitis; Cytokines; Follow-Up Studies; Respiratory Syncytial Virus Infections; Thymic Stromal Lymphopoietin
PubMed: 36694181
DOI: 10.1186/s12931-023-02323-7 -
Laeknabladid Mar 2011Acute bronchiolitis is a viral infection of the lower respiratory tract. The infection is frequent among young children and is most commonly caused by the respiratory... (Review)
Review
Acute bronchiolitis is a viral infection of the lower respiratory tract. The infection is frequent among young children and is most commonly caused by the respiratory syncytial virus. The infection causes inflammation and narrowing of the bronchioles which leads to obstructive breathing and respiratory difficulties. The diagnosis is primarily made by clinical examination; laboratory and radiological studies are of little value. Treatment is principally supportive and symptomatic. The prognosis is generally excellent and the majority of patients recover without sequelae. The aim of this article is to review the symptoms, diagnosis and treatment of acute bronchiolitis according to current evidence. The epidemiology, pathophysiology and prognosis will also be discussed.
Topics: Acute Disease; Bronchiolitis; Bronchiolitis, Viral; Evidence-Based Medicine; Humans; Predictive Value of Tests; Respiratory Syncytial Viruses; Risk Factors; Treatment Outcome
PubMed: 21451194
DOI: 10.17992/lbl.2011.03.355 -
Archivos Argentinos de Pediatria Apr 2009Bronchiolitis obliterans is an uncommon and severe form of chronic obstructive lung disease that results from an insult to the lower respiratory tract. The bronchiolitis... (Review)
Review
Bronchiolitis obliterans is an uncommon and severe form of chronic obstructive lung disease that results from an insult to the lower respiratory tract. The bronchiolitis obliterans was described as a complication of graft versus host disease in bone marrow or lung transplant recipients. Bronchiolitis obliterans is most commonly seen in children after severe viral lower respiratory tract infections. The understanding of pathology, pathogenesis and molecular pathology, as well as the best treatment in bronchiolitis obliterans remain the subject of ongoing investigations. This review discusses our current knowledge on the different areas of bronchiolitis obliterans associated to infectious disease.
Topics: Bronchiolitis Obliterans; Child; Child, Preschool; Humans; Infant
PubMed: 19452089
DOI: 10.1590/S0325-00752009000200011 -
Pediatric Allergy and Immunology :... Jul 2021While infant bronchiolitis contributes to substantial acute (eg, severity) and chronic (eg, asthma development) morbidities, its pathobiology remains uncertain. We...
BACKGROUND
While infant bronchiolitis contributes to substantial acute (eg, severity) and chronic (eg, asthma development) morbidities, its pathobiology remains uncertain. We examined the integrated relationships of local (nasopharyngeal) and systemic (serum) responses with bronchiolitis morbidities.
METHODS
In a multicenter prospective cohort study of infants hospitalized for bronchiolitis, we applied a network analysis approach to identify distinct networks (modules)-clusters of densely interconnected metabolites-of the nasopharyngeal and serum metabolome. We examined their individual and integrated relationships with acute severity (defined by positive pressure ventilation [PPV] use) and asthma development by age 5 years.
RESULTS
In 140 infants, we identified 285 nasopharyngeal and 639 serum metabolites. Network analysis revealed 7 nasopharyngeal and 8 serum modules. At the individual module level, nasopharyngeal-amino acid, tricarboxylic acid (TCA) cycle, and carnitine modules were associated with higher risk of PPV use (r > .20; P < .001), while serum-carnitine, amino acid, and glycerophosphorylcholine (GPC)/glycerophosphorylethanolamine (GPE) modules were associated with lower risk (all r < -.20; P < .05). The integrated analysis for PPV use revealed consistent findings-for example, nasopharyngeal-TCA (adjOR: 2.87, 95% CI: 1.68-12.2) and serum-GPC/GPE (adjOR: 0.54, 95% CI: 0.38-0.80) modules-and an additional module-serum-glucose-alanine cycle module (adjOR: 0.69, 95% CI: 0.56-0.86). With asthma risk, there were no individual associations, but there were integrated associations (eg, nasopharyngeal-carnitine module; adjOR: 1.48, 95% CI: 1.11-1.99).
CONCLUSION
In infants with bronchiolitis, we found integrated relationships of local and systemic metabolome networks with acute and chronic morbidity. Our findings advance research into the complex interplay among respiratory viruses, local and systemic response, and disease pathobiology in infants with bronchiolitis.
Topics: Asthma; Bronchiolitis; Child, Preschool; Humans; Infant; Metabolome; Nasopharynx; Prospective Studies
PubMed: 33559342
DOI: 10.1111/pai.13466 -
Indian Journal of Pediatrics Nov 2022To characterize thoracic (lung and diaphragm) ultrasound findings in children < 2 y with bronchiolitis, evaluate correlation between lung ultrasound severity score... (Observational Study)
Observational Study
OBJECTIVE
To characterize thoracic (lung and diaphragm) ultrasound findings in children < 2 y with bronchiolitis, evaluate correlation between lung ultrasound severity score (USS) and bronchiolitis severity score (BSS), and study the interobserver agreement of USS between study pediatrician and radiologist.
METHODS
In this prospective observational study, thoracic ultrasound was performed on children with bronchiolitis by the study pediatrician and USS score was assigned. A radiologist blinded to all clinical information, performed an independent thoracic ultrasound. Demographics, clinical course, and other relevant details were recorded.
RESULTS
Fifty-three children were enrolled; 29/53 patients (54.7%) were classified as mild bronchiolitis and 24/53 (45.2%) had moderate bronchiolitis as per clinical score; 13.2% (7/53) patients had both anterior and posterior subpleural consolidation and went on to require higher respiratory support either in the form of continuous positive airway pressure in 71.4% (5/7), oxygen for > 24 h in 14.2% (1/7), or heated humidified high-flow nasal cannula in 14.2% (1/7). These results were statistically significant (p < 0.001). A statistically significant correlation was found between the USS and type and duration of respiratory support (p value 0.002) and with the mean duration of hospital stay (p value < 0.001). There was significant correlation between the BSS and USS (p < 0.001). There was a very good agreement between the ultrasound findings of study pediatrician and radiologist (kappa 0.83).
CONCLUSION
The findings of lung ultrasound (LUS) are not specific for bronchiolitis. However, LUS can be used as a good prognostic tool in patients with bronchiolitis.
Topics: Bronchiolitis; Child; Humans; Infant; Lung; Oxygen; Point-of-Care Systems; Ultrasonography
PubMed: 35438475
DOI: 10.1007/s12098-022-04117-z -
Paediatric Respiratory Reviews Jun 2009Over the last year there have been more studies determining predisposition to severe bronchiolitis and its consequences. Studies have highlighted various... (Review)
Review
Over the last year there have been more studies determining predisposition to severe bronchiolitis and its consequences. Studies have highlighted various single-nucleotide polymorphisms (SNPs) to be significantly associated with respiratory syncytial virus (RSV) hospitalisation, and a candidate gene approach demonstrated that innate immune gene SNPs had the strongest association with bronchiolitis. The impact of 'other' viruses (RSV, influenza, adenovirus, parainfluenza, rhinovirus, human metapneumovirus [hMPV], coronavirus, boca-virus, enterovirus, paraechovirus) has been investigated. In one series only children with RSV infection experienced recurrent wheezing and in another only RSV infection was associated with respiratory complications (hypoxia correlated with prolonged hospitalisation). Others have examined the long-term outcome of viral infection in infancy. The above studies and others published in the last year will be discussed.
Topics: Bronchiolitis; DNA, Viral; Diagnosis, Differential; Hospitalization; Humans; Respiratory Syncytial Virus Infections; Respiratory Syncytial Viruses
PubMed: 19651389
DOI: 10.1016/S1526-0542(09)70003-X