Zapalenie oskrzelików
Rokowania, prognozy i postęp choroby

Rokowanie w zapaleniu oskrzelików u niemowląt jest generalnie korzystne, z większością pacjentów wracających do zdrowia w ciągu 3-7 dni, choć kaszel i świszczący oddech mogą utrzymywać się do 2-4 tygodni. Śmiertelność wynosi około 0,1% przy odpowiedniej opiece. Czynniki ryzyka ciężkiego przebiegu obejmują niską masę ciała przy przyjęciu (każdy wzrost masy o 1 kg zmniejsza ryzyko wentylacji mechanicznej o połowę, OR=0,51, 95% CI: 0,40-0,65, p<0,001) oraz ekspozycję na dym tytoniowy w gospodarstwie domowym, która znacząco zwiększa ryzyko konieczności tlenoterapii (OR=2,45, 95% CI: 1,60-3,74, p<0,001) i wentylacji mechanicznej (skorygowany OR=5,49, 95% CI: 2,78-10,83, p<0,001). Hospitalizacja dotyczy 2-3% niemowląt poniżej 12 miesiąca życia, a śmiertelność wśród hospitalizowanych w różnych kohortach waha się od 0,2% do 7%, zależnie od czynników ryzyka i dostępności intensywnej terapii. Wysokość nad poziomem morza powyżej 2500 m zwiększa ryzyko hospitalizacji. Wskaźniki przedłużonego pobytu i śmiertelności są wyższe u pacjentów wymagających tlenoterapii oraz u młodszych niemowląt.

  1. Zapalenie oskrzelików – Rokowanie (przewidywanie wyniku)
    1. Czynniki ryzyka ciężkiego przebiegu choroby
    2. Rokowanie u niemowląt hospitalizowanych
    3. Przewidywanie ryzyka hospitalizacji
    4. Ciężkie zapalenie oskrzelików i oddział intensywnej terapii
    5. Zapalenie oskrzelików a rozwój astmy
    6. Powikłania zapalenia oskrzelików
    7. Fenotypowanie pacjentów jako narzędzie prognostyczne
    8. Luki w dowodach dotyczących pacjentów wysokiego ryzyka
    9. Standaryzacja wyników w badaniach nad zapaleniem oskrzelików
    10. Podsumowanie rokowań
    11. Kolejne rozdziały

Zapalenie oskrzelików – Rokowanie (przewidywanie wyniku)

Rokowanie w zapaleniu oskrzelików jest generalnie korzystne, przy czym większość niemowląt wraca do zdrowia w ciągu 3-7 dni bez następstw, chociaż świszczący oddech i kaszel mogą utrzymywać się przez 2-4 tygodnie1. Śmiertelność wynosi zaledwie 0,1% przy odpowiedniej opiece medycznej2. Zapalenie oskrzelików to choroba zakaźna, samoograniczająca się, a terapia opiera się na leczeniu wspomagającym, dotlenianiu, nawodnieniu i kontroli gorączki3.

Czynniki ryzyka ciężkiego przebiegu choroby

Badania wykazały, że niska masa ciała przy przyjęciu oraz narażenie na dym tytoniowy w gospodarstwie domowym zwiększają ryzyko ciężkiego przebiegu zapalenia oskrzelików u niemowląt przyjętych do szpitala4. Analiza wieloczynnikowa wykazała, że niemowlęta z domów, w których pali się tytoń, były narażone na zwiększone ryzyko ciężkiej choroby wymagającej tlenoterapii (OR=2,45, 95% CI: 1,60-3,74, p<0,001) lub wentylacji mechanicznej (skorygowany OR=5,49, 95% CI: 2,78-10,83, p<0,001)5.

Masa ciała (kg) przy przyjęciu zmniejszała ryzyko konieczności wentylacji mechanicznej (skorygowany OR=0,51, 95% CI: 0,40-0,65, p<0,001), co oznacza, że ​​każdy wzrost masy przy przyjęciu o 1 kg zmniejszał o połowę prawdopodobieństwo, że niemowlę będzie wymagało wentylacji mechanicznej6. Związek między ekspozycją na dym tytoniowy w gospodarstwie domowym a ciężkim zapaleniem oskrzelików jest prawdopodobnie przyczynowy, ponieważ zaobserwowano efekt zależny od dawki, w którym nasilenie choroby wzrastało wraz ze wzrostem odsetka niemowląt narażonych na dym tytoniowy7.

Rokowanie u niemowląt hospitalizowanych

Hospitalizacja jest wymagana w 2-3% przypadków zapalenia oskrzelików wśród niemowląt poniżej 12 miesiąca życia8. Corocznie zapalenie oskrzelików wywołane RSV odpowiada za około 57 000-172 000 hospitalizacji9. Hospitalizacja jest znacznie bardziej prawdopodobna na wysokościach powyżej 2500 metrów10.

W badaniu przeprowadzonym w Kamerunie stwierdzono, że przedłużony pobyt w szpitalu dotyczył 46,98% pacjentów, a śmiertelność wyniosła 10,70% wśród pacjentów hospitalizowanych z powodu zapalenia oskrzelików11. Czynniki niezależnie związane z przedłużonym pobytem w szpitalu obejmowały podawanie tlenu [b=0,36, OR=2,35 (95% CI: 1,16-4,74), p=0,017], nieprawidłową częstość oddechów [b=0,38, OR=2,13 (1,00-4,55), p=0,050] oraz występowanie kaszlu [b=0,33, OR=2,35 (95% CI: 1,22-4,51), p=0,011] i biegunki [b=0,71, OR=6,44 (95% CI: 1,6-25,86), p=0,009] przy przyjęciu12.

Czynniki niezależnie związane ze śmiertelnością to wiek pacjenta [b=-0,07, OR=0,84 (95% CI: 0,74-0,97), p=0,014] i podawanie tlenu [b=1,08, OR=9,64 (95% CI: 1,16-79,85), p=0,036]13. Przedłużony czas pobytu odnotowano u połowy hospitalizowanych pacjentów, a śmiertelność była wysoka, szczególnie u młodszych pacjentów i u pacjentów otrzymujących tlen14.

Ogólnie śmiertelność u dzieci hospitalizowanych z powodu zapalenia oskrzelików w różnych seriach waha się od 0,2% do 7%15. Ta duża zmienność opiera się na badaniach różnych kohort z różnymi czynnikami ryzyka i w różnych punktach czasowych w odniesieniu do nowoczesnej intensywnej terapii16.

Przewidywanie ryzyka hospitalizacji

Opracowano i zwalidowano regułę predykcyjną RISK dla hospitalizacji z powodu RSV u wcześniaków urodzonych w 33-35 tygodniu ciąży17. Ogólne ryzyko hospitalizacji z powodu RSV wyniosło 5,1% w tej populacji zdrowych późnych wcześniaków18. Reguła RISK to prosty kliniczny algorytm identyfikujący podgrupę późnych wcześniaków urodzonych w 33-35 tygodniu ciąży ze zwiększonym ryzykiem hospitalizacji z powodu zapalenia oskrzelików wywołanego przez RSV19.

Ciężkie zapalenie oskrzelików i oddział intensywnej terapii

Badania przeprowadzone na oddziałach intensywnej terapii pediatrycznej (PICU) wśród dzieci z zapaleniem oskrzelików wywołanym przez RSV bez chorób współistniejących wykazują 2-3% śmiertelność, niezależnie od tego, czy dzieci miały wrodzoną wadę serca z nadciśnieniem płucnym20. W badaniu kohortowym z lat 1999-2007 w Wielkiej Brytanii śmiertelność związana z zapaleniem oskrzelików wywołanym przez RSV wynosiła 1,7%, przy czym wyższe ryzyko zgonu było związane z wcześniej istniejącymi schorzeniami, zwłaszcza anomaliami sercowymi21.

W przypadku pomyślnej profilaktyki i interwencji ważne jest odkrycie złożonej konstelacji czynników wpływających na funkcjonowanie neurokognitywne po przyjęciu na oddział intensywnej terapii pediatrycznej (PICU)22. Badanie wykazało, że u dzieci po przyjęciu na PICU z powodu zapalenia oskrzelików: (1) niższa masa urodzeniowa, młodszy wiek w momencie obserwacji i niższy status społeczno-ekonomiczny są związane z gorszymi wynikami neurokognitywnymi; oraz (2) większa ekspozycja na epizody kwasicy podczas pobytu na PICU wiąże się z gorszymi wynikami w zakresie pamięci werbalnej23.

Zapalenie oskrzelików a rozwój astmy

Chociaż niektóre badania sugerują zwiększone ryzyko astmy po zapaleniu oskrzelików, tylko niewielki odsetek dotkniętych dzieci rozwija astmę24. Historia nawracających świstów oraz pozytywny wywiad rodzinny w kierunku astmy, alergii lub atopowego zapalenia skóry mogą zwiększać prawdopodobieństwo rozwoju astmy u tych pacjentów w przyszłości25.

Zapalenie oskrzelików we wczesnym życiu zostało powiązane z późniejszym ryzykiem przetrwałych świstów lub astmy26. Metaanaliza wykazała, że zapalenie oskrzelików przed 2 rokiem życia było związane ze zwiększonym ryzykiem późniejszych świstów/astmy (ryzyko względne=2,46, 95% CI: 2,14-2,82, p<0,001)27.

Związek między wczesnym zapaleniem oskrzelików a późniejszym ryzykiem przewlekłych świstów lub astmy pozostaje kontrowersyjny28. Dzieci już predysponowane do astmy mogą być bardziej skłonne do świszczącego oddechu po ekspozycji na RSV lub inne zakaźne lub alergiczne bodźce oddechowe29. Z drugiej strony, postuluje się, że zakażenie RSV może predysponować daną osobę do późniejszego skurczu oskrzeli poprzez selektywne promowanie określonych podzbiorów pomocniczych komórek T30.

Badanie Fujiogi i wsp. dotyczące niemowląt hospitalizowanych z ciężkim zapaleniem oskrzelików wykazało, że osoby, które miały w wywiadzie problemy z oddychaniem i egzemę, zakażenie rinowirusem i małe prawdopodobieństwo zakażenia RSV, były narażone na największe ryzyko rozwoju astmy31. Ich ryzyko było ponad 2,5-krotnie większe niż u niemowląt z „klasycznym” zapaleniem oskrzelików wywołanym przez RSV32.

Powikłania zapalenia oskrzelików

Powikłania po zapaleniu oskrzelików są rzadkie, ale mogą być poważne, szczególnie u niemowląt przedwcześnie urodzonych lub z chorobami płuc, serca lub niedoborem odporności33. Nawet zdrowe niemowlęta mogą doświadczać ostrych lub przewlekłych powikłań, chociaż większość wraca do zdrowia bez incydentów34.

Chociaż znacząca zachorowalność jest rzadka, wiele małych badań sugeruje, że dzieci, które były hospitalizowane z powodu zapalenia oskrzelików wywołanego przez RSV, mają wyższą częstość występowania chorób reaktywnych dróg oddechowych i więcej nieprawidłowości w czynności płuc niż dzieci nigdy nie hospitalizowane z powodu RSV35. Te nieprawidłowości mogą utrzymywać się nawet przez 5 lat, ostatecznie normalizując się36.

Wiele badań wykazało, że dzieci, w tym gorączkujące niemowlęta poniżej 8 tygodnia życia, z potwierdzonym zakażeniem RSV mają niższe ryzyko poważnych zakażeń bakteryjnych lub wtórnej nadkażenia bakteryjnego niż grupa kontrolna (np. 0% vs 2,7% dla bakteriemii i 2% vs 14% dla zakażenia układu moczowego)37. Ryzyko współistniejących zakażeń bakteryjnych jest niskie38.

Fenotypowanie pacjentów jako narzędzie prognostyczne

Badacze z Children’s National wysunęli hipotezę, że nowatorska technika segmentacji pacjentów z wirusowym zapaleniem oskrzelików według fenotypu przy pierwszym epizodzie może zapewnić lepsze przewidywanie wyników39. Oceniając pacjentów z wirusowym zapaleniem oskrzelików przy pierwszej prezentacji i kategoryzując ich na podstawie fenotypu klinicznego, badacze byli w stanie lepiej przewidzieć wyniki i wzorce progresji choroby40.

Zgodnie z hipotezą, trzy grupy fenotypowe wykazały wyraźnie różne, istotne klinicznie wyniki41. Badacze uważają, że ten nowatorski podział pacjentów z wirusowym zapaleniem oskrzelików w oparciu o solidną kombinację oceny klinicznej i molekularnej może pomóc w bardziej zindywidualizowanej opiece i lepszych wynikach pacjentów42.

Luki w dowodach dotyczących pacjentów wysokiego ryzyka

Badania kliniczne dotyczące leczenia zapalenia oskrzelików często wykluczają dzieci z grupy wysokiego ryzyka43. Większość randomizowanych badań klinicznych (RCT) zawartych w wytycznych NICE (2015) wykluczała niemowlęta z jakimikolwiek stanami wysokiego ryzyka, chorobami współistniejącymi lub wymagającymi eskalacji opieki44. Biorąc pod uwagę wykluczenie niemowląt z grupy wysokiego ryzyka z badań, które są następnie wykorzystywane do formułowania zaleceń opartych na dowodach, znacznie ogranicza to możliwość uogólnienia wytycznych wśród niemowląt z różnymi podstawowymi schorzeniami45.

Potrzebne są randomizowane badania kontrolowane, aby określić skuteczność strategii leczenia zapalenia oskrzelików u niemowląt z grupy wysokiego ryzyka w pediatrycznym oddziale intensywnej terapii46. Przegląd systematyczny podkreślił podobny brak postępowania opartego na dowodach dla niemowląt z grupy wysokiego ryzyka z ostrym zapaleniem oskrzelików na PICU47.

Standaryzacja wyników w badaniach nad zapaleniem oskrzelików

Opracowano podstawowy zestaw wyników (Core Outcome Set – COS) do stosowania w przyszłych badaniach klinicznych dotyczących zapalenia oskrzelików48. COS składa się z 25 wyników istotnych dla personelu medycznego, pielęgniarek i innego personelu klinicznego oraz rodziców dzieci z zapaleniem oskrzelików, do wykorzystania w RCT dotyczących interwencji u dzieci z klinicznym rozpoznaniem zapalenia oskrzelików w warunkach szpitalnych49.

COS powinien być używany przez przyszłych badaczy jako minimalny zestaw wyników, które powinny być zbierane w badaniu zapalenia oskrzelików50. Co ważne, ten COS stanowi istotny krok w kierunku zwiększenia i poprawy bardzo potrzebnej syntezy dowodów w tym obszarze choroby51.

Podsumowanie rokowań

Zapalenie oskrzelików jest chorobą zakaźną, samoograniczającą się, a większość dzieci wraca do zdrowia w ciągu 3-10 dni bez następstw5253. Niektóre niemowlęta, które wracają do zdrowia po ostrym zapaleniu oskrzelików, mają zwiększoną częstość nawracających świstów54.

Czynniki ryzyka ciężkiego przebiegu obejmują niską masę ciała przy przyjęciu, narażenie na dym tytoniowy w gospodarstwie domowym, młodszy wiek i potrzebę podawania tlenu5556. Powikłania są rzadkie, ale mogą być poważne, szczególnie u niemowląt urodzonych przedwcześnie lub z chorobami płuc, serca lub obniżoną odpornością57.

Zapalenie oskrzelików w wieku poniżej 2 lat może być związane z późniejszym rozwojem świszczącego oddechu/astmy58, choć związek ten pozostaje kontrowersyjny59. Nowe podejścia do fenotypowania pacjentów mogą pomóc w lepszym przewidywaniu wyników i personalizacji opieki60.

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  1. 12.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Bronchiolitis – Pediatrics – Merck Manual Professional Edition
    https://www.merckmanuals.com/professional/pediatrics/respiratory-disorders-in-young-children/bronchiolitis
    Prognosis is excellent. Most children recover in 3 to 5 days without sequelae, although wheezing and cough may continue for 2 to 4 weeks. Mortality is 0.1% when medical care is adequate. […] An increased incidence of asthma is suspected in children who have had bronchiolitis in early childhood, but the association is controversial because the children who later develop asthma may be more severely affected by RSV and therefore are more likely to seek medical attention. The incidence seems to decrease as children age.
  • #2 Bronchiolitis – Pediatrics – Merck Manual Professional Edition
    https://www.merckmanuals.com/professional/pediatrics/respiratory-disorders-in-young-children/bronchiolitis
    Prognosis is excellent. Most children recover in 3 to 5 days without sequelae, although wheezing and cough may continue for 2 to 4 weeks. Mortality is 0.1% when medical care is adequate. […] An increased incidence of asthma is suspected in children who have had bronchiolitis in early childhood, but the association is controversial because the children who later develop asthma may be more severely affected by RSV and therefore are more likely to seek medical attention. The incidence seems to decrease as children age.
  • #3 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    According to the WHO 2015 Global Health Observatory data repository, acute lower respiratory infection in children younger than 5 years of age remains a leading cause of childhood mortality in the world. In 2015, acute respiratory tract infection accounted for an estimated 1.84 million deaths worldwide; 85% of these deaths occurred in Africa followed by 8% in Southeast Asia. […] […] Bronchiolitis is an infectious, self-limited disease. Therapy is based on supportive care, oxygenation, hydration, and fever control. With early recognition and treatment, prognosis is usually very good. Most children with bronchiolitis, regardless of severity, recover without sequelae. The course of disease is usually 7-10 days, but a few remain ill for weeks. Some infants who recover from acute bronchiolitis have an increased frequency of recurrent wheezing. […]
  • #4 Household Tobacco Smoke and Admission Weight Predict Severe Bronchiolitis in Infants Independent of Deprivation: Prospective Cohort Study | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0022425
    Low admission weight and householder tobacco smoking increased the risk of severe bronchiolitis in infants admitted to hospital. These effects were independent of a standard deprivation measure. […] Multivariate multinomial analysis using logistic regression found that infants from tobacco smoking households were at increased risk of severe disease needing supplemental oxygen (OR=2.45, 95%CI (1.60 to 3.74), p0.001) or mechanical ventilation (adjusted OR=5.49 (2.78 to 10.83), p0.001). […] Weight (kg) on admission reduced the risk of needing for mechanical ventilation (adjusted OR 0.51 (0.40 to 0.65), p0.001), meaning for every 1 kg increase in admission weight, odds of an infant requiring mechanical ventilation were halved. […] The same predictor variables were retained when participants in the model were restricted to those with proven RSV infection and the sizes of effects were very similar.
  • #5 Household Tobacco Smoke and Admission Weight Predict Severe Bronchiolitis in Infants Independent of Deprivation: Prospective Cohort Study | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0022425
    Low admission weight and householder tobacco smoking increased the risk of severe bronchiolitis in infants admitted to hospital. These effects were independent of a standard deprivation measure. […] Multivariate multinomial analysis using logistic regression found that infants from tobacco smoking households were at increased risk of severe disease needing supplemental oxygen (OR=2.45, 95%CI (1.60 to 3.74), p0.001) or mechanical ventilation (adjusted OR=5.49 (2.78 to 10.83), p0.001). […] Weight (kg) on admission reduced the risk of needing for mechanical ventilation (adjusted OR 0.51 (0.40 to 0.65), p0.001), meaning for every 1 kg increase in admission weight, odds of an infant requiring mechanical ventilation were halved. […] The same predictor variables were retained when participants in the model were restricted to those with proven RSV infection and the sizes of effects were very similar.
  • #6 Household Tobacco Smoke and Admission Weight Predict Severe Bronchiolitis in Infants Independent of Deprivation: Prospective Cohort Study | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0022425
    Low admission weight and householder tobacco smoking increased the risk of severe bronchiolitis in infants admitted to hospital. These effects were independent of a standard deprivation measure. […] Multivariate multinomial analysis using logistic regression found that infants from tobacco smoking households were at increased risk of severe disease needing supplemental oxygen (OR=2.45, 95%CI (1.60 to 3.74), p0.001) or mechanical ventilation (adjusted OR=5.49 (2.78 to 10.83), p0.001). […] Weight (kg) on admission reduced the risk of needing for mechanical ventilation (adjusted OR 0.51 (0.40 to 0.65), p0.001), meaning for every 1 kg increase in admission weight, odds of an infant requiring mechanical ventilation were halved. […] The same predictor variables were retained when participants in the model were restricted to those with proven RSV infection and the sizes of effects were very similar.
  • #7 Household Tobacco Smoke and Admission Weight Predict Severe Bronchiolitis in Infants Independent of Deprivation: Prospective Cohort Study | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0022425
    The relationship between exposure to household tobacco smoke and severe bronchiolitis is likely to be causal because a dose-response effect was observed where disease severity increased as the proportion of infants exposed to tobacco smoke increased. This corroborates with biochemical studies on infants. […] We assert that smoking by a household member doubles the odds of an infant admitted with bronchiolitis needing oxygen and along with low admission weight increases five-fold the odds of needing mechanical ventilation.
  • #8 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Hospitalization is required in 2-3% of bronchiolitis cases among infants younger than 12 months of age. Annually, RSV bronchiolitis accounts for about 57,000-172,000 hospitalizations. In a prospective, population-based surveillance of acute respiratory infections, RSV accounted for 20% of hospitalizations, 18% of ED visits, and 15% clinic visits in winter. Hospitalization is significantly more likely at altitudes above 2500 meters (8000 ft). […] […] Overall, the mortality in children hospitalized for bronchiolitis in different series ranges from 0.2% to 7%. This large variability is based on investigations of different cohorts with different risk factors and different points in time relative to modern intensive care. Morbidity and mortality from RSV mostly occur in children younger than 2 years. Other high-risk infants and children include premature infants younger than 6 months, infants and children with underlying pulmonary or cardiac disease, and those an immune deficiency. […]
  • #9 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Hospitalization is required in 2-3% of bronchiolitis cases among infants younger than 12 months of age. Annually, RSV bronchiolitis accounts for about 57,000-172,000 hospitalizations. In a prospective, population-based surveillance of acute respiratory infections, RSV accounted for 20% of hospitalizations, 18% of ED visits, and 15% clinic visits in winter. Hospitalization is significantly more likely at altitudes above 2500 meters (8000 ft). […] […] Overall, the mortality in children hospitalized for bronchiolitis in different series ranges from 0.2% to 7%. This large variability is based on investigations of different cohorts with different risk factors and different points in time relative to modern intensive care. Morbidity and mortality from RSV mostly occur in children younger than 2 years. Other high-risk infants and children include premature infants younger than 6 months, infants and children with underlying pulmonary or cardiac disease, and those an immune deficiency. […]
  • #10 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Hospitalization is required in 2-3% of bronchiolitis cases among infants younger than 12 months of age. Annually, RSV bronchiolitis accounts for about 57,000-172,000 hospitalizations. In a prospective, population-based surveillance of acute respiratory infections, RSV accounted for 20% of hospitalizations, 18% of ED visits, and 15% clinic visits in winter. Hospitalization is significantly more likely at altitudes above 2500 meters (8000 ft). […] […] Overall, the mortality in children hospitalized for bronchiolitis in different series ranges from 0.2% to 7%. This large variability is based on investigations of different cohorts with different risk factors and different points in time relative to modern intensive care. Morbidity and mortality from RSV mostly occur in children younger than 2 years. Other high-risk infants and children include premature infants younger than 6 months, infants and children with underlying pulmonary or cardiac disease, and those an immune deficiency. […]
  • #11 Predictors of prolonged length of hospital stay and in-hospital mortality in patients aged 1–24 months with acute bronchiolitis in Douala, Cameroon | BMC Pediatrics | Full Text
    https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04653-x
    Prolonged hospital stay was reported in 46.98% and mortality in 10.70% of patients hospitalised for bronchiolitis. […] Factors independently associated with prolonged hospital duration were oxygen administration [b=0.36, OR=2.35 (95% CI:1.164.74), p=0.017], abnormal respiratory rate [b=0.38, OR=2.13 (1.00-4.55), p=0.050] and patients presenting with cough [b=0.33, OR=2.35 (95% CI: 1.224.51), p=0.011], and diarrhoea [b=0.71, OR=6.44 (95% CI: 1.6-25.86), p=0.009] on admission. […] On the other hand, factors independently associated with mortality were age of the patient [b= -0.07, OR=0.84 (95% CI: 0.740.97), p=0.014] and oxygen administration [b=1.08, OR=9.64 (95% CI:1.1679.85), p=0.036]. […] Prolonged length of stay was reported in half of the patients hospitalized and mortality was high, especially in younger patients and in patients receiving oxygen. […] Age and need for oxygen were associated with mortality.
  • #12 Predictors of prolonged length of hospital stay and in-hospital mortality in patients aged 1–24 months with acute bronchiolitis in Douala, Cameroon | BMC Pediatrics | Full Text
    https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04653-x
    Prolonged hospital stay was reported in 46.98% and mortality in 10.70% of patients hospitalised for bronchiolitis. […] Factors independently associated with prolonged hospital duration were oxygen administration [b=0.36, OR=2.35 (95% CI:1.164.74), p=0.017], abnormal respiratory rate [b=0.38, OR=2.13 (1.00-4.55), p=0.050] and patients presenting with cough [b=0.33, OR=2.35 (95% CI: 1.224.51), p=0.011], and diarrhoea [b=0.71, OR=6.44 (95% CI: 1.6-25.86), p=0.009] on admission. […] On the other hand, factors independently associated with mortality were age of the patient [b= -0.07, OR=0.84 (95% CI: 0.740.97), p=0.014] and oxygen administration [b=1.08, OR=9.64 (95% CI:1.1679.85), p=0.036]. […] Prolonged length of stay was reported in half of the patients hospitalized and mortality was high, especially in younger patients and in patients receiving oxygen. […] Age and need for oxygen were associated with mortality.
  • #13 Predictors of prolonged length of hospital stay and in-hospital mortality in patients aged 1–24 months with acute bronchiolitis in Douala, Cameroon | BMC Pediatrics | Full Text
    https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04653-x
    Prolonged hospital stay was reported in 46.98% and mortality in 10.70% of patients hospitalised for bronchiolitis. […] Factors independently associated with prolonged hospital duration were oxygen administration [b=0.36, OR=2.35 (95% CI:1.164.74), p=0.017], abnormal respiratory rate [b=0.38, OR=2.13 (1.00-4.55), p=0.050] and patients presenting with cough [b=0.33, OR=2.35 (95% CI: 1.224.51), p=0.011], and diarrhoea [b=0.71, OR=6.44 (95% CI: 1.6-25.86), p=0.009] on admission. […] On the other hand, factors independently associated with mortality were age of the patient [b= -0.07, OR=0.84 (95% CI: 0.740.97), p=0.014] and oxygen administration [b=1.08, OR=9.64 (95% CI:1.1679.85), p=0.036]. […] Prolonged length of stay was reported in half of the patients hospitalized and mortality was high, especially in younger patients and in patients receiving oxygen. […] Age and need for oxygen were associated with mortality.
  • #14 Predictors of prolonged length of hospital stay and in-hospital mortality in patients aged 1–24 months with acute bronchiolitis in Douala, Cameroon | BMC Pediatrics | Full Text
    https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04653-x
    Prolonged hospital stay was reported in 46.98% and mortality in 10.70% of patients hospitalised for bronchiolitis. […] Factors independently associated with prolonged hospital duration were oxygen administration [b=0.36, OR=2.35 (95% CI:1.164.74), p=0.017], abnormal respiratory rate [b=0.38, OR=2.13 (1.00-4.55), p=0.050] and patients presenting with cough [b=0.33, OR=2.35 (95% CI: 1.224.51), p=0.011], and diarrhoea [b=0.71, OR=6.44 (95% CI: 1.6-25.86), p=0.009] on admission. […] On the other hand, factors independently associated with mortality were age of the patient [b= -0.07, OR=0.84 (95% CI: 0.740.97), p=0.014] and oxygen administration [b=1.08, OR=9.64 (95% CI:1.1679.85), p=0.036]. […] Prolonged length of stay was reported in half of the patients hospitalized and mortality was high, especially in younger patients and in patients receiving oxygen. […] Age and need for oxygen were associated with mortality.
  • #15 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Hospitalization is required in 2-3% of bronchiolitis cases among infants younger than 12 months of age. Annually, RSV bronchiolitis accounts for about 57,000-172,000 hospitalizations. In a prospective, population-based surveillance of acute respiratory infections, RSV accounted for 20% of hospitalizations, 18% of ED visits, and 15% clinic visits in winter. Hospitalization is significantly more likely at altitudes above 2500 meters (8000 ft). […] […] Overall, the mortality in children hospitalized for bronchiolitis in different series ranges from 0.2% to 7%. This large variability is based on investigations of different cohorts with different risk factors and different points in time relative to modern intensive care. Morbidity and mortality from RSV mostly occur in children younger than 2 years. Other high-risk infants and children include premature infants younger than 6 months, infants and children with underlying pulmonary or cardiac disease, and those an immune deficiency. […]
  • #16 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Hospitalization is required in 2-3% of bronchiolitis cases among infants younger than 12 months of age. Annually, RSV bronchiolitis accounts for about 57,000-172,000 hospitalizations. In a prospective, population-based surveillance of acute respiratory infections, RSV accounted for 20% of hospitalizations, 18% of ED visits, and 15% clinic visits in winter. Hospitalization is significantly more likely at altitudes above 2500 meters (8000 ft). […] […] Overall, the mortality in children hospitalized for bronchiolitis in different series ranges from 0.2% to 7%. This large variability is based on investigations of different cohorts with different risk factors and different points in time relative to modern intensive care. Morbidity and mortality from RSV mostly occur in children younger than 2 years. Other high-risk infants and children include premature infants younger than 6 months, infants and children with underlying pulmonary or cardiac disease, and those an immune deficiency. […]
  • #17 Prospective Validation of a Prognostic Model for Respiratory Syncytial Virus Bronchiolitis in Late Preterm Infants: A Multicenter Birth Cohort Study | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0059161
    This study aimed to update and validate a prediction rule for respiratory syncytial virus (RSV) hospitalization in preterm infants 3335 weeks gestational age (WGA). […] Our prospectively validated prediction rule identifies infants at increased RSV hospitalization risk, who may benefit from targeted preventive interventions. This prediction rule can facilitate country-specific, cost-effective use of RSV prophylaxis in late preterm infants. […] We showed that the overall RSV hospitalization risk was 5.1% in this population of healthy late preterm infants 3335 WGA. […] The RISK prediction rule is a simple clinical rule identifying a subgroup of 3335 WGA late preterm infants with increased risk of hospitalization for RSV bronchiolitis. Implementation of the RISK prediction rule will further improve cost-effectiveness of RSV prophylaxis.
  • #18 Prospective Validation of a Prognostic Model for Respiratory Syncytial Virus Bronchiolitis in Late Preterm Infants: A Multicenter Birth Cohort Study | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0059161
    This study aimed to update and validate a prediction rule for respiratory syncytial virus (RSV) hospitalization in preterm infants 3335 weeks gestational age (WGA). […] Our prospectively validated prediction rule identifies infants at increased RSV hospitalization risk, who may benefit from targeted preventive interventions. This prediction rule can facilitate country-specific, cost-effective use of RSV prophylaxis in late preterm infants. […] We showed that the overall RSV hospitalization risk was 5.1% in this population of healthy late preterm infants 3335 WGA. […] The RISK prediction rule is a simple clinical rule identifying a subgroup of 3335 WGA late preterm infants with increased risk of hospitalization for RSV bronchiolitis. Implementation of the RISK prediction rule will further improve cost-effectiveness of RSV prophylaxis.
  • #19 Prospective Validation of a Prognostic Model for Respiratory Syncytial Virus Bronchiolitis in Late Preterm Infants: A Multicenter Birth Cohort Study | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0059161
    This study aimed to update and validate a prediction rule for respiratory syncytial virus (RSV) hospitalization in preterm infants 3335 weeks gestational age (WGA). […] Our prospectively validated prediction rule identifies infants at increased RSV hospitalization risk, who may benefit from targeted preventive interventions. This prediction rule can facilitate country-specific, cost-effective use of RSV prophylaxis in late preterm infants. […] We showed that the overall RSV hospitalization risk was 5.1% in this population of healthy late preterm infants 3335 WGA. […] The RISK prediction rule is a simple clinical rule identifying a subgroup of 3335 WGA late preterm infants with increased risk of hospitalization for RSV bronchiolitis. Implementation of the RISK prediction rule will further improve cost-effectiveness of RSV prophylaxis.
  • #20 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Studies in pediatric ICUs (PICUs) of children with RSV bronchiolitis without comorbidities show a 2-3% death rate, regardless of whether the children had CHD with pulmonary hypertension. In a cohort study from 1999-2007 in the United Kingdom, RSV bronchiolitis-related mortality was 1.7% with higher risk of death associated with preexisting conditions, especially cardiac anomalies. […] […] Although significant morbidity is unusual, multiple small studies suggest that children who have been hospitalized with RSV bronchiolitis have a higher incidence of reactive airway disease and more abnormalities in pulmonary function than children never hospitalized for RSV. These abnormalities may persist for as long as 5 years, eventually normalizing. Conflicting small studies have failed to prove whether early treatment of acute RSV bronchiolitis with ribavirin reduces the persistence of pulmonary dysfunction. […]
  • #21 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Studies in pediatric ICUs (PICUs) of children with RSV bronchiolitis without comorbidities show a 2-3% death rate, regardless of whether the children had CHD with pulmonary hypertension. In a cohort study from 1999-2007 in the United Kingdom, RSV bronchiolitis-related mortality was 1.7% with higher risk of death associated with preexisting conditions, especially cardiac anomalies. […] […] Although significant morbidity is unusual, multiple small studies suggest that children who have been hospitalized with RSV bronchiolitis have a higher incidence of reactive airway disease and more abnormalities in pulmonary function than children never hospitalized for RSV. These abnormalities may persist for as long as 5 years, eventually normalizing. Conflicting small studies have failed to prove whether early treatment of acute RSV bronchiolitis with ribavirin reduces the persistence of pulmonary dysfunction. […]
  • #22
    https://link.springer.com/article/10.1007/s00431-023-05307-3
    For successful prevention and intervention, it is important to unravel the complex constellation of factors that affect neurocognitive functioning after pediatric intensive care unit (PICU) admission. […] This study aims (1) to elucidate the potential relevance of patient and PICU-related characteristics for long-term adverse neurocognitive outcome after PICU admission for bronchiolitis, and (2) to perform a preliminary exploration of the potential of machine learning as compared to linear regression to improve neurocognitive outcome prediction in a relatively small sample of children after PICU admission. […] The findings of this study suggest that in children with previous PICU admission for bronchiolitis, (1) lower birth weight, younger age at follow-up, and lower socioeconomic status are associated with poorer neurocognitive outcome; and (2) greater exposure to acidotic events during PICU admission is associated with poorer verbal memory outcome. […] The findings of this study provide no evidence for the added value of machine learning models as compared to linear regression analysis in the prediction of long-term neurocognitive outcome in a relatively small sample of children.
  • #23
    https://link.springer.com/article/10.1007/s00431-023-05307-3
    For successful prevention and intervention, it is important to unravel the complex constellation of factors that affect neurocognitive functioning after pediatric intensive care unit (PICU) admission. […] This study aims (1) to elucidate the potential relevance of patient and PICU-related characteristics for long-term adverse neurocognitive outcome after PICU admission for bronchiolitis, and (2) to perform a preliminary exploration of the potential of machine learning as compared to linear regression to improve neurocognitive outcome prediction in a relatively small sample of children after PICU admission. […] The findings of this study suggest that in children with previous PICU admission for bronchiolitis, (1) lower birth weight, younger age at follow-up, and lower socioeconomic status are associated with poorer neurocognitive outcome; and (2) greater exposure to acidotic events during PICU admission is associated with poorer verbal memory outcome. […] The findings of this study provide no evidence for the added value of machine learning models as compared to linear regression analysis in the prediction of long-term neurocognitive outcome in a relatively small sample of children.
  • #24 Pediatric Bronchiolitis – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK519506/
    The prognosis of bronchiolitis is generally favorable, with most infants recovering within 5 to 7 days. Although some studies suggest an increased risk of asthma following bronchiolitis, only a small percentage of affected children develop asthma. A history of recurrent wheezing and a positive family history of asthma, allergies, or atopic dermatitis may increase the likelihood of asthma development in these patients in the future. […] Complications from bronchiolitis are uncommon but can be severe, particularly in infants who are premature or have underlying pulmonary, cardiac, or immunocompromised conditions. Even healthy infants may experience acute or chronic complications, although most recover without incident.
  • #25 Pediatric Bronchiolitis – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK519506/
    The prognosis of bronchiolitis is generally favorable, with most infants recovering within 5 to 7 days. Although some studies suggest an increased risk of asthma following bronchiolitis, only a small percentage of affected children develop asthma. A history of recurrent wheezing and a positive family history of asthma, allergies, or atopic dermatitis may increase the likelihood of asthma development in these patients in the future. […] Complications from bronchiolitis are uncommon but can be severe, particularly in infants who are premature or have underlying pulmonary, cardiac, or immunocompromised conditions. Even healthy infants may experience acute or chronic complications, although most recover without incident.
  • #26 Association between early bronchiolitis and the development of childhood asthma: a meta-analysis | BMJ Open
    https://bmjopen.bmj.com/content/11/5/e043956
    Early life bronchiolitis has been hypothesised to be associated with the subsequent risk of persistent wheezing or asthma. However, the link remains controversial. […] Bronchiolitis before 2 years of age was associated with an increased risk of subsequent wheezing/asthma (relative risk=2.46, 95% CI 2.14 to 2.82, p0.001). […] The meta-analysis indicates an association between bronchiolitis before 2 years of age and the wheezing/asthma in later life. […] This meta-analysis on 33 studies provided considerable evidence indicating the positive association between early-life bronchiolitis and the subsequent development of wheezing/asthma. […] In summary, this meta-analysis indicates that bronchiolitis before 2 years of age may be associated with subsequent development of wheezing/asthma.
  • #27 Association between early bronchiolitis and the development of childhood asthma: a meta-analysis | BMJ Open
    https://bmjopen.bmj.com/content/11/5/e043956
    Early life bronchiolitis has been hypothesised to be associated with the subsequent risk of persistent wheezing or asthma. However, the link remains controversial. […] Bronchiolitis before 2 years of age was associated with an increased risk of subsequent wheezing/asthma (relative risk=2.46, 95% CI 2.14 to 2.82, p0.001). […] The meta-analysis indicates an association between bronchiolitis before 2 years of age and the wheezing/asthma in later life. […] This meta-analysis on 33 studies provided considerable evidence indicating the positive association between early-life bronchiolitis and the subsequent development of wheezing/asthma. […] In summary, this meta-analysis indicates that bronchiolitis before 2 years of age may be associated with subsequent development of wheezing/asthma.
  • #28 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Although bronchiolitis has been identified as a risk factor for asthma, this does not necessarily imply causation. Children already predisposed to asthma may be more likely to wheeze when exposed to RSV or other respiratory infectious or allergic stimuli. On the other hand, it is postulated that RSV infection may predispose an individual to later bronchospasm by selective promotion of specific subsets of helper T cells. […] […] A study by Fujiogi et al of infants hospitalized with severe bronchiolitis showed that those who had a history of breathing problems and eczema, rhinovirus infection, and a low likelihood of RSV infection were at highest risk for the development of asthma. Their risk was more than 2.5-fold greater than that of infants with „classic” RSV bronchiolitis. […] […] Multiple studies have shown that children, including febrile infants younger than 8 weeks, with confirmed RSV infection have a lower risk of serious bacterial infections or secondary bacterial superinfection than controls (eg, 0% vs 2.7% for bacteremia, and 2% vs 14% for urinary tract infection). The risk of concurrent bacterial infections is low.
  • #29 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Although bronchiolitis has been identified as a risk factor for asthma, this does not necessarily imply causation. Children already predisposed to asthma may be more likely to wheeze when exposed to RSV or other respiratory infectious or allergic stimuli. On the other hand, it is postulated that RSV infection may predispose an individual to later bronchospasm by selective promotion of specific subsets of helper T cells. […] […] A study by Fujiogi et al of infants hospitalized with severe bronchiolitis showed that those who had a history of breathing problems and eczema, rhinovirus infection, and a low likelihood of RSV infection were at highest risk for the development of asthma. Their risk was more than 2.5-fold greater than that of infants with „classic” RSV bronchiolitis. […] […] Multiple studies have shown that children, including febrile infants younger than 8 weeks, with confirmed RSV infection have a lower risk of serious bacterial infections or secondary bacterial superinfection than controls (eg, 0% vs 2.7% for bacteremia, and 2% vs 14% for urinary tract infection). The risk of concurrent bacterial infections is low.
  • #30 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Although bronchiolitis has been identified as a risk factor for asthma, this does not necessarily imply causation. Children already predisposed to asthma may be more likely to wheeze when exposed to RSV or other respiratory infectious or allergic stimuli. On the other hand, it is postulated that RSV infection may predispose an individual to later bronchospasm by selective promotion of specific subsets of helper T cells. […] […] A study by Fujiogi et al of infants hospitalized with severe bronchiolitis showed that those who had a history of breathing problems and eczema, rhinovirus infection, and a low likelihood of RSV infection were at highest risk for the development of asthma. Their risk was more than 2.5-fold greater than that of infants with „classic” RSV bronchiolitis. […] […] Multiple studies have shown that children, including febrile infants younger than 8 weeks, with confirmed RSV infection have a lower risk of serious bacterial infections or secondary bacterial superinfection than controls (eg, 0% vs 2.7% for bacteremia, and 2% vs 14% for urinary tract infection). The risk of concurrent bacterial infections is low.
  • #31 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Although bronchiolitis has been identified as a risk factor for asthma, this does not necessarily imply causation. Children already predisposed to asthma may be more likely to wheeze when exposed to RSV or other respiratory infectious or allergic stimuli. On the other hand, it is postulated that RSV infection may predispose an individual to later bronchospasm by selective promotion of specific subsets of helper T cells. […] […] A study by Fujiogi et al of infants hospitalized with severe bronchiolitis showed that those who had a history of breathing problems and eczema, rhinovirus infection, and a low likelihood of RSV infection were at highest risk for the development of asthma. Their risk was more than 2.5-fold greater than that of infants with „classic” RSV bronchiolitis. […] […] Multiple studies have shown that children, including febrile infants younger than 8 weeks, with confirmed RSV infection have a lower risk of serious bacterial infections or secondary bacterial superinfection than controls (eg, 0% vs 2.7% for bacteremia, and 2% vs 14% for urinary tract infection). The risk of concurrent bacterial infections is low.
  • #32 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Although bronchiolitis has been identified as a risk factor for asthma, this does not necessarily imply causation. Children already predisposed to asthma may be more likely to wheeze when exposed to RSV or other respiratory infectious or allergic stimuli. On the other hand, it is postulated that RSV infection may predispose an individual to later bronchospasm by selective promotion of specific subsets of helper T cells. […] […] A study by Fujiogi et al of infants hospitalized with severe bronchiolitis showed that those who had a history of breathing problems and eczema, rhinovirus infection, and a low likelihood of RSV infection were at highest risk for the development of asthma. Their risk was more than 2.5-fold greater than that of infants with „classic” RSV bronchiolitis. […] […] Multiple studies have shown that children, including febrile infants younger than 8 weeks, with confirmed RSV infection have a lower risk of serious bacterial infections or secondary bacterial superinfection than controls (eg, 0% vs 2.7% for bacteremia, and 2% vs 14% for urinary tract infection). The risk of concurrent bacterial infections is low.
  • #33 Pediatric Bronchiolitis – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK519506/
    The prognosis of bronchiolitis is generally favorable, with most infants recovering within 5 to 7 days. Although some studies suggest an increased risk of asthma following bronchiolitis, only a small percentage of affected children develop asthma. A history of recurrent wheezing and a positive family history of asthma, allergies, or atopic dermatitis may increase the likelihood of asthma development in these patients in the future. […] Complications from bronchiolitis are uncommon but can be severe, particularly in infants who are premature or have underlying pulmonary, cardiac, or immunocompromised conditions. Even healthy infants may experience acute or chronic complications, although most recover without incident.
  • #34 Pediatric Bronchiolitis – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK519506/
    The prognosis of bronchiolitis is generally favorable, with most infants recovering within 5 to 7 days. Although some studies suggest an increased risk of asthma following bronchiolitis, only a small percentage of affected children develop asthma. A history of recurrent wheezing and a positive family history of asthma, allergies, or atopic dermatitis may increase the likelihood of asthma development in these patients in the future. […] Complications from bronchiolitis are uncommon but can be severe, particularly in infants who are premature or have underlying pulmonary, cardiac, or immunocompromised conditions. Even healthy infants may experience acute or chronic complications, although most recover without incident.
  • #35 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Studies in pediatric ICUs (PICUs) of children with RSV bronchiolitis without comorbidities show a 2-3% death rate, regardless of whether the children had CHD with pulmonary hypertension. In a cohort study from 1999-2007 in the United Kingdom, RSV bronchiolitis-related mortality was 1.7% with higher risk of death associated with preexisting conditions, especially cardiac anomalies. […] […] Although significant morbidity is unusual, multiple small studies suggest that children who have been hospitalized with RSV bronchiolitis have a higher incidence of reactive airway disease and more abnormalities in pulmonary function than children never hospitalized for RSV. These abnormalities may persist for as long as 5 years, eventually normalizing. Conflicting small studies have failed to prove whether early treatment of acute RSV bronchiolitis with ribavirin reduces the persistence of pulmonary dysfunction. […]
  • #36 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Studies in pediatric ICUs (PICUs) of children with RSV bronchiolitis without comorbidities show a 2-3% death rate, regardless of whether the children had CHD with pulmonary hypertension. In a cohort study from 1999-2007 in the United Kingdom, RSV bronchiolitis-related mortality was 1.7% with higher risk of death associated with preexisting conditions, especially cardiac anomalies. […] […] Although significant morbidity is unusual, multiple small studies suggest that children who have been hospitalized with RSV bronchiolitis have a higher incidence of reactive airway disease and more abnormalities in pulmonary function than children never hospitalized for RSV. These abnormalities may persist for as long as 5 years, eventually normalizing. Conflicting small studies have failed to prove whether early treatment of acute RSV bronchiolitis with ribavirin reduces the persistence of pulmonary dysfunction. […]
  • #37 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Although bronchiolitis has been identified as a risk factor for asthma, this does not necessarily imply causation. Children already predisposed to asthma may be more likely to wheeze when exposed to RSV or other respiratory infectious or allergic stimuli. On the other hand, it is postulated that RSV infection may predispose an individual to later bronchospasm by selective promotion of specific subsets of helper T cells. […] […] A study by Fujiogi et al of infants hospitalized with severe bronchiolitis showed that those who had a history of breathing problems and eczema, rhinovirus infection, and a low likelihood of RSV infection were at highest risk for the development of asthma. Their risk was more than 2.5-fold greater than that of infants with „classic” RSV bronchiolitis. […] […] Multiple studies have shown that children, including febrile infants younger than 8 weeks, with confirmed RSV infection have a lower risk of serious bacterial infections or secondary bacterial superinfection than controls (eg, 0% vs 2.7% for bacteremia, and 2% vs 14% for urinary tract infection). The risk of concurrent bacterial infections is low.
  • #38 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Although bronchiolitis has been identified as a risk factor for asthma, this does not necessarily imply causation. Children already predisposed to asthma may be more likely to wheeze when exposed to RSV or other respiratory infectious or allergic stimuli. On the other hand, it is postulated that RSV infection may predispose an individual to later bronchospasm by selective promotion of specific subsets of helper T cells. […] […] A study by Fujiogi et al of infants hospitalized with severe bronchiolitis showed that those who had a history of breathing problems and eczema, rhinovirus infection, and a low likelihood of RSV infection were at highest risk for the development of asthma. Their risk was more than 2.5-fold greater than that of infants with „classic” RSV bronchiolitis. […] […] Multiple studies have shown that children, including febrile infants younger than 8 weeks, with confirmed RSV infection have a lower risk of serious bacterial infections or secondary bacterial superinfection than controls (eg, 0% vs 2.7% for bacteremia, and 2% vs 14% for urinary tract infection). The risk of concurrent bacterial infections is low.
  • #39 Segmenting viral bronchiolitis patients – Children’s National
    https://innovationdistrict.childrensnational.org/segmenting-viral-bronchiolitis-patients-to-better-predict-clinical-outcomes/
    By evaluating viral bronchiolitis patients at first presentation and categorizing them based on clinical phenotype, the researchers were able to better predict outcomes and disease progression patterns. […] The researchers believe this novel subdivision of viral bronchiolitis patients based on a robust combination of clinical and molecular assessment can help lead to more individualized care and better patient outcomes. […] Childrens National researchers hypothesized that a novel segmentation technique of viral bronchiolitis patients by phenotype at first episode could provide better outcome prediction. […] As hypothesized, the three phenotype groups displayed distinct clinically relevant outcomes. […] The researchers hope that the strong results of their pilot study will guide clinicians to revise current practices regarding viral bronchiolitis and personalize care of viral respiratory illnesses from first presentation in order to improve outcomes.
  • #40 Segmenting viral bronchiolitis patients – Children’s National
    https://innovationdistrict.childrensnational.org/segmenting-viral-bronchiolitis-patients-to-better-predict-clinical-outcomes/
    By evaluating viral bronchiolitis patients at first presentation and categorizing them based on clinical phenotype, the researchers were able to better predict outcomes and disease progression patterns. […] The researchers believe this novel subdivision of viral bronchiolitis patients based on a robust combination of clinical and molecular assessment can help lead to more individualized care and better patient outcomes. […] Childrens National researchers hypothesized that a novel segmentation technique of viral bronchiolitis patients by phenotype at first episode could provide better outcome prediction. […] As hypothesized, the three phenotype groups displayed distinct clinically relevant outcomes. […] The researchers hope that the strong results of their pilot study will guide clinicians to revise current practices regarding viral bronchiolitis and personalize care of viral respiratory illnesses from first presentation in order to improve outcomes.
  • #41 Segmenting viral bronchiolitis patients – Children’s National
    https://innovationdistrict.childrensnational.org/segmenting-viral-bronchiolitis-patients-to-better-predict-clinical-outcomes/
    By evaluating viral bronchiolitis patients at first presentation and categorizing them based on clinical phenotype, the researchers were able to better predict outcomes and disease progression patterns. […] The researchers believe this novel subdivision of viral bronchiolitis patients based on a robust combination of clinical and molecular assessment can help lead to more individualized care and better patient outcomes. […] Childrens National researchers hypothesized that a novel segmentation technique of viral bronchiolitis patients by phenotype at first episode could provide better outcome prediction. […] As hypothesized, the three phenotype groups displayed distinct clinically relevant outcomes. […] The researchers hope that the strong results of their pilot study will guide clinicians to revise current practices regarding viral bronchiolitis and personalize care of viral respiratory illnesses from first presentation in order to improve outcomes.
  • #42 Segmenting viral bronchiolitis patients – Children’s National
    https://innovationdistrict.childrensnational.org/segmenting-viral-bronchiolitis-patients-to-better-predict-clinical-outcomes/
    By evaluating viral bronchiolitis patients at first presentation and categorizing them based on clinical phenotype, the researchers were able to better predict outcomes and disease progression patterns. […] The researchers believe this novel subdivision of viral bronchiolitis patients based on a robust combination of clinical and molecular assessment can help lead to more individualized care and better patient outcomes. […] Childrens National researchers hypothesized that a novel segmentation technique of viral bronchiolitis patients by phenotype at first episode could provide better outcome prediction. […] As hypothesized, the three phenotype groups displayed distinct clinically relevant outcomes. […] The researchers hope that the strong results of their pilot study will guide clinicians to revise current practices regarding viral bronchiolitis and personalize care of viral respiratory illnesses from first presentation in order to improve outcomes.
  • #43 Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting | Pediatric Research
    https://www.nature.com/articles/s41390-024-03340-y
    Clinical trials for bronchiolitis management frequently exclude high-risk children. […] Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting. […] The majority of RCTs included in the NICE guidelines (2015) excluded those infants with any high-risk condition, comorbidity, or requiring escalation of care. […] Given the exclusion of high-risk infants from trials which are subsequently used to make evidence-based recommendations, this significantly limits the generalisability of the guidelines among infants with various underlying health conditions. […] Our systematic review highlighted a similar lack of evidence-based management for high-risk infants with acute bronchiolitis in the PICU.
  • #44 Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting | Pediatric Research
    https://www.nature.com/articles/s41390-024-03340-y
    Clinical trials for bronchiolitis management frequently exclude high-risk children. […] Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting. […] The majority of RCTs included in the NICE guidelines (2015) excluded those infants with any high-risk condition, comorbidity, or requiring escalation of care. […] Given the exclusion of high-risk infants from trials which are subsequently used to make evidence-based recommendations, this significantly limits the generalisability of the guidelines among infants with various underlying health conditions. […] Our systematic review highlighted a similar lack of evidence-based management for high-risk infants with acute bronchiolitis in the PICU.
  • #45 Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting | Pediatric Research
    https://www.nature.com/articles/s41390-024-03340-y
    Clinical trials for bronchiolitis management frequently exclude high-risk children. […] Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting. […] The majority of RCTs included in the NICE guidelines (2015) excluded those infants with any high-risk condition, comorbidity, or requiring escalation of care. […] Given the exclusion of high-risk infants from trials which are subsequently used to make evidence-based recommendations, this significantly limits the generalisability of the guidelines among infants with various underlying health conditions. […] Our systematic review highlighted a similar lack of evidence-based management for high-risk infants with acute bronchiolitis in the PICU.
  • #46 Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting | Pediatric Research
    https://www.nature.com/articles/s41390-024-03340-y
    Clinical trials for bronchiolitis management frequently exclude high-risk children. […] Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting. […] The majority of RCTs included in the NICE guidelines (2015) excluded those infants with any high-risk condition, comorbidity, or requiring escalation of care. […] Given the exclusion of high-risk infants from trials which are subsequently used to make evidence-based recommendations, this significantly limits the generalisability of the guidelines among infants with various underlying health conditions. […] Our systematic review highlighted a similar lack of evidence-based management for high-risk infants with acute bronchiolitis in the PICU.
  • #47 Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting | Pediatric Research
    https://www.nature.com/articles/s41390-024-03340-y
    Clinical trials for bronchiolitis management frequently exclude high-risk children. […] Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting. […] The majority of RCTs included in the NICE guidelines (2015) excluded those infants with any high-risk condition, comorbidity, or requiring escalation of care. […] Given the exclusion of high-risk infants from trials which are subsequently used to make evidence-based recommendations, this significantly limits the generalisability of the guidelines among infants with various underlying health conditions. […] Our systematic review highlighted a similar lack of evidence-based management for high-risk infants with acute bronchiolitis in the PICU.
  • #48 Which outcomes should be used in future bronchiolitis trials? Developing a bronchiolitis core outcome set using a systematic review, Delphi survey and a consensus workshop | BMJ Open
    https://bmjopen.bmj.com/content/12/3/e052943
    Objectives The objective of this study was to develop a core outcome set (COS) for use in future clinical trials in bronchiolitis. We wanted to find out which outcomes are important to healthcare professionals (HCPs) and to parents and which outcomes should be prioritised for use in future clinical trials. […] We have developed the first parent and HCP consensus on a COS for bronchiolitis in a hospital setting. The use of this COS will ensure outcomes in future bronchiolitis trials are important and relevant, and will enable the trial results to be compared and combined. […] We have developed a COS of 25 outcomes of importance to medically qualified staff, nurses and other clinical staff, and parents of children with bronchiolitis, for use in RCTs of interventions for children with a clinical diagnosis of bronchiolitis in a hospital setting.
  • #49 Which outcomes should be used in future bronchiolitis trials? Developing a bronchiolitis core outcome set using a systematic review, Delphi survey and a consensus workshop | BMJ Open
    https://bmjopen.bmj.com/content/12/3/e052943
    Objectives The objective of this study was to develop a core outcome set (COS) for use in future clinical trials in bronchiolitis. We wanted to find out which outcomes are important to healthcare professionals (HCPs) and to parents and which outcomes should be prioritised for use in future clinical trials. […] We have developed the first parent and HCP consensus on a COS for bronchiolitis in a hospital setting. The use of this COS will ensure outcomes in future bronchiolitis trials are important and relevant, and will enable the trial results to be compared and combined. […] We have developed a COS of 25 outcomes of importance to medically qualified staff, nurses and other clinical staff, and parents of children with bronchiolitis, for use in RCTs of interventions for children with a clinical diagnosis of bronchiolitis in a hospital setting.
  • #50 Which outcomes should be used in future bronchiolitis trials? Developing a bronchiolitis core outcome set using a systematic review, Delphi survey and a consensus workshop | BMJ Open
    https://bmjopen.bmj.com/content/12/3/e052943
    We believe the COS should be used by future trialists as the minimum set of outcomes that should be collected in a bronchiolitis trial. Importantly, this COS provides an essential step towards increasing and improving much-needed evidence synthesis in this disease area. […] This was an important study identifying the outcomes of importance to key stakeholder groups which will provide guidance to future trialists in paediatric bronchiolitis. This is particularly pertinent with anti-viral treatments in the therapeutic pipeline, and the need to clearly define how some existing interventions (such as high flow nasal cannula oxygen) are best used in clinical practice. We recommend researchers designing bronchiolitis trials consider this preliminary COS as a minimum for outcomes collected and reported in trials. Future work is now needed to test the validity and generalisability of the COS and ongoing work should include routine updating of the COS.
  • #51 Which outcomes should be used in future bronchiolitis trials? Developing a bronchiolitis core outcome set using a systematic review, Delphi survey and a consensus workshop | BMJ Open
    https://bmjopen.bmj.com/content/12/3/e052943
    We believe the COS should be used by future trialists as the minimum set of outcomes that should be collected in a bronchiolitis trial. Importantly, this COS provides an essential step towards increasing and improving much-needed evidence synthesis in this disease area. […] This was an important study identifying the outcomes of importance to key stakeholder groups which will provide guidance to future trialists in paediatric bronchiolitis. This is particularly pertinent with anti-viral treatments in the therapeutic pipeline, and the need to clearly define how some existing interventions (such as high flow nasal cannula oxygen) are best used in clinical practice. We recommend researchers designing bronchiolitis trials consider this preliminary COS as a minimum for outcomes collected and reported in trials. Future work is now needed to test the validity and generalisability of the COS and ongoing work should include routine updating of the COS.
  • #52 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    According to the WHO 2015 Global Health Observatory data repository, acute lower respiratory infection in children younger than 5 years of age remains a leading cause of childhood mortality in the world. In 2015, acute respiratory tract infection accounted for an estimated 1.84 million deaths worldwide; 85% of these deaths occurred in Africa followed by 8% in Southeast Asia. […] […] Bronchiolitis is an infectious, self-limited disease. Therapy is based on supportive care, oxygenation, hydration, and fever control. With early recognition and treatment, prognosis is usually very good. Most children with bronchiolitis, regardless of severity, recover without sequelae. The course of disease is usually 7-10 days, but a few remain ill for weeks. Some infants who recover from acute bronchiolitis have an increased frequency of recurrent wheezing. […]
  • #53 Bronchiolitis – Pediatrics – Merck Manual Professional Edition
    https://www.merckmanuals.com/professional/pediatrics/respiratory-disorders-in-young-children/bronchiolitis
    Prognosis is excellent. Most children recover in 3 to 5 days without sequelae, although wheezing and cough may continue for 2 to 4 weeks. Mortality is 0.1% when medical care is adequate. […] An increased incidence of asthma is suspected in children who have had bronchiolitis in early childhood, but the association is controversial because the children who later develop asthma may be more severely affected by RSV and therefore are more likely to seek medical attention. The incidence seems to decrease as children age.
  • #54 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    According to the WHO 2015 Global Health Observatory data repository, acute lower respiratory infection in children younger than 5 years of age remains a leading cause of childhood mortality in the world. In 2015, acute respiratory tract infection accounted for an estimated 1.84 million deaths worldwide; 85% of these deaths occurred in Africa followed by 8% in Southeast Asia. […] […] Bronchiolitis is an infectious, self-limited disease. Therapy is based on supportive care, oxygenation, hydration, and fever control. With early recognition and treatment, prognosis is usually very good. Most children with bronchiolitis, regardless of severity, recover without sequelae. The course of disease is usually 7-10 days, but a few remain ill for weeks. Some infants who recover from acute bronchiolitis have an increased frequency of recurrent wheezing. […]
  • #55 Household Tobacco Smoke and Admission Weight Predict Severe Bronchiolitis in Infants Independent of Deprivation: Prospective Cohort Study | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0022425
    Low admission weight and householder tobacco smoking increased the risk of severe bronchiolitis in infants admitted to hospital. These effects were independent of a standard deprivation measure. […] Multivariate multinomial analysis using logistic regression found that infants from tobacco smoking households were at increased risk of severe disease needing supplemental oxygen (OR=2.45, 95%CI (1.60 to 3.74), p0.001) or mechanical ventilation (adjusted OR=5.49 (2.78 to 10.83), p0.001). […] Weight (kg) on admission reduced the risk of needing for mechanical ventilation (adjusted OR 0.51 (0.40 to 0.65), p0.001), meaning for every 1 kg increase in admission weight, odds of an infant requiring mechanical ventilation were halved. […] The same predictor variables were retained when participants in the model were restricted to those with proven RSV infection and the sizes of effects were very similar.
  • #56 Predictors of prolonged length of hospital stay and in-hospital mortality in patients aged 1–24 months with acute bronchiolitis in Douala, Cameroon | BMC Pediatrics | Full Text
    https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04653-x
    Prolonged hospital stay was reported in 46.98% and mortality in 10.70% of patients hospitalised for bronchiolitis. […] Factors independently associated with prolonged hospital duration were oxygen administration [b=0.36, OR=2.35 (95% CI:1.164.74), p=0.017], abnormal respiratory rate [b=0.38, OR=2.13 (1.00-4.55), p=0.050] and patients presenting with cough [b=0.33, OR=2.35 (95% CI: 1.224.51), p=0.011], and diarrhoea [b=0.71, OR=6.44 (95% CI: 1.6-25.86), p=0.009] on admission. […] On the other hand, factors independently associated with mortality were age of the patient [b= -0.07, OR=0.84 (95% CI: 0.740.97), p=0.014] and oxygen administration [b=1.08, OR=9.64 (95% CI:1.1679.85), p=0.036]. […] Prolonged length of stay was reported in half of the patients hospitalized and mortality was high, especially in younger patients and in patients receiving oxygen. […] Age and need for oxygen were associated with mortality.
  • #57 Pediatric Bronchiolitis – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK519506/
    The prognosis of bronchiolitis is generally favorable, with most infants recovering within 5 to 7 days. Although some studies suggest an increased risk of asthma following bronchiolitis, only a small percentage of affected children develop asthma. A history of recurrent wheezing and a positive family history of asthma, allergies, or atopic dermatitis may increase the likelihood of asthma development in these patients in the future. […] Complications from bronchiolitis are uncommon but can be severe, particularly in infants who are premature or have underlying pulmonary, cardiac, or immunocompromised conditions. Even healthy infants may experience acute or chronic complications, although most recover without incident.
  • #58 Association between early bronchiolitis and the development of childhood asthma: a meta-analysis | BMJ Open
    https://bmjopen.bmj.com/content/11/5/e043956
    Early life bronchiolitis has been hypothesised to be associated with the subsequent risk of persistent wheezing or asthma. However, the link remains controversial. […] Bronchiolitis before 2 years of age was associated with an increased risk of subsequent wheezing/asthma (relative risk=2.46, 95% CI 2.14 to 2.82, p0.001). […] The meta-analysis indicates an association between bronchiolitis before 2 years of age and the wheezing/asthma in later life. […] This meta-analysis on 33 studies provided considerable evidence indicating the positive association between early-life bronchiolitis and the subsequent development of wheezing/asthma. […] In summary, this meta-analysis indicates that bronchiolitis before 2 years of age may be associated with subsequent development of wheezing/asthma.
  • #59 Bronchiolitis: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/961963-overview
    Although bronchiolitis has been identified as a risk factor for asthma, this does not necessarily imply causation. Children already predisposed to asthma may be more likely to wheeze when exposed to RSV or other respiratory infectious or allergic stimuli. On the other hand, it is postulated that RSV infection may predispose an individual to later bronchospasm by selective promotion of specific subsets of helper T cells. […] […] A study by Fujiogi et al of infants hospitalized with severe bronchiolitis showed that those who had a history of breathing problems and eczema, rhinovirus infection, and a low likelihood of RSV infection were at highest risk for the development of asthma. Their risk was more than 2.5-fold greater than that of infants with „classic” RSV bronchiolitis. […] […] Multiple studies have shown that children, including febrile infants younger than 8 weeks, with confirmed RSV infection have a lower risk of serious bacterial infections or secondary bacterial superinfection than controls (eg, 0% vs 2.7% for bacteremia, and 2% vs 14% for urinary tract infection). The risk of concurrent bacterial infections is low.
  • #60 Segmenting viral bronchiolitis patients – Children’s National
    https://innovationdistrict.childrensnational.org/segmenting-viral-bronchiolitis-patients-to-better-predict-clinical-outcomes/
    By evaluating viral bronchiolitis patients at first presentation and categorizing them based on clinical phenotype, the researchers were able to better predict outcomes and disease progression patterns. […] The researchers believe this novel subdivision of viral bronchiolitis patients based on a robust combination of clinical and molecular assessment can help lead to more individualized care and better patient outcomes. […] Childrens National researchers hypothesized that a novel segmentation technique of viral bronchiolitis patients by phenotype at first episode could provide better outcome prediction. […] As hypothesized, the three phenotype groups displayed distinct clinically relevant outcomes. […] The researchers hope that the strong results of their pilot study will guide clinicians to revise current practices regarding viral bronchiolitis and personalize care of viral respiratory illnesses from first presentation in order to improve outcomes.

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