Bronchiolitis is an acute viral infection affecting the respiratory system of children under one year of age, with a higher prevalence during the first 6 months of life and a higher incidence between November and March.
The infectious agent most involved (in about 75% of cases) is respiratory syncytial virus (RSV), but other viruses can also be the cause (metapneumovirus, coronavirus, rhinovirus, adenovirus, influenza and parainfluenza viruses).
Infection is secondary to transmission, which mainly occurs through direct contact with infected secretions.
The infection phase usually lasts 6 to 10 days.
The infection affects the bronchi and bronchioles, triggering an inflammatory process, increased mucus production and airway obstruction with possible difficulty in breathing.
Factors that increase the risk of greater severity are prematurity, infant’s age (
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What are the symptoms of bronchiolitis?
It usually starts with fever and rhinitis (inflammation of the nose); then there may be an insistent cough, which progressively worsens, and breathing difficulties – more or less marked – characterized by an increase in the respiratory rate and intercostal notches.
It usually resolves spontaneously and without consequences.
However, in some cases hospitalization may be necessary, especially before the age of six months.
In these young babies, there is often a drop in saturation (oxygen in the blood) levels and dehydration can be observed due to feeding difficulties and increased water loss caused by the work of breathing.
In addition, in patients born prematurely or under 6 weeks of age there is an increased risk of apnea (prolonged breathing pause) and their cardio-respiratory parameters should be monitored.
The disease is usually mild and resolves on its own in about 12 days.
How is bronchiolitis diagnosed?
The diagnosis of bronchiolitis is clinical, based on the course of symptoms and on pediatric examination.
It is only in special cases, deemed necessary by the doctor, that certain laboratory and / or instrumental tests can be carried out.
These include: the search for respiratory viruses on nasopharyngeal aspirations, the determination of oxygenation using a saturometer (arterial saturation
Very rarely, a chest x-ray is necessary (thickening and areas of lack of air can be found in several areas of the lungs due to impaired ventilation).
How to prevent bronchiolitis?
A few simple rules of hygiene can reduce the risk of contracting bronchiolitis or avoiding associated infections that can worsen the clinical picture.
Always try to
- Avoid contact of young children with other children or adults with respiratory tract infections;
- Always wash your hands before and after taking care of your child;
- Encourage breastfeeding and provide adequate amounts of fluids;
- Give frequent nasal washes with physiological or hypertonic solution;
- Never smoke at home, even in rooms other than where the baby is.
How is bronchiolitis treated?
An infant without breathing difficulties, with a SaO2> 94% in the air and able to eat can be cared for at home under the careful care of the attending pediatrician.
Patients with bronchiolitis are usually treated with frequent nasal washes with aspiration of secretions and aerosol therapy with 3% hypertonic solution.
The latter helps the child to mobilize the abundant catarrhal mucous secretions.
Bronchodilators (drugs which dilate the muscles of the bronchi and thus improve breathing) can be used by inhalation 3 to 4 times a day if clinical improvement has been observed after a first “trial” administration in pediatric surgery or at home. .
Treatment should be discontinued if there is no evidence of efficacy.
Oral cortisone is sometimes prescribed, but the most recent scientific literature does not show that children receiving this treatment get better.
Routine use of antibiotics is not recommended, except in immunocompromised children or if concomitant bacterial infection is suspected.
It is helpful to divide meals by increasing the frequency and decreasing the quantity.
When hospitalization is necessary, the child receives supportive treatment to ensure
- Adequate oxygenation of the blood by administration of humidified and warmed oxygen (high flow oxygen is given only in severe cases);
- Adequate hydration, if feeding is difficult, through administration of intravenous glucosaline solutions.
Bronchiolitis: when should the child be hospitalized?
In all cases of poor oxygenation or refusal to feed the child, according to the indications of the treating pediatrician, the Emergency pediatrician must assess the child for possible hospitalization.
The following are considered to be additional risk factors: prematurity or the age of less than two months, concomitant chronic pathologies (bronchodosplasia, congenital heart disease, immunodeficiencies, neurological pathologies), reduced reactivity, difficulty in being cared for at home by the parents.
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