Bronchiolitis: Recommendations for diagnosis,monitoring and management of children one to 24 months of age

Bronchiolitis is the most common reason for admission to hospital in the first year of life. There is tremendous variation in the clinical management of this condition across Canada and around the world, including significant use of unnecessary tests and ineffective therapies. This statement pertains to generally healthy children ≤2 years of age with bronchiolitis. The diagnosis of bronchiolitis is based primarily on the history of illness and physical examination findings. Laboratory investigations are generally unhelpful. Bronchiolitis is a self-limiting disease, usually managed with supportive care at home. Groups at high risk for severe disease are described and guidelines for admission to hospital are presented. Evidence for the efficacy of various therapies is discussed and recommendations are made for management. Monitoring requirements and discharge readiness from hospital are also discussed.     

Increased risk of autism spectrum disorder among early life asthma patients: An 8-year nationwide population-based prospective study

Previous research has suggested an association between autism spectrum disorder (ASD) and allergic disorders, but epidemiological evidence regarding asthma remains limited. We conducted a nationwide population-based prospective cohort study (1:4 case:control patients, age- and gender-matched), hypothesizing that asthma in infancy or toddlerhood increased the risk of ASD. The participants comprised 2134 asthmatic infants and children and 8536 controls aged 0–3 years in 2002. We identified cases of ASD that occurred near the end of the follow-up period (December 31, 2010), determining that asthmatic infants and children exhibited a higher accumulative incidence rate of ASD than did the controls (1.3% vs 0.7%, P = .007). After adjusting for age at enrollment, gender, level of urbanization, and comorbid allergic diseases (i.e., allergic rhinitis and atopic dermatitis), asthmatic infants and children exhibited an elevated risk of developing ASD (hazard ratio: 2.01, 95% confidence interval: 1.19–3.40). This prospective study indicated a temporal relation between asthma and subsequent ASD diagnosis, supporting the immune hypothesis of ASD pathogenesis. Further studies are required to clarify the probable interactional effects between these disorders and define a homogenous ASD subgroup.     

42例喘息性患儿纤维支气管镜诊疗分析

目的探讨纤维支气管镜技术对喘息性疾病患儿的诊断及治疗价值。方法回顾我科2011年10月～2012年5月42例喘息性疾病患儿的临床资料。病例均由纤支镜进一步明确病因,并行支气管肺泡灌洗及注药治疗。结果镜下所见：单纯性支气管内膜炎16例（38％）,支气管软化12例（28．6％）,支气管异物7例（16．7％）,狭窄4例（9．5％）,先天性气管畸形3例（7．1％）。镜下炎性改变明显、支气管软化、狭窄患儿经纤支镜灌洗、局部注药,疗效较好。支气管异物7例成功取出。所观察到的并发症为一过性。结论喘息性疾病患儿以气管支气管炎症、软化、支气管异物为主要病因,纤支镜对喘息性患儿的病因诊断和治疗有重要作用。     

孟鲁司特治疗呼吸道合胞病毒毛细支气管炎症状及反复喘息疗效研究

背景　呼吸道合胞病毒（RSV）毛细支气管炎易出现反复喘息,且下呼吸道分泌物中半胱氨酸白三烯（CysLTs）水平升高。而孟鲁司特是一种白三烯受体拮抗剂,关于其治疗RSV毛细支气管炎症状的研究相对较少。目的　探讨孟鲁司特改善婴幼儿RSV毛细支气管炎后症状及减轻反复喘息发作的有效性和安全性。方法　2015年6月-2017年6月连续纳入在潍坊市妇幼保健院出院的RSV毛细支气管炎患儿,随机分为治疗组、对照组。Ⅰ期,治疗组：口服孟鲁司特颗粒（4 mg）12周,1次/d;对照组：口服安慰剂12周,1次/d。对两组无症状天数、个人日记评分进行评估。随访9个月（Ⅱ期）,观察Ⅰ+Ⅱ期反复喘息人数和医疗资源应用情况等。依据意向性分析（ITT）原则,应用全分析集（FAS）分析数据。结果　共纳入研究对象186例,治疗组92例,对照组94例。治疗组完成Ⅰ期研究的患儿为89例,对照组为90例;治疗组完成Ⅰ+Ⅱ期的患儿为84例,对照组为86例。治疗组平均依从性为97.8%（7 560/7 728）,对照组平均依从性为97.4%（7 690/7 896）,两组患儿平均依从性比较,差异无统计学意义（χ2=3.16,P=0.07）。在Ⅰ期研究期间,两组无症状天数、日间无症状天数、夜间无症状天数、个人日记评分比较,差异均无统计学意义（P>0.05）。在整个研究过程中（Ⅰ+Ⅱ期）,治疗组RSV毛细支气管炎喘息复发人数少于对照组（P<0.05）,治疗组喘息患儿出现2次及以上喘息比例低于对照组（χ2=5.14,P=0.02）。Ⅰ+Ⅱ期研究期间治疗组医疗资源应用人数、β-受体激动剂应用人数、糖皮质激素应用人数、住院人数低于对照组（P<0.05）。在事后亚组分析中,治疗组有湿疹史与父母哮喘史的患儿中无症状天数〔（49.7±20.2）、（51.3±20.9）d〕多于对照组〔（36.3±20.4）、（37.8±19.3）d〕（t=2.19,P=0.03;t=2.24,P=0.03）。整个研究过程中没有患儿因不良反应退出研究,两组间胃肠道紊乱、皮疹、转氨酶升高发生率比较,差异均无统计学意义（χ2=0.23,P=0.63;χ2=0.03,P=0.86;χ2=0.15,P=0.69）。结论　口服孟鲁司特（4 mg）12周不能改善RSV毛细支气管炎患儿呼吸道症状,但能降低患儿反复喘息发作次数。口服孟鲁司特（4 mg）有一定效果且安全。     

Associated factors with recurrent wheezing in infants: is there difference between the sexes?

ObjectiveIdentify associated factors for recurrent wheezing (RW) in male and female infants.MethodsCross-sectional multicentric study using the standardized questionnaire from the Estudio Internacional sobre Sibilancias en Lactantes (EISL). The questionnaire was applied to parents of 9345 infants aged 12–15 months at the time of immunization/routine visits.ResultsOne thousand two hundred and sixty-one (13.5%) males and nine hundred sixty-three (10.3%) females have had RW (≥3 episodes), respectively (p10 colds episodes (OR = 3.46; IC 95% 2.35–5.07), air pollution (OR = 1.33; IC 95% 1.12–1.59), molds at home (OR = 1.23; IC 95% 1.03–1.47), Afro-descendants (OR = 1.42; IC 95% 1.20–1.69), bronchopneumonia (OR = 1.41; IC; 1.11–1.78), severe episodes of wheezing in the first year (OR = 1.56; IC 95% 1.29–1.89), treatment with bronchodilators (OR = 1.60; IC 95% 1.22–2,1) and treatment with oral corticosteroids (OR = 1,23; IC 95% 0.99–1,52). Associated factors for RW for females were passive smoking (OR = 1.24; IC 95% 1.01−1,51), parents diagnosed with asthma (OR = 1.32; IC 95% 1,08−1,62), parents with allergic rhinitis (OR = 1.26; IC 95% 1.04–1.53), daycare attendance (OR = 1.48; IC 95% 1.17−1,88), colds in the first 6 months of life (OR = 2.19; IC 95% 1.69–2.82), personal diagnosis of asthma (OR = 1.84; IC 95% 1.39–2.44), emergency room visits (OR = 1.78; IC 95% 1.44–2.21), nighttime symptoms (OR = 2.89; IC 95% 2.34–3.53) and updated immunization (OR = 0.62; IC 95% 0.41−0.96).ConclusionThere are differences in associated factors for RW between genders. Identification of these differences could be useful to the approach and management of RW between boys and girls.     

孟鲁司特治疗呼吸道合胞病毒感染的毛细支气管炎的疗效及对气管炎症和再次喘息的影响

目的探讨孟鲁司特治疗呼吸道合胞病毒感染的毛细支气管炎的疗效及对气管炎症和再次喘息的影响。方法选择呼吸道合胞病毒感染的毛细支气管炎患儿120例随机分为观察组与对照组各60例,对照组给予镇咳、平喘、抗病毒等常规治疗,观察组在常规治疗的基础上再给予孟鲁司特维持治疗12周,比较两组患儿治疗有效率、喘息改善时间、平均住院时间,治疗前、后血清半胱氨酰白三烯(Cys LTs)、嗜酸粒细胞阳离子蛋白(ECP)水平及再次喘息发生率。结果 1观察组治疗有效率为100%,明显高于对照组的88.33%,差异有统计学意义(P0.05)。2观察组喘息改善时间、平均住院时间较对照组短,差异有统计学意义(P0.05)。3两组治疗后Cys LTs、ECP水平较治疗前明显降低,观察组治疗后Cys LTs、ECP水平较对照组降低明显,差异有统计学意义(均P0.05);4观察组治疗12周再次喘息发生率为18.33%,明显低于对照组的33.33%,比较差异有统计学意义(P0.05)。结论孟鲁司特治疗呼吸道合胞病毒感染性毛细支气管炎显效较快,可有效抑制气管炎症,减少喘息复发。     

克拉霉素对反复喘息急性加重期患儿TNF-α、IL-1β和IL-10产生的影响

目的:评价克拉霉素对反复喘息急性加重期患儿鼻咽灌洗液中TNF-α、IL-1β和IL-10的影响。方法:将54例反复喘息急性加重期患儿为研究对象,分别给予克拉霉素与安慰剂治疗,并于治疗过程中检测患儿鼻咽灌抽吸物中TNF-α、IL-1β和IL-10含量的变化情况。结果:与安慰剂相比,克拉霉素治疗3～5天后鼻咽抽吸物中TNF-α和IL-1β显著降低(P<0.05);治疗3～8周后TNF-α、IL-1β和IL-10水平均有不同程度降低,但肺炎嗜衣原体和肺炎支原体感染患儿IL-10水平无明显影响。结论:克拉霉素能降低喘息急性加重期患儿粘膜中TNF-α、IL-1β和IL-10的浓度。     

病毒相关性喘息性支气管炎患儿血清sICAM-1的检测及其与喘息高危因素的相关性分析

目的:探讨血清可溶性细胞间粘附分子-1(sICAM-1)在病毒相关性喘息性支气管炎发病中的作用,分析血清sICAM-1水平与喘息反复发作的高危因素者之间的关系。方法:采用酶联免疫吸附试验方法测定70例病毒相关性喘息性支气管炎急性期和恢复期以及30例健康儿童血清sICAM-1水平,分析病毒相关性喘息性支气管炎喘息反复发作的可能相关因素。结果:急性期血清sICAM-1水平高于恢复期和对照组,差异有统计学意义(P<0.05);恢复期血清sICAM-1水平与对照组比较差异无统计学意义(P>0.05)。随访期内有23例患儿喘息反复发作,其血清sICAM-1水平为(218.94±60.82)ng/ml。有过敏性疾病史和遗传史患儿血清sICAM-1水平显著高于无过敏性疾病史和遗传史患儿,差异有统计学意义(P<0.05)。结论:血清sICAM-1参与了病毒相关性喘息性支气管炎发生和发展以及喘息复发,有过敏性疾病和遗传史病毒感染所致的喘息性支气管炎患儿易喘息反复发作。