The aim of the study is to describe the clinical course of infants hospitalized with bronchiolitis who underwent high flow oxygen supplementation via nasal cannula (HFNC) and investigate HFNC failure.Out of 824 infants admitted for bronchiolitis over seven epidemic seasons, we extracted clinical charts of the 130 infants who required oxygen delivered by HFNC and clinical, epidemiological, laboratory, and radiological data were analysed. We ran a multivariate logistic regression analysis (adjusted for age and sex) in order to determine factors associated with HFNC failure. HFNC therapy failed only in 11 (8.5%) out of 130 infants. Infants with HFNC failure were younger with a lower admission weight, and they received more frequently low flow oxygen before HFNC than patients who underwent HFNC only. Clinical severity score at admission and laboratory findings were similar in the two groups. They showed more frequently complete upper lobe consolidations on chest X-ray than infants exclusively supported by HFNC. Moreover, respiratory syncytial virus was more frequently detected in patients with HFNC failure. The presence of complete lobe consolidation was the only significant factor associated with HFNC failure. An early identification of complete lobe consolidation in severe infants with bronchiolitis may guide a personalized management. Highlights box• HFNC is a safe and useful method of non-invasive respiratory support. However, several questions concerning HFNC clinical practice remain unanswered.• Patients who experienced a failure of HFNC showed more frequently a complete lobe consolidation on CXR than infants in whom HFNC allowed to overcome respiratory distress.• An early identification of consolidation with adequate follow-up and proper therapeutic strategies may further reduce the number of children requiring more intensive care.
The recent Sars-Cov2 pandemic has brought back to the attention of the scientific community the issue of respiratory viruses. In both the adult and pediatric population, respiratory viruses still represent an important cause of morbidity and mortality, representing the third leading cause of death among children under 5 years of age worldwide.In this review we report the latest epidemiologic and clinical updates regarding respiratory viruses with a particular focus on the most important among them in pediatrics such as respiratory syncytial virus, rhinoviruses, enteroviruses, and adenoviruses, highlighting how M a n u s c r i p t a c c e p t e d f o r p u b l i c a t i o n and why the COVID-19 pandemic has changed the epidemiological panorama of respiratory viruses globally. Impact statementRespiratory viruses represent an important cause of morbidity and mortality. COVID-19 pandemic has changed the epidemiological panorama of respiratory viruses globally.
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