PDF(Sci-hub)
Abstract：
Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection. Criteria for hospitalization include low oxygen saturation (<90-92%), moderate-to-severe respiratory distress, dehydration and presence of apnea. Children with pre-existing risk factors should be carefully assessed.To date, there is no specific treatment for viral bronchiolitis, and the mainstay of therapy is supportive care. This consists of nasal suctioning and nebulized 3% hypertonic saline, assisted feeding and hydration, humidified O2 delivery. The possible role of any pharmacological approach is still debated, and till now there is no evidence to support the use of bronchodilators, corticosteroids, chest physiotherapy, antibiotics or antivirals. Nebulized adrenaline may be sometimes useful in the emergency room. Nebulized adrenaline can be useful in the hospital setting for treatment as needed. Lacking a specific etiological treatment, prophylaxis and prevention, especially in children at high risk of severe infection, have a fundamental role. Environmental preventive measures minimize viral transmission in hospital, in the outpatient setting and at home. Pharmacological prophylaxis with palivizumab for RSV bronchiolitis is indicated in specific categories of children at risk during the epidemic period. Viral bronchiolitis, especially in the case of severe form, may correlate with an increased incidence of recurrent wheezing in pre-schooled children and with asthma at school age.The aim of this document is to provide a multidisciplinary update on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications, identify gaps in knowledge and drive future research.
摘要：
急性细支气管炎是全球1岁以下儿童下呼吸道感染和住院的主要原因。它通常是一种轻度疾病，但是有些孩子可能会出现严重的症状，需要在ICU住院和通气支持。具有预先存在的危险因素的婴儿（早产，支气管肺发育不良,先天性心脏病和免疫缺陷）可能会患上严重的疾病。毛细支气管炎的临床诊断是基于病史和体格检查（鼻漏，咳嗽,cracks,喘息和呼吸窘迫的迹象)。病因诊断,用抗原或基因组检测来鉴定涉及的病毒，可能对减少感染的医院传播有作用。住院标准包括低氧饱和度（<90-92％），中度至重度呼吸窘迫，脱水和呼吸暂停的存在。有预先存在危险因素的儿童应仔细评估。迄今为止,病毒性细支气管炎没有特殊的治疗方法,治疗的主要手段是支持治疗.这包括鼻吸和雾化的3%高渗盐水，辅助喂养和水合，加湿O2输送。任何药理学方法的可能作用仍然存在争议，到目前为止还没有证据支持使用支气管扩张剂，皮质类固醇,胸部理疗,抗生素或抗病毒药物。雾化肾上腺素有时可能在急诊室有用。雾化肾上腺素可以在医院环境中根据需要进行治疗。缺乏特定的病因治疗，预防和预防，尤其是严重感染的高危儿童，有根本的作用。环境预防措施尽量减少病毒传播在医院，在门诊和家里。在流行期间处于危险中的特定类别的儿童中，表明帕利珠单抗用于RSV细支气管炎的药物预防。病毒性细支气管炎,特别是在严重形式的情况下，可能与学龄前儿童反复喘息和学龄期哮喘的发生率增加有关。本文件的目的是提供目前关于毛细支气管炎的管理和预防建议的多学科最新情况。为了分享有用的适应症，找出知识差距，推动未来的研究。
