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Infect Dis Now 2021 May 12. Epub 2021 May 12.

GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Créteil, France; Service de pédiatrie, Centre Hospitalier Armand trousseau, Paris, France.

Since the beginning of the COVID-19 pandemic, reduced incidence of many viral and bacterial infections has been reported in children: bronchiolitis, varicella, measles, pertussis, pneumococcal and meningococcal invasive diseases. The purpose of this opinion paper is to discuss various situations that could lead to larger epidemics when the non-pharmaceutical interventions (NPI) imposed by the SARS-CoV-2 epidemic will no longer be necessary. While NPIs limited the transmission of SARS-CoV-2, they also reduced the spread of other pathogens during and after lockdown periods, despite the re-opening of schools since June 2020 in France. Read More

Pediatrics 2021 May 10. Epub 2021 May 10.

Division of Pediatric Critical Care Medicine, Department Critical Care Medicine, and

Objectives: To determine the changes in ICU admissions, ventilatory support, length of stay, and cost for patients with bronchiolitis in the United States.

Methods: Retrospective cross-sectional study of the Pediatric Health Information Systems database. All patients age <2 years admitted with bronchiolitis and discharged between January 1, 2010 and December 31, 2019, were included. Read More

Pediatrics 2021 May 10. Epub 2021 May 10.

Johns Hopkins University, Baltimore, Maryland.

Sci Rep 2021 May 7;11(1):9790. Epub 2021 May 7.

Center On the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

The prevalence of maternal obesity has increased dramatically with adverse consequences on infant health. Prior studies have reported associations between maternal obesity and childhood wheeze, asthma as well as lower respiratory tract infections (LRTI). However, studies examining the association of obesity with early-life LRTIs in low-income urban minority populations are still lacking. Read More

Pediatr Pulmonol 2021 May 7. Epub 2021 May 7.

Department of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

Aim: To assess the impact of the coronavirus disease 2019 (COVID-19) outbreak on pediatric emergency department (ED) visits for acute bronchiolitis during the epidemic season.

Methods: A retrospective analytical cross-sectional study was performed in our hospital, analyzing medical charts of all children under 2 years of age with a diagnosis of acute bronchiolitis admitted to our ED in the last years. Demographics and clinical data of patients affected with acute bronchiolitis during the 2020-2021 season-COVID-19 outbreak-were compared to those of the 5 previous years. Read More

Acad Emerg Med 2021 May 7. Epub 2021 May 7.

University of Nebraska Medical Center, Children's Hospital Medical Center, Omaha, Nebraska, USA.

Objective: Variation in bronchiolitis management by race and ethnicity within emergency departments (EDs) has been described in single-center and prospective studies, but large-scale assessments across EDs and inpatient settings are lacking. Our objective is to describe the association between race and ethnicity and bronchiolitis management across 37 US free-standing children's hospitals from 2015 to 2018.

Methods: Using the Pediatric Health Information System, we analyzed ED and inpatient visits from November 2015 to November 2018 of children with bronchiolitis 3 to 24 months old. Read More

Pediatrics 2021 May 6. Epub 2021 May 6.

Departments of Pediatric Emergency.

Objectives: To analyze the impact of an integrated care pathway on reducing unnecessary treatments for acute bronchiolitis.

Methods: We implemented an evidence-based integrated care pathway in primary care (PC) centers and the referral emergency department (ED). This is the third quality improvement cycle in the management of acute bronchiolitis implemented by our research team. Read More

BMJ Open 2021 May 3;11(5):e048823. Epub 2021 May 3.

Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Introduction: The Canadian Bronchiolitis Epinephrine Steroid Trial (CanBEST) and the Bronchiolitis Severity Cohort (BSC) study enrolled infants with bronchiolitis during the first year of life. The CanBEST trial suggested that treatment of infants with a combined therapy of high-dose corticosteroids and nebulised epinephrine reduced the risk of admission to hospital. Our study aims to-(1) quantify the risk of developing asthma by age 5 and 10 years in children treated with high-dose corticosteroid and epinephrine for bronchiolitis during infancy, (2) identify risk factors associated with development of asthma in children with bronchiolitis during infancy, (3) develop asthma prediction models for children diagnosed with bronchiolitis during infancy. Read More

Int J Clin Exp Pathol 2021 15;14(4):526-532. Epub 2021 Apr 15.

Department of Pathology, Daegu Catholic University Hospital, Catholic University of Daegu, College of Medicine South Korea.

Follicular bronchiolitis is a rare pulmonary disorder characterized by the presence of multiple hyperplastic lymphoid follicles with a peribronchiolar distribution. An 11-year-old girl with total atelectasis of the right middle lobe (RML) and diffuse multiple small nodules at both lung bases presented to our hospital with frequent upper respiratory infections and pneumonia. The disease progressed during a 3-month period of macrolide therapy, and thoracoscopic biopsy with lobectomy of the atelectatic RML was performed. Read More

BMC Pediatr 2021 Apr 30;21(1):211. Epub 2021 Apr 30.

Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.

Background: 25(OH) vitamin D levels are inversely associated with respiratory infections and childhood wheezing.

Objective: To evaluate serum 25(OH) vitamin D levels in infants and toddlers with acute bronchiolitis, compared to subjects with non-respiratory febrile illness.

Methods: A prospective cross-sectional case-control study which compared serum 25(OH) vitamin D levels between infants and toddlers diagnosed with acute bronchiolitis to subjects with non-respiratory febrile illness. Read More

Pediatr Pulmonol 2021 Apr 30. Epub 2021 Apr 30.

Department of Civil Engineering and Computer Science, Medical Engineering Laboratory, University of Rome "Tor Vergata", Rome, Italy.

Objectives: To determine whether in infants with bronchiolitis admitted to a pediatric intensive care unit (PICU) the starting rate for high-flow nasal cannula (HFNC) therapy set by the attending physicians upon clinical judgment meets patients' peak inspiratory flow (PIF) demands and how it influences respiratory mechanics and breathing effort.

Methodology: We simultaneously obtained respiratory flow and esophageal pressure data from 31 young infants with moderate-to-severe bronchiolitis before and after setting the HFNC rate at 1 L/kg/min (HFNC-1), 2 L/kg/min (HFNC-2) or upon clinical judgment and compared data for PIF, respiratory mechanics, and breathing effort.

Results: Before HFNC oxygen therapy started, 16 (65%) infants had a PIF less than 1 L/kg/min (normal-PIF) and 15 (45%) had a PIF more than or equal to 1 L/kg/min (high-PIF). Read More

J Hosp Med 2021 May;16(5):319

Section of Hospital Medicine, Department of Medicine and Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.

J Hosp Med 2021 May;16(5):267-273

Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Background: Febrile infants aged 0 to 60 days are often hospitalized for a 36-to-48 hour observation period to rule out invasive bacterial infections (IBI). Evidence suggests that monitoring blood and cerebrospinal fluid (CSF) cultures for 24 hours may be appropriate for most infants. We aimed to decrease the average culture observation time (COT) from 38 to 30 hours among hospitalized infants 0 to 60 days old over 12 months. Read More

J Hosp Med 2021 May;16(5):261-266

Department of Pediatrics, Division of Inpatient Medicine, University of Utah, Salt Lake City, Utah.

Background: We implemented an observation unit and home oxygen therapy (OU-HOT) protocol at our children's hospital during the 2010-2011 winter season to facilitate earlier discharge of children hospitalized with bronchiolitis. An earlier study demonstrated substantial reductions in inpatient length of stay and costs in the first year after implementation.

Objective: Evaluate long-term reductions in length of stay and cost. Read More

J Clin Monit Comput 2021 Apr 29. Epub 2021 Apr 29.

Department of Pediatrics, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Ave., Peoria, IL, 61637, USA.

The use of clinical scoring to assess for severity of respiratory distress and respiratory failure is challenging due to subjectivity and interrater variability. Transcutaneous Capnography (TcpCO) can be used as an objective tool to assess a patient's ventilatory status. This study was designed to assess for any correlation of continuous monitoring of TcpCO with the respiratory clinical scores and deterioration in children admitted for acute respiratory distress. Read More

Int J Mol Sci 2021 Apr 2;22(7). Epub 2021 Apr 2.

Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola Hospital, 40138 Bologna, Italy.

Respiratory syncytial virus (RSV) represents the main cause of acute respiratory tract infections in children worldwide and is the leading cause of hospitalization in infants. RSV infection is a self-limiting condition and does not require antibiotics. However hospitalized infants with clinical bronchiolitis often receive antibiotics for fear of bacteria coinfection, especially when chest radiography is performed due to similar radiographic appearance of infiltrate and atelectasis. Read More

Am J Emerg Med 2021 Apr 21;45:144-148. Epub 2021 Apr 21.

Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd MS#113, LA, California 90027, USA. Electronic address:

Objectives: To explore the predictive ability of capillary blood gas (CBG) pCO for respiratory decompensation in infants aged ≤6 months with bronchiolitis admitted from the emergency department; to determine whether end-tidal CO (etCO) capnography can serve as a less invasive substitute for CBG pCO.

Study Design: This was a prospective cohort study of previously healthy infants aged ≤6 months admitted for bronchiolitis from the emergency department (ED). Initial CBG pCO and etCO capnography were obtained in the ED prior to inpatient admission. Read More

Medicine (Baltimore) 2021 Apr;100(17):e25523

Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul.

Background: The pediatric lung transplant is a very important treatment for patients with end-stage lung diseae, and pulmonary rehabilitation (PR) is also an important factor in determining the prognosis. However, there is no much literature available on pulmonary rehabilitation in pediatric patients' post lung transplant. Through this case report, we would like to present our intensive PR program for pediatric patients' post-lung transplant. Read More

Nefrologia 2021 Apr 23. Epub 2021 Apr 23.

Department of Pediatrics, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina.

Two types of early-childhood hyperkalemia had been recognized, according to the presence or absence of urinary salt wasting. This condition was attributed to a maturation disorder of aldosterone receptors and is characterized by sustained hyperkalemia, hyperchloremic metabolic acidosis due to reduced ammonium urinary excretion and bicarbonate loss, and normal creatinine with growth delay. We present three patients of the type without salt wasting, which we will call transient early-childhood hyperkalemia without salt wasting, and discuss its physiopathology according to new insights into sodium and potassium handling by the aldosterone in distal nephron. Read More

Tunis Med 2021 Jan;99(1):106-119

Introduction: Pediatric services are tracer services for the assessment of the integration and performance of the national health system.

Objectives: Describe the typology of morbidity notified to the Pediatrics department of the Msaken regional hospital (Sousse, Tunisia) and the flow of its patients.

Methods: This is a descriptive and exhaustive study, covering all the patients hospitalized in the pediatric ward of Msaken, during the year 2015. Read More

Pediatrics 2021 May;147(5)

Alberta Research Centre for Health Evidence and

Context: Uncertainty exists as to which treatments are most effective for bronchiolitis, with considerable practice variation within and across health care sites.

Objective: A network meta-analysis to compare the effectiveness of common treatments for bronchiolitis in children aged ≤2 years.

Data Sources: Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials. Read More

Pediatrics 2021 May;147(5)

Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Cureus 2021 Mar 15;13(3):e13896. Epub 2021 Mar 15.

Pediatrics, Memorial University of Newfoundland, St. John's, CAN.

Objectives This study examines the practice patterns with respect to the technique of non-oral hydration of infants admitted with bronchiolitis at one Canadian tertiary care institution. Additionally, the authors assess the infants' parents' attitudes regarding hydration through a nasogastric (NG) tube instead of an intravenous (IV) line. Methods A retrospective chart review was conducted for all infants admitted with bronchiolitis from May 1, 2016, to April 30, 2018, with a focus on the method of hydration, investigation with chest radiography, and use of IV antibiotics. Read More

Pediatr Int 2021 Apr 20. Epub 2021 Apr 20.

Center for Child Health Research, Faculty of Medicine and Life Sciences, University of Tampere and University Hospital, Tampere, Finland.

Background: Toll-interacting protein is a key factor in regulating innate immunity responses via gate-keeping Toll-like receptors. Genetic variance in innate immunity has been linked with susceptibility to infections. Children with viral bronchiolitis in infancy are at increased risk of later asthma. Read More

Syst Rev 2021 Apr 19;10(1):116. Epub 2021 Apr 19.

Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, 4-472 Edmonton Clinic Health Academy, 11405-87 Avenue NW, Edmonton, Alberta, T6G 1C9, Canada.

Background: Living systematic reviews (LSRs) can expedite evidence synthesis by incorporating new evidence in real time. However, the methods needed to identify new studies in a timely manner are not well established.

Objectives: To explore the value of complementary search approaches in terms of search performance, impact on results and conclusions, screening workload, and feasibility compared to the reference standard. Read More

Am J Physiol Lung Cell Mol Physiol 2021 Apr 14. Epub 2021 Apr 14.

Department of Pediatrics and Human Development, Michigan State University, United States.

Viral infections affecting the lower respiratory tract place enormous burdens on hospitals. As neither vaccines nor anti-viral agents exist for many viruses, understanding risk factors and outcomes in each patient using minimally invasive analysis, such as blood, can lead to improved healthcare delivery. A cohort of PAXGene RNAseq of infants admitted with moderate or severe acute bronchiolitis and respiratory syncytial virus (RSV) were compared with case-control statistical analysis and cohort-based outlier mapping for precision transcriptomics. Read More

JAMA Pediatr 2021 Apr 12. Epub 2021 Apr 12.

Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.

Importance: In developed countries, bronchiolitis is the most common reason for infants to be admitted to the hospital, and all international bronchiolitis guidelines recommend supportive care; however, significant variation in practice continues with infants receiving non-evidence-based therapies. Deimplementation research aims to reduce the use of low-value care, and advancing science in this area is critical to delivering evidence-based care.

Objective: To determine the effectiveness of targeted interventions vs passive dissemination of an evidence-based bronchiolitis guideline in improving treatment of infants with bronchiolitis. Read More

Front Pediatr 2021 22;9:643219. Epub 2021 Mar 22.

Departement of Emergency and Pediatrics, Louis-Mourier Hospital, APHP, Colombes, France.

Human rhinoviruses (HRVs) are the leading cause of common colds. With the development of new molecular methods since the 2000s, HRVs have been increasingly involved among severe clinical infections. Recent knowledge of the HRV genetic characteristics has also improved the understanding of their pathogenesis. Read More

Am J Clin Nutr 2021 Apr 7. Epub 2021 Apr 7.

Priority Research Centre Grow Up Well, University of Newcastle, Newcastle, NSW, Australia.

Background: The risk of wheezing is high in infancy and is heightened in infants with a family history of asthma/atopy. The role of breastfeeding in influencing respiratory health for these high-risk infants is unclear.

Objectives: To systematically appraise evidence for the association between breastfeeding and wheeze incidences and severity in high-risk infants. Read More

Pediatrics 2021 May 6;147(5). Epub 2021 Apr 6.

Division of Pediatric Critical Care, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, Tennessee.

In rare instances, severe respiratory syncytial virus (RSV) infections of the lower respiratory tract can cause life-threatening extrapulmonary complications. In this report, we describe 4 previously healthy, term and late-preterm infants admitted to the PICU with respiratory failure due to RSV bronchiolitis who developed necrotizing enterocolitis shortly after admission. All infants exhibited progressive abdominal distention, had typical radiographic findings, and developed simple or complex ascites. Read More