Division of Pediatric Anesthesia and Intensive Care, Buzzi Children's Hospital, Milano, Italy.
Hospital Nacional de Niños "Dr. Carlos Saenz Herrera", San José, Costa Rica.
Eur J Pediatr. 2024 Jun;183(6):2733-2742. doi: 10.1007/s00431-024-05530-6. Epub 2024 Mar 30.
We aimed to describe differences in the epidemiology, management, and outcomes existing between centers located in countries which differ by geographical location and economic status during to post-pandemic bronchiolitis seasons. This was a prospective observational cohort study performed in two academic centers in Latin America (LA) and three in Italy. All consecutive children with a clinical diagnosis of bronchiolitis were included, following the same data collection form. Nine hundred forty-three patients have been enrolled: 275 from the two Latin American Centers (San Jose, 215; Buenos Aires, 60), and 668 from Italy (Rome, 178; Milano, 163; Bologna, 251; Catania, 76). Children in LA had more frequently comorbidities, and only rarely received palivizumab. A higher number of patients in LA had been hospitalized in a ward (64% versus 23.9%, p < 0.001) or in a PICU (16% versus 6.2%, p < 0.001), and children in LA required overall more often respiratory support, from low flow oxygen to invasive mechanical ventilation, except for CPAP which was more used in Italy. There was no significant difference in prescription rates for antibiotics, but a significantly higher number of patients treated with systemic steroids in Italy.
We found significant differences in the care for children with bronchiolitis in Italy and LA. Reasons behind such differences are unclear and would require further investigations to optimize and homogenize practice all over the world.
• Bronchiolitis is among the commest cause of morbidity and mortality in infants all over the world.
• There are significant differences on how clinicians care for bronchiolitis in different centers and continents. Differences in care can be principally due to different local practices than differences in patients severity/presentations. • Understanding these differences should be a priority to optime and standardize bronchiolitis care globally.
描述地理位置和经济地位不同的国家/地区的中心之间在流行后毛细支气管炎季节的流行病学、管理和结局方面存在的差异。这是一项在拉丁美洲（LA）的两个学术中心和意大利的三个中心进行的前瞻性观察队列研究。所有符合毛细支气管炎临床诊断的连续患儿均纳入研究，采用相同的数据收集表格。共纳入 943 名患儿：275 名来自拉丁美洲的两个中心（圣何塞，215 名；布宜诺斯艾利斯，60 名），668 名来自意大利（罗马，178 名；米兰，163 名；博洛尼亚，251 名；卡塔尼亚，76 名）。LA 的患儿合并症更常见，且很少使用帕利珠单抗。LA 的患儿更多地在病房（64%比 23.9%，p<0.001）或 PICU（16%比 6.2%，p<0.001）住院，LA 的患儿更常需要呼吸支持，从低流量吸氧到有创机械通气，除了 CPAP，CPAP 在意大利使用更普遍。抗生素的使用没有显著差异，但意大利使用全身皮质类固醇的患儿数量明显更多。
我们发现意大利和 LA 之间在毛细支气管炎患儿的治疗方面存在显著差异。造成这种差异的原因尚不清楚，需要进一步研究以优化和统一全球的实践。
毛细支气管炎是全世界婴儿发病率和死亡率最高的疾病之一。
不同中心和大洲的临床医生在毛细支气管炎的治疗方面存在显著差异。护理方面的差异主要归因于当地实践的不同，而不是患者严重程度/表现的不同。了解这些差异应是优化和标准化全球毛细支气管炎护理的首要任务。
