OBJECTIVES:To determine the viruses and risk factors associated with hospital and intensive care unit (ICU) admissions in infants with acute bronchiolitis.INTRODUCTION:Bronchiolitis is a major cause of morbidity in infants. Widespread use of molecular-based methods has yielded new insights about its etiology, but the impact of viral etiologies on early outcomes is still unclear.METHODS:Seventy-seven infants with bronchiolitis who were under two years of age and visited an emergency unit were included. Using molecular-based methods, samples were tested for 12 different respiratory viruses. Logistic regression models were used to identify clinical and virological variables associated with the main endpoints: hospital admission and ICU admission.RESULTS:We identified at least one virus in 93.5% of patients, and coinfections were found in nearly 40% of patients. RSV was the most common pathogen (63.6%), followed by rhinovirus (39%). Identification of RSV was only associated with an increased risk of hospital admission in the univariate model. Younger age and enterovirus infection were associated with an increased risk of hospital admission, while atopy of a first-degree relative showed a protective effect. Prematurity was associated with an increased risk of admission to the ICU. Coinfections were not associated with worse outcomes.CONCLUSIONS:Molecular-based methods resulted in high rates of viral identification but did not change the significant role of RSV in acute bronchiolitis. Younger age and enterovirus infection were risk factors for hospital admission, while prematurity appeared to be a significant risk factor for admission to the ICU in acute viral bronchiolitis.

Introduction Respiratory tract diseases are the major cause of morbidity and mortality in children under the age of 5 years, constituting the highest rate of hospitalization in this age group. Objectives To determine the prevalence of hospitalizations for respiratory diseases in childhood in the last 5 years and to assess the impact of social isolation due to COVID-19 on the seasonal behavior of these diseases. Methods A cross-sectional clinical study was carried out, with a survey of all patients aged 0 to 17 years who were admitted with a diagnosis of respiratory diseases between January 2015 and July 2020. The database was delivered to the researchers anonymized. The variables used for analysis were date of admission, date of discharge, length of stay, age, sex and diagnosis. In order to make the analysis possible, the diagnoses were grouped into upper respiratory infection (URI), asthma / bronchitis, bronchiolitis and pneumonia. Results 2236 admissions were included in the study. Children under 5 years old account for 81% of hospitalizations for respiratory disease in our population. In the adjusted model, an average reduction of 38 hospitalizations was observed in the period of social isolation (coefficient: -37.66; 95% CI (- 68.17; -7.15); p = 0.016). Conclusion The social isolation measures adopted during the COVID-19 pandemic dramatically interfered with the seasonality of childhood respiratory diseases. This was reflected in the unexpected reduction in the number of hospitalizations in the pediatric population during this period.

ObjectiveTo determine the risk factors associated with stridor, with special attention to the role of the cuffed orotracheal cannula.MethodsProspective analysis of all the intubated patients submitted to mechanical ventilator support from January 2008 to April 2011. The relevant factors for stridor collected were age, weight, size and type of airway tube, diagnosis, and duration of mechanical ventilation. The effects of variables on stridor were evaluated using uni- and multivariate logistic regression models.ResultsA total of 136 patients were included. Mean age was 1.4 year (3 days to 17 years). The mean duration of mechanical ventilation was 73.5 hours. Fifty-six patients (41.2%) presented with stridor after extubation. The total reintubation rate was 19.6% and 12.5 in patients with and without stridor, respectively. The duration of mechanical ventilation (>72 hours) was associated with a greater risk for stridor (odds ratio of 8.60; 95% confidence interval of 2.98-24.82; p<0.001). The presence of the cuffed orotracheal cannula was not associated with stridor (odds ratio of 98; 95% confidence interval of 0.46-2.06; p=0.953).ConclusionThe main risk factor for stridor after extubation in our population was duration of mechanical ventilation. The presence of the cuffed orotracheal cannula was not associated with increased risk for stridor, reinforcing the use of the cuffed orotracheal cannula in children with respiratory distress.

High-flow nasal cannula (HFNC) therapy is routinely used in the treatment of infants with bronchiolitis. This study sought to identify markers associated with failure of HFNC therapy that serve as warnings for early staging of other ventilatory support products. A retrospective study of infants with a diagnosis of bronchiolitis, receiving HFNC and admitted to the pediatric intensive care unit from January 2016 to June 2017, was conducted. The subjects were divided into two study groups according to the success or failure of HFNC therapy. Risk factors were assessed using the following variables: age, time between hospital admission and start of HFNC, equipment model, and the need for a nasogastric tube. Eighty-one infants were studied, and 18 (21.7%) of them exhibited therapy failure. The results of the logistic models showed that the chances of failure for patients requiring a nasogastric tube during HFNC use were more likely than those for patients with oral nutrition (OR = 8.17; 95% CI 2.30–28.99; p = 0.001). The HFNC failure was not associated with the device used (OR = 1.56; 95% CI 0.54–4.52; p = 0.41), time between hospital admission and HFNC installation (OR = 1.01; 95% CI 0.98–1.03; p = 0.73), or age (OR = 0.98; 95% CI 0.82–1.17; p = 0.82). Among late outcomes evaluated, the patients with therapy failure had longer total durations of O2 use (p < 0.001) and longer hospital stays (p < 0.001). The need to use a nasogastric tube during HFNC use was associated with HFNC therapy failure and can be considered as a marker of severity in children with bronchiolitis.

BackgroundType 1 diabetes patients have a higher risk of developing hypoglycemia or hyperglycemia during physical activity, which may compromise their safety during exercise but results regarding the exercise capacity of patients with type 1 DM when compared to control subjects have been contradictory.AimTo evaluate if type 1 diabetes affects the capacity of adolescents to exercise.MethodsThe study enrolled 37 adolescents in stage 2–4 of the Tanner scale, aged from 10 to 14 years, 21 with type 1 diabetes and 16 without any chronic diseases. All subjects performed an incremental submaximal exercise test in a cycle ergometer. At the end of every test stage, glycemia and blood lactate levels were measured. During the test, heart rate was monitored and the Borg rating of perceived exertion (RPE) was used to assess fatigue.ResultsThe two groups displayed no significant differences in anthropometric variables. The response to exercise, as evaluated by Borg RPE (p = 0.829), maximum oxygen uptake (VO2max) (p = 0.977), heart rate (p = 0.998), maximum load (p = 0.977), absolute load at lactate threshold (p = 0.377) and relative load at lactate threshold (p = 0.282), was also similar between the control and the type 1 diabetes group. Finally, there were no significant correlations between HbA1c levels, VO2max, duration of disease and pre-test glycemia levels.ConclusionsWe detected no significant differences in lactate threshold, VO2max and heart rate during exercise between healthy adolescents and non-sedentary adolescents with type I diabetes, indicating that both groups had similar physical fitness and, therefore, that type 1 diabetes is not an obstacle for physical activity. This study was approved by the ethical committee of the Hospital Israelita Albert Einstein (Ethical Committee Number: 53638416.9.0000.0071) and free and informed consent was obtained from all participants and their legal representatives.