SIMRI-Società Italiana per le Malattie Respiratorie Infantili, Italy.
Ital J Pediatr. 2014 Oct 24;40:65. doi: 10.1186/1824-7288-40-65.
Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection. Criteria for hospitalization include low oxygen saturation (<90-92%), moderate-to-severe respiratory distress, dehydration and presence of apnea. Children with pre-existing risk factors should be carefully assessed.To date, there is no specific treatment for viral bronchiolitis, and the mainstay of therapy is supportive care. This consists of nasal suctioning and nebulized 3% hypertonic saline, assisted feeding and hydration, humidified O2 delivery. The possible role of any pharmacological approach is still debated, and till now there is no evidence to support the use of bronchodilators, corticosteroids, chest physiotherapy, antibiotics or antivirals. Nebulized adrenaline may be sometimes useful in the emergency room. Nebulized adrenaline can be useful in the hospital setting for treatment as needed. Lacking a specific etiological treatment, prophylaxis and prevention, especially in children at high risk of severe infection, have a fundamental role. Environmental preventive measures minimize viral transmission in hospital, in the outpatient setting and at home. Pharmacological prophylaxis with palivizumab for RSV bronchiolitis is indicated in specific categories of children at risk during the epidemic period. Viral bronchiolitis, especially in the case of severe form, may correlate with an increased incidence of recurrent wheezing in pre-schooled children and with asthma at school age.The aim of this document is to provide a multidisciplinary update on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications, identify gaps in knowledge and drive future research.
急性细支气管炎是全球 1 岁以下儿童下呼吸道感染和住院的主要原因。它通常是一种轻度疾病，但有些儿童可能会出现严重症状，需要住院并在 ICU 接受通气支持。有预先存在的危险因素（早产儿、支气管肺发育不良、先天性心脏病和免疫缺陷）的婴儿可能易患疾病的严重形式。细支气管炎的临床诊断主要基于病史和体格检查（流涕、咳嗽、啰音、喘息和呼吸窘迫迹象）。通过抗原或基因组检测来确定涉及的病毒的病因诊断可能有助于减少医院感染的传播。住院标准包括低氧饱和度（<90-92%）、中重度呼吸窘迫、脱水和存在呼吸暂停。有预先存在的危险因素的儿童应仔细评估。迄今为止，尚无针对病毒性细支气管炎的特定治疗方法，治疗的主要方法是支持性治疗。这包括鼻腔抽吸和雾化 3%高渗盐水、辅助喂养和补液、加湿氧气输送。任何药物治疗方法的可能作用仍存在争议，迄今为止，尚无证据支持使用支气管扩张剂、皮质类固醇、胸部理疗、抗生素或抗病毒药物。肾上腺素雾化有时在急诊室可能有用。在医院环境中，按需使用肾上腺素雾化可能是有用的。由于缺乏针对特定病因的治疗方法，预防和预防措施，特别是在有严重感染高风险的儿童中，具有重要作用。环境预防措施可最大限度地减少医院、门诊和家庭中的病毒传播。在流行期间，针对特定类别的高危儿童使用 RSV 细支气管炎的帕利珠单抗进行药物预防是有指征的。病毒性细支气管炎，尤其是严重形式，可能与学龄前儿童反复喘息的发生率增加以及学龄期哮喘有关。本文件旨在提供关于细支气管炎管理和预防的最新多学科建议，以分享有用的适应症，确定知识空白，并推动未来的研究。
