Clinical and etiological characteristics of acute bronchiolitis in children at Novosibirsk

Abstract

Acute bronchiolitis is often a viral inflammation of the terminal bronchioles, with the development of severe broncho-obstructive syndrome. The maximum frequency of this pathology is recorded in children under one year old. The high prevalence of viral agents capable of inducing the development of this pathology, the lack of effective etiotropic treatment, the severity of respiratory failure (RF), as well as the high incidence of adverse consequences after bronchiolitis, actualize the study of this issue. Moreover, different territories have differences in epidemiological and etiological data regarding acute bronchiolitis. We carried out a prospective observation of 150 children who were hospitalized for acute bronchiolitis in the Children`s city hospital № 3 in 2018-2019. The disease had a strict winter seasonality (60,7% of cases of acute bronchiolitis were recorded in the winter months). Treatment in the intensive care unit and intensive care required 19 children (13%), 131 patients received treatment in the specialized department of the infectious diseases hospital. The first degree of RF at admission had 66 children, the second – 32 children, the third – 19 children, while RF was absent in 33 patients. Patients with third grade of RF received respiratory support using mechanical ventilation. A complicated flow of the disease, in the form of the development of secondary viral-bacterial pneumonia, was recorded in 17 (11,3%) patients. Etiological verification by PCR was performed in 85 (56,6%) patients. The leading etiological agents in Novosibirsk were: respiratory syncytial virus – 33 (38,8%), bocavirus – 19 (22,4%), adenovirus – 15 (17,6%), metapneumovirus – 10 (11, 8%), other viral agents – 8 (9,4%) cases. Certain etiological features were observed, in particular bronchiolitis caused by the respiratory syncytial virus was significantly more often (p = 0,001) recorded in premature infants, in turn, bocavirus bronchiolitis was reliably (р = 0,0001) more often characterized by a more pronounced intoxication syndrome, with higher numbers of fever. The development of a severe course of bronchiolitis, requiring mechanical ventilation was significantly more often recorded in premature babies born before 36 weeks of gestation (OR 3,8, 95% CI 3,6-37,5, р ≤ 0,05), as well as in children who were on artificial feeding (OR 11, 95% CI 2,4-49,7, р ≤ 0,05). This fact allows us to consider prematurity and the presence of artificial feeding as a risk factor for the severe course of acute bronchiolitis in children.

Keywords

• bronchiolitis
• bronchial obstructive syndrome
• infectious diseases
• respiratory failure
• viral infections
• pediatrics