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Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Respiratory syncytial virus (RSV) is the most common cause of acute lower respiratory tract infection and hospitalization in children. Globally, in 2019, there were an estimated 33 million acute respiratory infections associated with RSV, resulting in 3.6 million pediatric hospitalizations. People 65 years and older are also at risk for severe RSV infection with an estimated 5.2 million cases, 470,000 hospitalizations, and 33,000 hospital deaths among adults ≥ 60 years in high-income countries pupil. A vaccine has just been authorized for pregnant women to prevent RSV infections in infants and two other vaccines (only one of which is marketed in France) for the elderly. What to expect from vaccination? How effective? How long does the protection last? What side effects? [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

RSV infections are a burden on children's health and on our healthcare system. Yet, our therapeutic and preventive arsenal against it has until now been very thin. Palivizumab has proved effective in protecting infants at risk, but its high cost and monthly injection requirement have prevented its widespread use. The arrival of new antibodies on the market gives us hope of a turning point in the prevention of these infections. The development of vaccines against RSV is an ideal complement to the limited range of treatments currently available. The coming winters will put our prevention strategies to the test, but the data from the current winter are already encouraging. [ABSTRACT FROM AUTHOR]

Few studies have identified predictors of inappropriate use of medications and medical tests in bronchiolitis. This study aimed to look for potential factors associated with the inappropriate use of medications and tests in bronchiolitis. A retrospective study that included all infants under two years of age in tertiary center admitted due to Bronchiolitis from January 2015 to December 2018. We defined a composite score as the main outcome variable. 1930 patients were included. The most prescribed medications were nebulized hypertonic saline in 1789 patients (92.6%), albuterol (56%), and β-lactam antibiotics (26.4%). The medical tests more commonly ordered were hemogram (95.9%), chest X-rays (92.2%) and C-reactive protein (79.8%). After controlling for potential confounders, it was found that the length of hospital stay increases the risk of the inappropriate use of medications and tests (OR 1.29; CI 95% 1.01-1.65), whereas fever (OR 0.22; CI 95% 0.06-0.71) and leukocytosis ( 15,000/μL) (OR 0.09; CI 95% 0.03-0.32) at admission decrease the risk of the inappropriate use of medications and tests. Inappropriate use of diagnostic tests and drugs for bronchiolitis was a highly prevalent outcome in our population. Patients with longer hospitalizations, absence of fever and a normal white blood cell count at admission, were at increased risk of inappropriate use of medications and medical tests.

Spontaneous gastric perforation is rare in infants and the mechanisms leading to its onset are poorly understood. This study reports the first case of spontaneous gastric perforation occurred in Congo. This case report describes a 5-month years old female infant who, on the fourth day of hospitalization for severe acute bronchiolitis associated with diarrhea complicated by moderate acute dehydration, had violent onset of severe and painful abdominal distension associated with signs of shock. Abdominal x-ray without treatment showed a large volume pneumoperitoneum. Laparotomy showed round perforation on the posterior wall of the stomach which was sutured. The postoperative course was marked by the occurrence of septic shock and by infant death. [ABSTRACT FROM AUTHOR]

The article focuses on COVID-19 and children and reports from Public Health France and the High Council of Public Health and evolution of bronchiolitis mainly related to respiratory syncitial virus (RSV) in the child. It mentions interference between COVID 19 and bronchiolitis to monitor the impact of transmission barrier measures RSV. It also mentions development of a comprehensive and concerted child health policy and promote carrying out of epidemiological surveys.

RESPIRATORY SYNCYTIAL VIRUS VACCINES. Respiratory syncytial virus (RSV) is responsible for lower respiratory infections, particularly in children under five years of age (acute infant bronchiolitis) and the elderly over 60. Monoclonal antibodies (palivizumab and nirsevimab) are used to prevent bronchiolitis. Four types of vaccine are currently under development: subunit vaccines composed of recombinant proteins or viral pseudoparticles, messenger RNA vaccines, recombinant vector vaccines and live attenuated vaccines. They are indicated for pregnant women to protect infants against bronchiolitis in the first months of life, and for people over 60 or with comorbidities., Competing Interests: Q. Le Hingrat déclare n’avoir aucun lien d’intérêts. D. Bouzid déclare avoir participé à des interventions ponctuelles pour Moderna.

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Objectif: Établir un protocole interrégional actualisé de prise en charge de la bronchiolite aiguë du nourrisson de moins de 1 an. Méthode: Un groupe de travail composé de pédiatres et d’urgentistes des hôpitaux universitaires du Grand Ouest (HUGO) s’est réuni autour de l’analyse des données récentes de la littérature. Les recommandations issues de ce travail ont ensuite été soumises et validées par les pédiatres des HUGO. Résultats: Après avoir établi des critères permettant de distinguer un asthme débutant du nourrisson d’une bronchiolite aiguë virale, les indications d’examens complémentaires ainsi que les prescriptions d’antibiotiques et de kinésithérapie respiratoire ont été précisées et réservées à des situations très limitées. De même, des modalités de prescription de l’oxygénothérapie et du support nutritionnel ont été proposées. Enfin, d’autres thérapeutiques comme les nébulisations de sérum salé hypertonique ont été jugées prometteuses mais leur place dans la prise en charge de la bronchiolite aiguë du nourrisson reste encore à préciser. Conclusion: Alors que la prise en charge de la bronchiolite aiguë du nourrisson en France est actuellement guidée par la conférence de consensus de la Haute Autorité de santé (HAS) qui date de 2000 et que nos confrères européens et nord-américains ont récemment mis à jour leurs recommandations, ce travail a permis d’actualiser les modalités de prise en charge de cette affection et d’homogénéiser les pratiques au sein des HUGO. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: La Conférence de Consensus de 2000 recommandait un traitement symptomatique systématique des bronchiolites aiguës du nourrisson, notamment par desobstruction rhinopharyngée et encourageait la kinésithérapie respiratoire, depuis remise en cause par différentes études. L’objectif principal de cette étude était d’évaluer la concordance des prises en charge thérapeutiques des bronchiolites aiguës, en médecine générale, par rapport aux recommandations de la Conférence de Consensus. Patients et méthodes: Ont été inclus les nourrissons de 0 à 24 mois, présentant une bronchiolite, consultant un médecin généraliste, en Vendée ou en Loire-Atlantique, de novembre 2011 à avril 2012 et dont les parents ont accepté la participation à l’étude. Le critère de jugement principal était la concordance des prises en charge thérapeutiques par rapports aux recommandations (traitements instaurés, orientation vers les urgences pédiatriques). Les données ont été recueillies via des questionnaires remplis par les médecins généralistes participants. Résultats: Sur les 1236 questionnaires distribués, 134 ont été remplis et 118 prises en charge thérapeutiques ont pu être analysées. Au total, 52,5 % de prises en charge thérapeutiques étaient concordantes au regard des recommandations et 57,5 % en cas de premières bronchiolites. Cinquante pour cent des nourrissons avec un critère imposant une hospitalisation selon la Conférence de Consensus, ne l’ont pas été, ce qui montre probablement l’intérêt de nouvelles recommandations, avec mise en exergue des critères d’hospitalisation. [ABSTRACT FROM AUTHOR]

RSV is an almost obligatory virus responsible for upper (rhinitis and otitis) and lower (bronchiolitis and asthma attack) respiratory infections in children under 5 years of age. Reinfections are frequent at all ages because immunity is only partial and does not last long. Young children under the age of 1 are the most affected. The majority of these children are healthy. Having a risk factor (premature birth, heart disease, bronchopulmonary dysplasia, but also passive smoking) increases the severity of RSV pathology. Very few children currently benefit from prevention by anti-RSV monoclonal antibodies. The annual cost of care, the various socio-economic costs are a public health reality in three care sectors: out-patient, pediatric emergencies, hospitalization. Subsequent consequences: repeated wheezing and asthma, should also be taken into consideration and integrated into public health decisions. Progress in recognizing this pathology is desirable: distribution of diagnostic tests in the city; providing parents with information., Competing Interests: C. Weil Olivier déclare avoir participé à des boards nationaux et internationaux portant sur le VRS avec les laboratoires Sanofi et Janssen. - M. Lorrot déclare n’avoir aucun lien d’intérêts.

Résumé: Contexte: La bronchiolite est une maladie généralement bénigne, mais qui peut être sévère quand elle induit une hypoxie qui n’est pas toujours d’appréciation clinique facile. Le but de ce travail est d’étudier la valeur et la pertinence d’un signe clinique : le pourcentage de la prise alimentaire des dernières 24h par rapport à la quantité habituellement ingérée (Alim 24h), de déterminer une valeur pertinente de ce pourcentage pour détecter l’hypoxie et de comparer ce signe aux autres signes cliniques habituels. Méthodes: Dans cette étude observationnelle, prospective, multicentrique, 171 nourrissons de zéro à six mois présentant une bronchiolite (rhinorrhée+toux+dyspnée expiratoire bruyante) ont été inclus par 18 pédiatres de pratique libérale. Ont été exclus les enfants avec facteurs de risque (ancien prématuré, maladie chronique cardiaque ou pulmonaire), les enfants nourris au sein, les enfants ayant reçu un traitement à visée bronchique. La quantité de lait bue au biberon, la nourriture prise à la petite cuillère durant les dernières 24h étaient additionnées et comparées à l’alimentation habituelle. Il était recherché un tirage sous-costal, intercostal, sus costal, des battements des ailes du nez, une cyanose, des pauses respiratoires, une polypnée, une fièvre et la présence du virus respiratoire syncytial. La saturation transcutanée en oxygène (SpO2) était mesurée en tenant compte de la valeur stable la plus élevée. Le seuil de l’hypoxie est fixé à 95 %. Tout résultat inférieur à 95 % était contrôlé. Résultats: Si Alim 24h est supérieur ou égal à 50 %, la probabilité que SpO2 soit supérieure ou égale à 95 % était de 96 % [IC 95 %, 91–99 %]. En analyse univariée, Alim 24h inférieur à 50 % avait l’odds ratio le plus élevé (13,8) pour dépister SpO2 inférieure à 95 % par rapport aux autres valeurs d’Alim 24h et aux autres signes cliniques, un des meilleurs compromis (spécificité élevée 90 % – sensibilité moyenne 60 %) pour discriminer les enfants à risque d’hypoxie. En analyse multivariée après ajustement sur l’âge, la SpO2 était inférieure à 95 % était liée à la présence d’un tirage intercostal (OR=9,1 [IC 95 %, 2,4–33,8 %]) et Alim 24h était inférieur à 50 % (OR=10,9 [IC 95 %, 3,0–39,1 %]). La décision d’hospitaliser 17 enfants était fortement liée à l’âge (OR=14,7 [IC 95 %, 3,1–69,8 %]), à Alim 24h (OR=10,6 [IC 95 %, 3,0–37,3 %]) et à la présence d’un tirage intercostal (OR=3,4 [IC 95 %, 1,0–11,4 %]). Conclusion: En pratique, Alim 24h est un signe simple, facile à évaluer, à mémoriser et à utiliser par les parents, pertinent pour un dépistage ou un suivi à distance. S’il est supérieur ou égal à 50 %, le risque d’hypoxie chez un nourrisson non prématuré et en bonne santé auparavant, est très faible. S’il est inférieur à 50 %, la consultation médicale est nécessaire pour une évaluation plus complète. [ABSTRACT FROM AUTHOR]

Copyright of Revue Francaise d'Allergologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Acute bronchiolitis is an acute respiratory infection which commonly occurs in infancy. Respiratory syncytial virus is the major cause of lower respiratory tract infection. Some other virus may be found during co-infections. The aim of this study was to search for biological markers correlated with gravity and risk factors for asthma and allergy. The follow-up was done during the multicenter and prospective study Bronchiolitis (PHRC 2000 No. 2000/020/HP), performed between November 2001 and January 2006, which included seven centers in France: Rouen, Le Havre, Lille, Elbeuf, Evreux, Brest and Saint-Nazaire associated with Nantes. Clinical and biological data were gathered during initial course, then at 1month and 1year. For the population of 209 infants, mean age was 3months, the gravity was evaluated by scoring. The laboratory results correlated with clinical scoring were the following: viral evaluation, absolute numbers of leucocytes, lymphocytes and eosinophils, flow cytometry for sub-populations of lymphocytes, allergology including IgE, eosinophilic cationic protein, and basophil activation test. The results of the study are presented and discussed. [Copyright &y& Elsevier]

Abstract: The human metapneumovirus (hMPV) is a new Pneumovirinae related to the avian metapneumovirus type C. hMPV genome differs from human respiratory syncytial virus (RSV) genome by the gene order and the lack of nonstructural genes. Two genetic sub-groups and four sub-types of hMPV are identified. hMPV infections evolve as regular winter outbreaks which have roughly the same size and overlaping RSV epidemics. Among hospitalized children in Caen, hMPV is detected in 9.7% of the cases after RSV (37%), rhinovirus (18%), influenza virus (14.5%), adenovirus (9%), and parainfluenza virus (5%). Most of hMPV infections are observed in children suffering from bronchiolitis, but the localization to lower respiratory tract and the severity of the disease are less frequent in comparison with RSV infections. hMPV is very difficult to isolate using cell culture. Up to now, the only way for hMPV diagnosis was the TS–CRP assays. But the recent apparition of direct antigenic tests allows us to get a fair, rapid, and economic diagnostic tool. [Copyright &y& Elsevier]

Copyright of Revue Francophone des Laboratoires is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Community-acquired bronchopneumonia is very common in children and responsible for a great morbidity. It can be revealed by bronchiolitis, due to viral infection, bronchitis (80% due to viruses), and pneumonia potentially much more severe due to bacteria (60%), viruses (40%) or both causes (20%). Being unable to exclude a bacterial origin in pneumonia leads physicians to prescribe systematically antibiotics. [Copyright &y& Elsevier]

Abstract: Objective: Usefulness of nasal continuous positive airway pressure (NCPAP) in severe acute bronchiolitis has been checked. The objective of this descriptive study was to evaluate the feasibility, safety and risk factors of NCPAP failure. Population and methods: One hundred and forty-five infants were hospitalised in our intensive care unit during the 2 last epidemics (2003–2004, 2004–2005). Among them, 121 needed a respiratory support, either invasive ventilation (N =68) or NCPAP (N =53). Results: General characteristics were similar during the 2 periods. Percentage of NCPAP failure, defined by tracheal intubation requirement during the stay in paediatric intensive care unit, was quite similar during the 2 periods (25%), but number of NCPAP increased twofold. Whatever the evolution was in the NCPAP group, we observed a significant decrease in respiratory rate (60±16 vs 47.5±13.7 cycle/min., P <0.001) and PaCO2 (64.3±13.8 vs 52.6±11.7 mmHg, P =0.001) during NCPAP. Only PRISM calculated at day 1 and initial reduction of PaCO2 were predictive of NCPAP failure. Percentage of ventilator associated pneumonia was similar (22%) between the invasive ventilation group and infants who where intubated because of failure of NCPAP. Duration of respiratory support and stay were reduced in the NCPAP group (P <0.002). Conclusion: NCPAP appears to be a safe alternative to immediate intubation in infants with severe bronchiolitis. [Copyright &y& Elsevier]

Abstract: Beneficial effect of continuous positive airway pressure (CPAP) during non invasive ventilation (NIV) has been reported in infants with respiratory syncytial virus (RSV) infection, but no study has analyzed the predictors of its failure. Objective: To evaluate the feasibility of NIV and to determine NIV failure criteria. Population and methods: All infants hospitalized in one PICU with presumed RSV infection between 2002 and 2006 were prospectively included. When respiratory support was needed, NIV was first started according to a pre-established protocol. Results: One hundred and one infants, 43 females, 58 males, median age 49 days (range: 10–334), median weight 3,9 kg (range: 2,4–12) were included. RSV infection was confirmed in 84/101. Sixty-seven infants were transported by the paediatric medical transport system, 27 with NIV and 15 with invasive ventilation (IV). Fifteen infants were in IV at admission, 69 received NIV during their PICU stay (12 secondarily requiring IV) and 17 were never ventilated. A significant decrease in PCO2 with increase in pH was observed within 2 hours of NIV. Parameters associated with NIV failure were apneas, high values of admission PCO2 and H24 PRISM score. The 17 non-ventilated infants were older and had a lower severity score than those who were ventilated. Conclusion: In infants with RSV and needing respiratory support, NIV represented the sole method of respiratory support in 68% of cases. NIV failure criteria were apneas, high values of admission PCO2 and H24 PRISM score. [Copyright &y& Elsevier]

Abstract: The observation of an infant having presented two severe respiratory syncytial virus (RSV) infections in the same winter with associated otitis media led us to consider virus-asthma relations in the child and middle ear place in the airway unit. Viruses (in particular RSV and rhinovirus) are indeed implied in 80% of asthma exacerbations in school-age children. Nevertheless, the role of viral respiratory infections in the genesis of asthma has not been clearly established. Severe RSV bronchiolitis requiring hospitalization seem associated with atopic asthma risk unlike less severe forms. RSV would be thus more revealing a particular susceptibility of the airways than a true etiologic factor. RSV cytopathic effect could indeed be facilitated by an epithelial susceptibility, primum movens of primary asthmatic remodeling. A new entity emerges within the airway unit: the middle ear. IgE sensitisation and wheezing recently seemed independent risk factors of otitis media with effusion. Epithelial infiltrate of the Eustachian tube and effusion located in the middle ear of the atopic patients, have Th2 profile. The "allergic oto-rhino-bronchitis" concept thus impose a total therapeutic approach of the airways of patients presenting with respiratory allergy, in particular otologic. [Copyright &y& Elsevier]

Copyright of EMC-Pneumologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Radiologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Viral bronchiolitis is usually associated with favorable outcome as regard to mortality. Only few studies reported severe bronchiolitis requiring mechanical ventilation, and respiratory outcome is not well described. Methods. – Therefore, we conducted a retrospective study in a series of 135 children admitted in a single Pediatric Intensive Care Unit (PICU) over a four year period (1994–1998). All of them were admitted for viral bronchiolitis requiring mechanical ventilation. Results. – At admission, 83% of them were less than three months old. Prematurity at birth was present in 33,3%. Mortality was observed in four cases (2,9%), all premature babies with mechanical ventilation at birth. Univariate analysis showed as main factors associated to mortality: prematurity (P =0,056) and acute respiratory distress syndrome (P =0,017). Childhood asthma was observed in 40,4% of children without any associated factor wether at birth or in PICU related to such outcome. Conclusion. – Bronchiolitis associated with mechanical ventilation is particulary observed in very young babies and prematurity is the main factor associated to mortality. Mechanical ventilation seems not to be associated with unfavorable respiratory outcome. Considering physiology and population, non invasive ventilation could be an effective alternative of mechanical ventilation. [Copyright &y& Elsevier]

Nosocomial infections are a preoccupation in a pediatric hospital mainly during the winter with bronchiolitis and gastroenteritis epidemics. We have examined the risk factors of nosocomial infections.Material and methods. – A prospective study was conducted between November, 1999 and March, 2000 in the infants units of the Le Havre hospital. We systematically listed the admissions and contacted the family after their discharge by phone. A geographic information system was implemented to display the epidemiological data; this software is able to illustrate the sectors at risk.Results. – During the study, 687 infants were hospitalized of whom 458 for bronchiolitis and community-acquired gastroenteritis. Mean age was 5.4 months old. No nosocomial bronchiolitis occured. Prevalence of nosocomial gastroenteritis was 10% (68 cases including nine after discharge). Infants with nosocomial infection were younger than those with community-acquired infection (6.6 months vs. 11.2 months, P < 0.01). The mean length of stay was longer in nosocomial infection (7.7 vs. 4.1 days, P < 0.05). Among the infants with bronchiolitis, 16% have developed nosocomial intestinal infections (RR = 2.65, IC: 1.59–4.4; P < 0.01). The geographic analysis pointed the area with nosocomial risk (bedroom without water, nearness of nurse office and games room).Conclusion. – Geographic information system is a part of the quality control system and may have some interaction effect on final decision making. Incidence of nosocomial infections showed the need for a prevention strategy in a pediatric hospital. [Copyright &y& Elsevier]

Emergencies occurring after maternity discharge in near-term or full-term newborns are infrequent (1%) but life-threatening. A survey has been performed in the Paris area covering: 1) Maternities and Pediatric Emergencies ; 2) SAMU/SMUR (medical emergency system) ; and 3) PMI (medico-social primary centers) in 2001 and 2002. The rate of re-admission after discharge at D3-D4 was 2%. The Emergency Medical Service call incidence was 1%, and a medicalized ambulance was directly sent to the home in one out of ten calls. The call for medical assistance and emergency visits occurred mostly between D13 and D16, for the following reasons: fever, malaise, respiratory or gastrointestinal symptoms. The infants who have required EMS activation had a more severe pathology and poorer prognosis. Given the results of these studies and the ongoing debate in the literature over early maternity discharges, the most frequent etiologies are detailed with their appropriate management. Late-onset neonatal infections and congenital cardiopathies carry the most severe prognosis. Respiratory symptoms primarily due to RSV bronchiolitis requires hospitalization. Child abuse should not be forgotten. Thus, careful evaluation before discharge and appropriate follow-up are essential for a good outcome. [Copyright &y& Elsevier]

Purpose. – The purpose of this paper is twofold: to describe the clinical and anatomical characteristics of bronchiolitis associated with airflow obstruction in adults; to present through a clinical approach, a classification of the main aetiologies or pathological frames associated with that entity.Key points. – The constrictive bronchiolitis type is the most frequently encountered. On clinical grounds, cough, crackles, and a progressive dyspnea develop usually within a few weeks. Radiological signs of bronchiolar abnormalities are best visualized on high resolution expiratory CT scan. The decrease in maximal airflows and oxygen tension is of limited amplitude and poorly reversible with bronchodilators. Diagnosis is easily performed when a causative event, or the clinical context, can be delineated: inhalation of toxic fumes, diffuse bronchiectasis, rheumatoid arthritis, lung or bone marrow transplantation. Delayed formation of bronchiectasis in the central airways is common. The treatment is not standardized; corticosteroids are usually prescribed as a first line therapy; the benefit of the addition of, or substitution with immunosuppressive drugs has not been adequately evaluated, but is, on the mean, of limited amplitude.Perspectives. – Recent advances in the identification of inhaled agents toxic for the distal airways help in establishing appropriate measures of prevention. When the aetiology of the bronchiolitis cannot be suspected, extensive search of a causative agent should be performed, including microbial and mineral analysis of bronchoalveolar products. Negative results should lead to perform a surgical lung biopsy. The study of chronic rejection processes in animal models of lung transplantation, the identification of inhibitory factors of bronchiolar fibrogenesis, and the efficacy of some anti-cytokines on inflammatory processes could result in new therapeutic approaches. [Copyright &y& Elsevier]

Copyright of EMC-Pediatrie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives. – Despite the lack of clinical studies, chest physiotherapy (CP) is widely used in children with acute bronchiolitis. The main goal of this study was to evaluate its short-term efficacy in children under mechanical ventilation for acute bronchiolitis.Methods. – Twenty children were studied. All were under mechanical ventilation on a pressure-controlled mode. Oxygen saturation, transcutaneous PCO2 and tidal volume were measured before any intervention, after endotracheal succion, after CP and endotracheal succion and 1 h later.Results. – Thirty-eight analyses were performed. Baseline tidal volume, oxygen saturation and transcutaneous PCO2 were not modified after endotracheal succion. Immediately and 1 h after CP, SpO2 (98% vs. 94.5%), and tidal volume (66 vs. 55 ml) significantly increased.Conclusion. – The increase of O2 saturation and tidal volume may be linked to the improvement of bronchial sputum clearance. Further studies are needed to estimate the long-term efficacy of CP in acute bronchiolitis. [Copyright &y& Elsevier]

This prospective study was designed to identify risk factors associated with admission in pediatric intensive care units (PICU) among infants hospitalized for treatment of RSV induced bronchiolitis. This study was population-based and was conducted in Burgundy, a French region with 1 800 000 inhabitants where passive immunoprophylaxis for RSV bronchiolitis was not set up at the time of the study.Results – From December 1st 1999 to April 30th 2000, 484 infants were hospitalized for RSV bronchiolitis in Burgundy: 19.6% were born prematurily (gestational age ⟦GA〉 below 37 weeks) and at admission, 68.3% had a postnatal age below six months (mean=5 ± 5.9 months; median value=3 months). The duration of hospitalization was 7.3 ± 12.4 days (median value=6 days). Among the 484 infants, 31 (6.4%) needed admission in PICU, eight needed mechanical ventilation (1.7%) and one died (0.2%).Univariate analysis identified anamnestic risk factors associated with admission in PICU: prematurity; low birth weight; past history of neonatal respiratory distress syndrome (RDS); mechanical ventilation for RDS treatment; bronchopulmonary dysplasia (BPD) and congenital heart disease. Multivariate analysis identified three independent factors associated with an increased risk for admission in PICU: GA below 32 weeks; RDS and congenital heart disease.Conclusion – This study suggests that population at risk for severe RSV bronchiolitis with PICU admission should include all very preterm infants with RDS whatever the outcome of RDS (with or without BPD). These epidemiological data could be helpful to set up indications for passive immunoprophylaxis of RSV induced bronchiolitis. [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The 2000 French consensus conference for acute viral bronchiolitis management underlined the fundamental role of chest physiotherapy. According to Chalumeau and al., rib fractures were found out in 1/1000 children hospitalized for bronchiolitis or pneumonia. However, such complication of chest physiotherapy is exceptional. We report 2 cases with third to sixth lateral rib fractures after chest physiotherapy in infants with bronchiolitis. Despite the rarity of these complications, clinicians must keep in mind this etiology while facing rib fractures in infants. [Copyright &y& Elsevier]