Abstract:
Acute viral bronchiolitis in young infants remains a cause of
substantial morbidity and health care costs. It is the most common
lower respiratory tract condition and the most common reason for
the hospitalization of infants. A number of respiratory viruses have
been associated with acute viral bronchiolitis although respiratory
syncytial virus (RSV) remains the most frequently identified virus.
The majority of affected infants have a mild self-limiting disease,
while others have more severe illness and require hospitalization
and,sometimes,ventilatory support. Bronchiolitis has an overall
mortality rate of 0.2-0.5%, with 99% of deaths occurring in developing countries.
Bronchiolitis is a clinical diagnosis based on a typical pattern of
rhinorrhoea, cough, poor feeding, tachypnoea, subcostal recession
and auscultatory findings of wheezing and fine inspiratory crackles. There is a distinct seasonal pattern with a peak in incidences
in autumn and winter.
Evidence-based reviews have suggested a limited role for
diagnostic laboratory or radiographic tests in typical cases of
bronchiolitis. A nasopharyngeal aspirate has been identified as
the most sensitive methodfor virus detection. Pulse oximetry also
provides valuable information about the severity of the disease and
guides subsequent management.
Supportive therapy remains the major treatment option, as no
other specific treatments to date haveshown to provide clinically
significantbenefits. Minimal handling, oxygen supplementation,
and appropriate fluid management (including nasogastric feeds
if necessary) are the mainstay of therapy. Nasal suctioning can be
helpful as well. Very young infants may require cardiopulmonary
monitoring for apnoea. There is a wide variation in treatment for
bronchiolitis, which has led to the development of evidence-based
clinical practice guidelines for treatment. Bronchodilators are inconsistently used and have been advocated for certain subgroups
of infants. Several large, recent trials have revealed a lack of efficacy for routine use of either bronchodilators or corticosteroids
for the treatment of bronchiolitis. Preliminary evidence suggests
a potential future role nebulized hypertonic saline.
Description:
Paediatric Respiratory Services, Southampton University Hospitals, United Kingdom, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica Moldova
