Background and AimsThere is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline.Patients and MethodsWe performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours. The primary outcome measure was the length of hospital stay.ResultsA total of 185 infants were analyzed: 94 in the epinephrine plus 3% hypertonic saline group and 91 in the placebo plus 3% hypertonic saline group. Baseline demographic and clinical characteristics were similar in both groups. Length of hospital stay was significantly reduced in the epinephrine group as compared with the placebo group (3.94 ±1.88 days vs. 4.82 ±2.30 days, P = 0.011). Disease severity also decreased significantly earlier in the epinephrine group (P = 0.029 and P = 0.036 on days 3 and 5, respectively).ConclusionsIn our setting, nebulized epinephrine in 3% hypertonic saline significantly shortens hospital stay in hospitalized infants with acute moderate bronchiolitis compared to 3% hypertonic saline alone, and improves the clinical scores of severity from the third day of treatment, but not before.Trial Registration EudraCT 2009-016042-57
pilot was carried out from 8 am-8 pm Monday to Friday. Data collected included time of arrival and assessment, admission rates, parental and staff satisfaction. Results During Jan 2013 and April 2013 between 8 am-8 pm there was a total of 785 admissions. A retrospective analysis was carried out on 80 randomly selected charts. Ages ranged from 3 weeks to 13 years 9 months, with a median age of 3 years 5 months. 97% of patients were seen within 4 h of nursing triage with only 59% being reviewed by a senior doctor within the following 4 h of their initial medical review.There were 100 APAU admissions during May 2013. Only 87 charts were available and audited. Ages ranged from 2 days to 14 years with a median age of 1 year 7 months. Common diagnoses included gastroenteritis and respiratory tract infections. 100% of patients were medically assessed within 4 h of nursing triage with 85% of patients being reviewed by a senior doctor within the following 4 h (p value 0.01).Admission rates fell from 95% to 44% during the hours of 8 am-8 pm (p value < 0.0001). Staff impression of our facilities for managing direct admissions as good or excellent improved from 25% to 95%. Patient and parent feedback was excellent. Conclusion We have shown that developing a model of acute paediatric assessment in a DGH setting can both reduce admissions and improve quality outcomes. Both physical infrastructure and funding remain issues for sustainability however we believe that this project demonstrates the value in investing in acute paediatric care.Primary Care: Infections Background and aims The smoking parent is considered a risk factor of severity for acute bronchiolitis (AB). We aimend to evaluate the relationship between parental history of smoking and length of stay of infants hospitalised for AB. Methods Prospective descriptive study including all infants admitted for moderately bronchiolitis, between 2011 and 2013. They were grouped in smoking parent or not. Severe bronchiolitis and patients with serious risk factors were excluded. The primary outcome was length of stay (LOS). The following variables were recorded: age, sex, atopic dermatitis, parental atopy, number of siblings, breastfeeding, RSV, treatment received, need for PICU, mortality and clinical score at admission. Results Among the 137 enrolled infants, 56.2% had no smoking parent. There were no statistically significant differences (p > 0.05) between the two groups in the following variables: median age (40 vs 59 days), male gender (48% vs 53%), atopic dermatitis (6.7% vs 15.6%), breastfeeding (59.7% vs 53.3%), number of siblings (0.66 vs. 0.63) day care attendance (16.9% vs. 6.7%), severity score (5.35 vs 5.28), percentage of positive RSV (67% vs 65%) and PICU admission (7.8% vs 5%). There were statistically significant differences in parental atopy (p =
Background and aims The advantages of breastfeeding are largely documented. Amongst other positive effects it reduces the risk of infectious disease in infants. We evaluated the effect of breastfeeding in the length of stay for infants with moderately ill bronchiolitis. Patients and methods Prospective descriptive study including all moderately ill bronchiolitis infants admitted to our hospital between 2011-2014. They were grouped in exclusively breastfed or not. Severe bronchiolitis and patients with serious risk factors were excluded. The primary outcome was length of stay (LOS). The following variables were recorded: age, sex, atopic dermatitis, parental smoking, atopy in parents, number of siblings, RSV, treatment received and clinical scale of bronchiolitis at admission. Results Among the 185 enrolled infants, 54.5% were exclusively breastfed. There were no statistically significant differences (p > 0.05) in: male gender (47% vs 44%), atopic dermatitis (31% vs 31%), smoking parents (37% vs 44%), parental atopy (31% vs 31%), number of siblings (0.66 vs. 0.68) day care attendance (16% vs. 10%) and percentage of positive RSV (61% vs 60%). The median LOS in the breastfeeding group was 3.14 days compared with 2.82 days in the other group (p = 0.004). There were statistically significant differences in median age (p = 0.000) and the severity at admission (p = 0.021). Conclusion In our series, breastfeeding does not protect from bronchiolitis. The breastfed group were admitted at a younger age which could explain their longer LOS. Interestingly, breastfed infants had a lower score of severity at admission suggesting a relative protective role of against severe bronchiolitis. Background and aims Cardiac dysfunction during bronchiolitis has been reported but few studies have assessed right ventricular function (RVF). The aim of this study was to assess RVF in infants with severe bronchiolitis with different respiratory support. Methods Prospective study of under 3-month-old infants admitted to the PICU for severe bronchiolitis. Patients were classified in 3 groups according to the respiratory support: CPAP, bilevel positive airway pressure (BLPAP) and mechanical ventilation (MV). If the respiratory support was changed, echocardiography was repeated. Morphology and systolic and diastolic function were evaluated by echocardiography including Tissue Doppler imaging (TDI). O-017 RIGHT VENTRICULAR FUNCTION IN INFANTS WITH SEVERE BRONCHIOLITIS AND DIFFERENT RESPIRATORY SUPPORTResults 30 echocardiographies were performed: 9 in infants with CPAP (4-8 cmH 2 O), 10 in BLPAP (13-16 cmH 2 O/6-8 cmH 2 O) and 10 in MV (PEEP 5-9 cmH 2 O and MAP 9-17 cmH 2 O). There was no difference in age or weight between the groups. The most relevant results are shown in Table 1. Conclusions As respiratory support increases, decreased systolic and diastolic RVF is observed by TDI in infants with severe bronchiolitis. -2014-307384.87 Background and aims No bronchodilator nebulised in saline has significantly proven to be more effective than...
Background and aims The advantages of breastfeeding are largely documented. Amongst other positive effects it reduces the risk of infectious disease in infants. We evaluated the effect of breastfeeding in the length of stay for infants with moderately ill bronchiolitis. Patients and methods Prospective descriptive study including all moderately ill bronchiolitis infants admitted to our hospital between 2011-2014. They were grouped in exclusively breastfed or not. Severe bronchiolitis and patients with serious risk factors were excluded. The primary outcome was length of stay (LOS). The following variables were recorded: age, sex, atopic dermatitis, parental smoking, atopy in parents, number of siblings, RSV, treatment received and clinical scale of bronchiolitis at admission. Results Among the 185 enrolled infants, 54.5% were exclusively breastfed. There were no statistically significant differences (p > 0.05) in: male gender (47% vs 44%), atopic dermatitis (31% vs 31%), smoking parents (37% vs 44%), parental atopy (31% vs 31%), number of siblings (0.66 vs. 0.68) day care attendance (16% vs. 10%) and percentage of positive RSV (61% vs 60%). The median LOS in the breastfeeding group was 3.14 days compared with 2.82 days in the other group (p = 0.004). There were statistically significant differences in median age (p = 0.000) and the severity at admission (p = 0.021). Conclusion In our series, breastfeeding does not protect from bronchiolitis. The breastfed group were admitted at a younger age which could explain their longer LOS. Interestingly, breastfed infants had a lower score of severity at admission suggesting a relative protective role of against severe bronchiolitis. Background and aims Cardiac dysfunction during bronchiolitis has been reported but few studies have assessed right ventricular function (RVF). The aim of this study was to assess RVF in infants with severe bronchiolitis with different respiratory support. Methods Prospective study of under 3-month-old infants admitted to the PICU for severe bronchiolitis. Patients were classified in 3 groups according to the respiratory support: CPAP, bilevel positive airway pressure (BLPAP) and mechanical ventilation (MV). If the respiratory support was changed, echocardiography was repeated. Morphology and systolic and diastolic function were evaluated by echocardiography including Tissue Doppler imaging (TDI). O-017 RIGHT VENTRICULAR FUNCTION IN INFANTS WITH SEVERE BRONCHIOLITIS AND DIFFERENT RESPIRATORY SUPPORTResults 30 echocardiographies were performed: 9 in infants with CPAP (4-8 cmH 2 O), 10 in BLPAP (13-16 cmH 2 O/6-8 cmH 2 O) and 10 in MV (PEEP 5-9 cmH 2 O and MAP 9-17 cmH 2 O). There was no difference in age or weight between the groups. The most relevant results are shown in Table 1. Conclusions As respiratory support increases, decreased systolic and diastolic RVF is observed by TDI in infants with severe bronchiolitis. -2014-307384.87 Background and aims No bronchodilator nebulised in saline has significantly proven to be more effective than...
Backgrounds and aims Wood Downes's modified by Ferres score (WDF) was not designed for the bronchiolitis, but its use has been generalised to evaluate the severity. Our aim is to relate the length of stay and the bronchiolitis´s severity at admission, by WDF. Patient and methods We included the acute bronchiolitis hospitalised during two epidemics (2011)(2012)(2013). They were classified in mild (MiB; WDF <4), moderated (MB; WDF 4-7) or severe (SB; WDF > 7) according to the scale WDF realised at admission. The mild ones and to the patients without WDF at admission were excluded. The main variable was the length of stay. We registered: age, RSV, sex, previous and during treatment and UCIP's need. Analysis with SPSS 17.0. Results 208 hospitalised infants were included (mean age of 72,9 days (5-373). Positive RSV in 67,8%. 90,5% were MB and 9,5% SB. Both groups were homogeneous in demographics data and previous admission treatment (p > 0.05). The mean WDF at admission was 5,42 (4-10). During the hospitalisation, they received nebulised bronchodilator in 3% hypertonic saline solution (3%SSH) (65%) or 3%SSH (35%). 22% received corticoids and 8,2% antibiotics. Length of stay: 5,3 days (0-46). The MB had an mean length of stay of 4,8 days and the SB of 13,44 (p = 0.0001). Conclusions WDF's scale has demonstrated, in our sample, to be a good predictor of the length of stay in moderate and severe bronchiolitis. The SB had a statistically significant more length of stay than MB.
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