whether the virus itself creates bronchial hyperreactivity. Nor is the extent to which the interaction of atopy contributes to the initial illness and subsequent persistence of symptoms fully understood. In addition, therefore, we have attempted to throw further light on the role of this latter factor, atopy, by looking at the atopic status of these children in terms of personal and family history of atopic illness and their rate of skin test positivity to three common allergens. Patients and methodsEighty one children, all of whom had been admitted to hospital during winter epidemics of respiratory syncytial virus infection were studied. The criterion for entry into the study was a clinical diagnosis of acute bronchiolitis in a child with no previous history of similar illness, as evidenced by a brief prodrome of upper respiratory symptoms followed by rapid onset of cough, wheeze, tachypnoea, and poor feeding associated with hyperinflation, recession, and fine crepitations with or without rhonchi.9The first 21 children enrolled for study and follow up were only those whose bronchiolitis was of sufficient severity to preclude oral feeding, but all subsequent admissions, irrespective of severity, were considered eligible. Forty one of 65 for whom results were 1064 copyright.
SUMMARYWe assessed the clinical progress of 55 children 2 years after admission to hospital with acute bronchiolitis and performed lung function tests on 40. During the 2 year follow up period 75 % of the children had wheezed, 36 % had 2 or more lower respiratory symptoms lasting more than 2 weeks, 33 % had more than 100 days of lower respiratory symptoms, and 13 % were readmitted to hospital with acute respiratory disease. In addition 60% of the children were hyperinflated on lung function tests. Many of the children with hyperinflation at the 2 year assessment had not been hyperinflated 1 year earlier, suggesting variable airways obstruction. Reversibility of airways obstruction was also assessed by response to nebulised salbutamol. Nine children had a fall > 15 % in airways resistance after salbutamol and these children had the highest baseline airways resistances. Airways resistance was higher in the children with a family history of atopy.Although children often wheeze for some years after acute viral bronchiolitis, the exact relation between bronchiolitis and asthma is unclear.1-4 Evidence is also accumulating that bronchiolitis may sow the seeds for chronic obstructive lung disease in adult life4-6 and furthermore asymptomatic children may have abnormalities in lung function many years after an attack,7 leaving the possibility that clinical illness will develop subsequently.We have been collecting information on lung function and symptoms after the acute episode in a cohort of children admitted to hospital with acute bronchiolitis. Our first report on 22 of these infants, all of whom had severe initial disease, showed marked disturbances in lung function in the first year after the acute illness.8 We were concerned that these children might not be representative as all were fed via a nasogastric tube and we therefore collected further data on a larger group of children whose only criterion for inclusion was that they had been admitted to hospital with bronchiolitis. The results of the total cohort showed that at follow up after 1 year over 60 % had had further wheezing and that 17% had marked hyperinflation on lung function tests.9 We aimed to obtain sequential information on children whose progress in the first year after bronchiolitis had been studied9 and to report on clinical progress and lung function a year later. Patients and methodsAll 55 children included in this study were admitted to hospital during an epidemic of infection caused by respiratory syncytial virus (RSV). They had a clinical diagnosis of bronchiolitis with tachypnoea, breathlessness, hyperinflation, and widespread crepitations. Viral studies were positive for RSV in 27 patients and adenovirus type 1 was isolated in 1 patient.The first 24 children studied had severe disease and were fed by a nasogastric tube but our only selection criterion subsequently was that the children had been admitted to hospital for bronchiolitis. Nevertheless, milder cases of acute viral bronchiolitis are probably under represented in the cohort.Mean age o...
To analyse the effects of apnoea and bradycardia on the oxygen saturation (SaO2) of preterm infants and to make recommendations for apnoea alarm limits, polygraphic recordings were made on 89 occasions of 27 preterm infants; 1029 apnoeic episodes were analysed.Reduction in SaO2 was positively correlated with duration of apnoea, but the scatter of results was such that reductions in SaO2 of up to 40% occurred with apnoeas of less than 10 seconds duration. The median initial SaO2 was significantly lower in those episodes that resulted in bradycardia (92% compared with 95%), and there was also a significantly greater reduction in median SaO2 (9%9 compared with 5%).This study illustrates the difficulty of setting alarm limits for the detection of apnoea. We suggest that rather than simply detecting apnoea it is more appropriate to monitor heart rate and SaO2 in infants with recurrent apnoea.
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