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Bronchiolitis is the most frequent cause of hospitalization in infants younger than 1 year of age. We sought to evaluate the correlation between lymphocyte count and clinical manifestation in infants hospitalized with bronchiolitis.We performed a retrospective cohort study evaluating 1297 children hospitalized for bronchiolitis from 2004 to 2019. A nasal washing was tested for 14 respiratory viruses by PCR. A clinical severity score, ranging 0-8, was assigned at hospital admission. History and clinical course were recorded for each infant. Patients were divided in 3 groups according to lymphocyte count tertiles. Parents of enrolled patients have been phoned annually over 5 years to evaluate respiratory sequelae.A total of 433 children had 2914.2 ± 745.5/mmInfants with low lymphocyte count are more likely to have a worse clinical course of bronchiolitis.

Emergency room admissions have decreased globally during the COVID-19 pandemic, particularly for respiratory diseases. We evaluated hospital admissions for respiratory diseases in the first year of the Italian pandemic and compared them with the corresponding period in 2016-2017.The study was carried out at the Sapienza University in Rome, Italy, and covered 9 March to 28 February 2020-2021 and 2016-2017. We tested 85 hospitalised children who were negative for the virus that causes COVID-19 in 2020-2021 and compared them with 476 hospitalised children from 2016-2017, as we had also tested nasal washing samples for 14 respiratory viruses during that period.Hospitalisations for acute respiratory tract infections were 82.2% lower in 2020-2021 than 2016-2017. The respiratory syncytial virus (RSV) and several other viruses were detected less frequently during the pandemic. An extraordinary finding was that rhinoviruses remained seasonal. In 2020-2021, we detected a virus in 54.1% of the hospitalised children: rhinoviruses in 41, RSV in 4 and other viruses in 1. This was significantly lower than the 71.6% in 2016-2017: RSV in 130, rhinoviruses in 128 and other viruses in 83.Pandemic measures dramatically reduced childhood respiratory infections, particularly RSV, but were less effective at reducing rhinoviruses.

Background The heterogeneity of bronchiolitis may imply or reflect a different predisposition to respiratory sequelae. Objective Our aim was to investigate whether, among infants hospitalized with bronchiolitis, different clinical profiles extracted by latent class analysis (LCA) are associated with different risks of wheezing. Methods Over 15 consecutive epidemic seasons (2004–2019), we prospectively enrolled infants

Viral bronchiolitis is a common lower respiratory tract infection in infants. Environmental and genetic factors can favor respiratory tract infections.The aim of this study is to analyze risk factors for bronchiolitis and to investigate the predisposing factors for developing transient wheezing and asthma through a 6-year follow-up after hospitalization for bronchiolitis compared with a group of healthy controls that belonged to Piccolipiù cohort, who never had bronchiolitis.We enrolled 645 infants hospitalized with bronchiolitis. A structured questionnaire was used to obtain demographic and clinical data. At 6 years of age, 370 cases and 183 controls were investigated for the presence of asthma by the structured questionnaire, for prick test and for spirometry, and were classified to asthmatic, transient wheezing, and no wheezing/no asthma.Breastfeeding was an independent protective factor (odds ratio [OR]: 0.3, 95% confidence interval [95% CI]: 0.2-0.4, p 0.001) and tobacco smoke was a risk factor for the development of bronchiolitis (OR: 2.1, 95% CI: 1.4-3.1, p 0.001). Analyzing follow-up, bronchiolitis increased the risk of developing transient wheezing by 12.9 (95% CI: 6.3-26.1, p 0.001) and of developing asthma by 4.6 (95% CI: 1.9-10.7, p 0.001). A positive family history of atopy increased the risk of developing asthma by 3.1 (95% CI: 1.4-6.7, p = 0.005). Asthmatic patients had a lower % FEV1, a lower % flow-volume curve (FVC), and a lower FEV1/FVC value, and they had more frequently positive skin prick test.Bronchiolitis is influenced by environmental factors: tobacco smoke increases its risk and breastfeeding is a protective factor. At the end of 6 years of follow-up, bronchiolitis is a significant risk factor to have pre-school wheezing and asthma.

BACKGROUND Community-acquired pneumonia (CAP) represents one of the most common infectious diseases among children. Diagnosis of CAP is mainly clinical. Chest X-ray (CXR) remains the gold standard for the diagnosis in severe or controversial conditions. Recently, some authors have focused on the application of ultrasound in lung diseases but the role of lung ultrasound (LUS) in the diagnosis of CAP is still debated. We aimed to study the concordance between LUS and CXR in evaluating specific signs of CAP. As a secondary aim, we sought to determine the sensitivity and specificity of LUS in CAP diagnosis compared with CXR. Finally, we evaluated the role of LUS during the follow up. METHODS We enrolled 68 children (

The use of electronic cigarettes (e-cigarette) and vaping devices started as a potential aid for cessation and reducing the harmful consequences of cigarette smoking, mainly in the adult population. Today e-cigarette use is highly increasing in vulnerable populations, especially young and pregnant women, due to the misconception of its harmless use.Despite the growing acknowledgment in e-cigarette as a potential harmful device, and due to mixed information found concerning its beneficial aid for smokers, along with an insufficient clinical study done in human models, it is important to further evaluate the possible benefits and risks of non-combusting, vaping nicotine or non-nicotine delivery devices.In this review we tried to summarize the latest updated information found in the literature, concentrating mainly in the variety of adverse effects of e-cigarette use and its contribution for recent and future health concerns.

Background: We previously demonstrated an 81% reduction in pediatric Emergency Rooms (ER) admissions in Italy during lockdown, from March 9 to May 3, 2020 (doi: 10.3390/ijerph17238753.). Since May 2020 lockdown measures were mitigated allowing the reopening of schools in September 2020. Aim: To evaluate pediatric ER admissions during schools reopening in Italy. Methods: We performed a retrospective multicenter study involving 11 Italian pediatric ERs. We compared total ER admissions from September 24, 2020 to November 6, 2020 with those during the corresponding timeframe in 2019. We evaluated 16 ER specific diagnoses grouped in Air communicable and Non-air communicable. Finally, we recognized four different triage categories: white, green, yellow and red. Results: In 2020 total ER admissions reduced by 51% compared to 2019 (8744 vs 17080, respectively). The decrease in Air communicable diseases was significantly higher compared to Non-air communicable diseases (-60% vs -41%, respectively). ER admissions in each triage category decreased in 2020 compared to 2019 but, in percentage, yellow codes increased and green codes decreased. Conclusions: We can speculate that social distancing and simple hygiene measures drastically reduced the circulation of air communicable diseases even during the reopening of schools. The increase in yellow codes during the lockdown period may be related to a lack of primary care and, consequently, a delay in ER admissions.

The use of electronic cigarettes (e-cigarette) and vaping devices started as a potential aid for cessation and reducing the harmful consequences of cigarette smoking, mainly in the adult population. Today e-cigarette use is highly increasing in vulnerable populations, especially young and pregnant women, due to the misconception of its harmless use. Despite the growing acknowledgment in e-cigarette as a potential harmful device, and due to mixed information found concerning its beneficial aid for smokers, along with an insufficient clinical study done in human models, it is important to further evaluate the possible benefits and risks of non-combusting, vaping nicotine or non-nicotine delivery devices. In this review we tried to summarize the latest updated information found in the literature, concentrating mainly in the variety of adverse effects of e-cigarette use and its contribution for recent and future health concerns.

In the last twenty years, despite high vaccination coverage, epidemics of pertussis are occurring in both developing and developed countries. Many reasons could explain the pertussis resurgence: the increasing awareness of the disease, the availability of new diagnostic tests with higher sensitivity, the emergence of new Bordetella pertussis (B. pertussis) strains different from those contained in the current vaccines, the asymptomatic transmission of B. pertussis in adolescents and adults and the shorter duration of protection given by the acellular pertussis (aP) vaccine. New preventive strategies have already been implemented, such as booster doses of aP vaccine in adolescents and adults, maternal immunisation during pregnancy and the "cocooning" strategy, but more are still needed. Knowing what is new about this old disease is necessary to reduce its incidence and to protect infants too young to be vaccinated, which have the highest risk of complications and death.

The diffusion of the SARS‐CoV‐2 virus and the implementation of restrictive measures led to a drastic reduction of respiratory syncytial virus (RSV) diffusion. Few RSV cases have been detected worldwide, even after the removal of the restrictions. We review the current literature and present possible explanations on why there has been a significant reduction of RSV detection during the COVID‐19 pandemic. We also hypothesize what may happen when RSV begins to circulate again. The increase of an immunologically naïve population, with infants born from mothers who have not reinforced their immunity to RSV, could lead to greater RSV epidemics in the coming seasons. It is crucial to prepare the scientific community and to keep RSV surveillance active to avoid dramatic consequences.

Bronchoalveolar lavage (BAL) is a procedure used to collect epithelial lining fluid from the airways, after the injection of sterile 0.9% saline solution. Two types of BAL procedures are currently used: nonbronchoscopic and bronchoscopic BAL. The first one consists in the insertion of a catheter through the orotracheal tube of mechanically ventilated patients to reach the distal airways. The latter is performed using a flexible bronchoscope, the size of which is established according to the age of the patient. The precise location where the lavage is performed is decided based on the type of disease affecting the lung: the right middle lobe or the lingula are chosen for diffuse lung disease, the most affected lobe (radiologically or endoscopically targeted) in the case of localized disease, while multiple samples from different lobes are taken in patients with cystic fibrosis. The amount of fluid needed to perform an efficient BAL could be calculated according to the patient’s weight, age, or lung function. After the injection of saline solution, the fluid can be recovered by manual or mechanical aspiration; the first aliquot collected should be used for microbiological study, while the other aliquots to evaluate cells and solutes.

Background: Community-acquired pneumonia (CAP) is an acute bacterial or viral inflammation of the lung parenchyma. Worldwide it is one of the most common infectious diseases among children. Diagnosis of CAP is clinical, but chestX-ray (CXR) is used in special clinical situation or severe cases. The role of lung ultrasound (LUS) to diagnose and manage CAP is still debated. Aim: 1) To evaluate concordance between LUS and CXR in evaluating specific signs of CAP (Cohen’s Test). 2) To determine sensitivity and specificity of LUS in the diagnosis of CAP compared to CXR. 3) To evaluate the role of LUS during the follow-up of patients hospitalized for CAP. Methods: We enrolled 68 patients younger than 16 years: 41 cases with clinical and radiological diagnosis of CAP and 27 controls with no respiratory diseases who performed a LUS during hospitalization. Nine-teen cases were re-evaluated 30 days after discharge with both LUS and CXR. Results: LUS confirmed CAP diagnosis in 40/41 cases, showing the presence of single or multiple consolidations. Concordance (K) between LUS and CXR was 0.88 in the right hemithorax and 0.70 in the left hemithorax. Moreover, LUS showed 97% of sensitivity and 96% of specificity in the diagnosis of CAP compared to CXR. During the follow-up, LUS sensitivity and specificity were 100% and 94%, respectively. Conclusion: Our study showed the potential benefit of LUS in the diagnosis and follow-up of children with CAP, possibly avoiding the need to take CXR.

Introduction Acute bronchiolitis is the most common respiratory illness and the main cause of respiratory failure in infant. Effective therapy is not available. A relatively new, safe and promising method of non-invasive respiratory support is oxygen delivery by high-flow nasal cannula (HFNC), but several questions concerning HFNC clinical practice remain unanswered. Aim The main aim of our study is to analyse the clinical course of infants hospitalized for bronchiolitis who underwent HFNC in order to identify clinical, laboratory or radiological findings that can have an impact on HFNC failure, which is defined as requirement for mechanical ventilation (MV). Methods We conducted a retrospective data analysis of case records of 130 patients less than 12 months hospitalized for bronchiolitis who underwent HFNC and clinical epidemiological laboratory and radiological data were collected. Results Only 11 (8.5%) out 130 infants required invasive mechanical ventilation for clinical deterioration. Patients who needed to switch from HFNC to MV because of a progressive respiratory failure showed more frequently a complete upper lobe consolidation on CXR (90.9%) than infants exclusively supported by HFNC (14.9%). They were younger with a lower admission weight and they had a lower lymphocyte count than patients who underwent HFNC only. Discussion Our study suggests that a complete upper lobe consolidation in young infants is a significant risk factor for HFNC failure. Further studies are needed to understand if an early identification of consolidation following by an adequate follow-up and proper therapeutic strategies may reduce the number of children who require mechanical ventilation.

Pneumonia is an important cause of morbidity and mortality in children. We described viral aetiologies, with particular interest in detecting SARS-CoV-2, in hospitalized pneumonia children. Human rhinovirus was the most frequently detected agent. No children tested positive for SARS-CoV-2. Our findings suggest that SARS-CoV-2 infection is rare in children and it was not circulating in Rome before COVID-19 outbreak.

Aim: The most frequent cause of lower respiratory tract infection in infants is bronchiolitis. Up to now there is no agreement on the upper limit age of bronchiolitis. Our aim was to identify if there are clinical differences in infants hospitalized for bronchiolitis between 0–6 months and 6–12 months of age. A secondary aim was to establish whether there was differences in terms of recurrent wheezing at 12, 24, and 36 months of follow-up.Methods: We retrospectively analyzed clinical and virological records of 824 infants hospitalized for bronchiolitis during 11 consecutive epidemic seasons. From each infant at admission to the hospital nasopharyngeal washing was collected, clinical severity was assessed and clinical data were extracted from a structured questionnaire. At 12–24–36 months after discharge, parents were interviewed seeking information on recurrent wheezing.Results: A total of 773 infants (Group1) were ≤6 months of age, while 51 were >6 months (Group 2). No differences between family history for atopy and passive smoking exposure were observed between the two groups. Respiratory syncyzial virus was detected more frequently in Group 1 and human bocavirus in Group 2. The clinical severity score (p = 0.011) and the use of intravenous fluids (p = 0.0001) were higher in Group 1 with respect to Group 2 infants. At 36 months follow-up 163/106 (39.4%) Group 1 and 9/9 Group 2 infants experienced recurrent wheezing (p = 0.149).Conclusion: We demonstrated that 0-6 months old infants bronchiolitis differs from > 6 months bronchiolitis.

Aim To test the hypothesis that the balance of type-1/type-2 immune response differs between infants hospitalized with respiratory syncytial virus (RSV) bronchiolitis during the peak months and those during the nonpeak months. Methods We prospectively enrolled 90 unrelated full-term previously healthy infants hospitalized during the first year of life for RSV sole bronchiolitis over 2 epidemics (November 2016 to April 2017 and October 2017 to April 2018). We stratified infants as follows: hospitalized during the peak months (n: 71) and during the nonpeak months (n: 19). The frequencies of CD4+ producing interferon (IFN)-γ and interleukin (IL)-4 and of CD8+ producing IFN-γ T cells were measured by flow cytometry from infant peripheral whole blood. The T-helper cell (Th2) polarization index was calculated as the ratio between CD4+ T cells producing IL-4 and CD4+ T cells producing IFN-γ. Results Infants hospitalized during nonpeak months were significantly less frequently breast-fed, had a higher eosinophils count, a significantly higher percentage of CD4+ T cells producing IL-4 and higher Th2 polarization index than infants hospitalized during the peak months. Conclusions We elucidated the presence of different endotypes in infants with RSV sole bronchiolitis. Previously healthy full-term infants hospitalized during the nonpeak months seem to be more likely those with a possible predisposition to atopy.

BACKGROUND Bronchiolitis is the most common acute viral infection of the lower respiratory tract in infants. Clinical severity is associated with different risk factors; however, no clinical, laboratory, or radiological findings are able to predict the course of the disease in full-term infants. Lung ultrasound (LUS) is a valid technique for the diagnosis and evaluation of pediatric respiratory diseases. AIMS The aim of our study was to correlate an LUS score with a clinical score, to describe lung ultrasound findings in cases and controls, and to compare LUS findings with chest X-ray (CXR) in infants hospitalized with bronchiolitis. METHODS We conducted a single-center, longitudinal, prospective study on 92 infants. Sixty-three out of 92 infants were hospitalized for acute bronchiolitis (cases) and twenty-nine out of 92 for diseases not involving the respiratory system (controls). All patients with bronchiolitis underwent a clinical evaluation with the assignment of a clinical severity score and performed lung ultrasound with the assignment of an LUS score. Twenty-three out of 63 infants with bronchiolitis underwent also a CXR for clinical indications. Control infants performed only LUS. RESULTS In infants with bronchiolitis LUS score showed a positive correlation with the clinical score (r = .62, p

Background A study of respiratory syncytial virus-A (RSV A) genotype ON1 genetic variability and clinical severity in infants hospitalized with bronchiolitis over 6 epidemic seasons (2012–2013 to 2017–2018) was carried out. Methods From prospectively enrolled term infants hospitalized for bronchiolitis, samples positive for RSV A ON1 (N = 139) were sequenced in the second half of the G gene. Patients’ clinical data were obtained from medical files and each infant was assigned a clinical severity score. ANOVA comparison and adjusted multinomial logistic regression were used to evaluate clinical severity score and clinical parameters. Results The phylogenetic analysis of 54 strains showed 3 distinct clades; sequences in the last 2 seasons differed from previous seasons. The most divergent and numerous cluster of 2017–2018 strains was characterized by a novel pattern of amino acid changes, some in antigenic sites. Several amino acid changes altered predicted glycosylation sites, with acquisition of around 10 new O-glycosylation sites. Clinical severity of bronchiolitis increased in 2016–2017 and 2017–2018 and changed according to the epidemic seasons only. Conclusions Amino acid changes in the hypervariable part of G protein may have altered functions and/or changed its immunogenicity, leading to an impact on disease severity.

Background: Respiratory Syncytial Virus (RSV) is the leading cause of bronchiolitis. The local bacterial ecosystem may influence RSV disease severity and the immune response. Aim: To evaluate the association between RSV infection, nasal microbiota composition (NMC) and patients’ immune response in infants with bronchiolitis. Materials and Methods: We characterized the NMC of 47 hospitalized infants Results: NMC differed among RSV and non RSV groups. In RSV-positive nasal samples alfa-diversity was reduced and NMC differed between RSV-A and RSV-B. Discriminant bacterial species were Clostridium indolis for RSV-A group and Hemophilus haemolyticus for RSV-B. In infants with RSV, there was a significant cross-correlation among NMC (evaluated as β diversity) and white blood cells level, expression of Lambda3 and Beta IFN genes and Th1/Th2 response. Conclusions: This preliminary study showed differences in the NMC in relation to the aetiological cause of bronchiolitis and the type of immune response, that are worthy of further examination in larger groups.

Background: Risk factors for bronchiolitis and for long term respiratory sequelae remain unclear. Aim: To study the occurrences of asthma and allergic sensitization after bronchiolitis. Materials: 622 children hospitalized for bronchiolitis (cases) during 9 consecutive seasons and 65 healthy children enrolled in “Piccolipiu” cohort with negative history for bronchiolitis (controls) were followed for 6 years. A structured questionnaire was used to obtain demographic information from all children. Parents were interviewed 5 years after hospitalization to check whether their children experienced recurrent wheezing. At 6 years of age 253 cases and all controls performed prick test. Results: Cases had lower gestational age (p=0.001), lower birth weight (p=0.016), higher smoking exposure during their first year of life (p Conclusions: Environmental factors seems to have an important role in bronchiolitis. Bronchiolitis is a risk factor or asthma but not for allergic sensitization.

Rationale: We aimed to study wheezing recurrence after bronchiolitis from different RSV genotypes: RSVA NA1 and ON1, and RSVB BA. Methods: We prospectively enrolled term infants Results: 125 infants had NA1, 49 ON1, and 41 BA bronchiolitis. At 3 years, we registered wheezing in 65.6% NA1, 77.6% ON1 and 75.6% BA bronchiolitis children. Patients with wheezing had a higher RSV load when hospitalized with bronchiolitis (6.3±1.6 vs 5.6±1.5; p=0.015 copies/ml), particularly in ON1 infants (7.3±1.1vs 6.3±1.3; p=0.026). Among NA1 infants, wheezing was more frequent in children who had a severe bronchiolitis comparing to those children who had a mild bronchiolitis (75.9% vs 56.7%; p=0.025). The logistic regression analysis adjusted for sex, family history of asthma, passive smoking exposure, RSV genotype and eosinophils count, found severe bronchiolitis (OR: 2.9; 95% CI: 1.3, 6.6; p=0.01) and high viral load (OR:1.3; 95% CI: 1.0, 1.6; p=0.04) as risk factors for wheezing at 3 years. Conclusion: Viral factors (genotype specific-viral load) and clinical factors (severity score) contribute to the occurrence of respiratory sequelae after hospitalization for RSV sole bronchiolitis.

Background: Respiratory syncytial virus (RSV)-A genotype ON1 caused a less severe bronchiolitis course than the previously circulating RSV-A genotype (Midulla, F et al JID 2018;219:526-534). However, ON1 continued to circulate worldwide and to differentiate in new strains. Aim: to study the variability of the viral glycoprotein G in relation to clinical severity in bronchiolitis cases. Methods: From prospectively enrolled previously healthy term infants hospitalized for bronchiolitis in 2012-13 to 2017-18 epidemic seasons, cases positive to RSV-A ON1 only were selected. After sequencing the second half of the G gene of about 70 samples, a phylogenetic analysis was performed. Demographic and clinical data were compared among divergent ON1 clades. Results: The phylogenetic analysis of the G gene identified genomic variants appearing since 2012; some of them were not maintained in the following seasons. All sequences did not present polymorphisms in the conserved tract of the G protein that binds the cellular receptor and in the heparin-binding domain. Nonetheless, most strains sequenced in the 2017-18 season set well apart from those of the previous epidemic seasons, in two distant branches of the phylogenetic tree. The two more divergent branches were characterized by patterns of aminoacid changes never reported before, some of which located in antigenic sites. Moreover, substitutions may have altered N- and O-glycosilation sites. Patients infected with divergent strains presented higher severity scores. Conclusions: The aminoacid changes detected in the hypervariable part of the G protein may have altered functions and/or changed its immunogenicity determining an impact on disease severity.

Introduction: Respiratory syncytial virus (RSV) A ON1, firstly detected in 2010, has progressively replaced the previous circulating subtype RSV A NA1. Aims and Objectives: The aim of our study was to compare the clinical severity of RSV A ON1 bronchiolitis in hospitalised children over six epidemic seasons. Methods: We enrolled 497 patients younger than 12 months, hospitalised for RSV bronchiolitis, through the epidemic seasons 2005/2006-2017/2018. We analyzed the genotype in 391 samples and selected the RSV A ON1 positive patients. For each patient, demographic and clinical data were collected from clinical records. A severity score (range 0-8) was calculated based on respiratory rate, peripheral oxygen saturation, presence of withdrawals and feeding difficulty. Furthermore, we retrospectively collected the number of bronchiolitis visiting the Emergency Department and the number of hospitalised bronchiolitis through the epidemic seasons 2012/2013-2017/2018. Results: From the epidemic season 2012/2013, when RSV A ON1 was first detected, the rate of bronchiolitis hospitalised per bronchiolitis visited in the Emergency Department progressively increased (from 51.3% in 2012/2013 to 66.9% in 2017/2018). The severity score showed the same trend: β coefficient 0.52 (95% confidential interval: 0.38-0.66), p-value Conclusions: During the last six seasons (from 2012/2013) the severity of RSV A ON1 bronchiolitis has progressively increased. This phenomenon could be explained by the variability of the virus or by the host immune response.

The role of human bocavirus (HBoV) as a respiratory pathogen has not been fulfilled yet. We aimed to describe clinical and serological characteristics of children with HBoV hospitalized for acute respiratory tract infection and to evaluate whether differences occur between HBoV alone and in co-infection. We retrospectively reviewed data from 60 children (median age of 6.2 months, range 0.6–70.9) hospitalized for acute respiratory symptoms, with HBoV detected from a respiratory sample, using a reverse transcriptase-PCR for 14 respiratory viruses (including respiratory syncytial virus (RSV), influenza virus A and B, human coronavirus OC43, 229E, NL-63 and HUK1, adenovirus, rhinovirus, parainfluenza virus1–3, and human metapneumovirus). HBoV was detected alone in 29 (48.3%) patients, while in co-infection with other viruses in 31 patients (51.7%), with a peak between December and January. Among the 60 patients, 34 were bronchiolitis, 19 wheezing, 3 pneumonia, 2 upper respiratory tract infection, and 2 whooping cough. Seven children (11.6%) required admission to the paediatric intensive care unit (PICU) for respiratory failure. No differences was observed in age, family history for atopy and/or asthma, clinical presentations, chest X-ray, or laboratory findings in children with HBoV alone vs. multiple viral detection. RSV was the most frequently co-detected virus (61.3%). When compared with HBoV detection alone, the co-detection of RSV and HBoV was associated with male sex (P = 0.013), younger age (P = 0.01), and lower blood neutrophil count (P = 0.032). HBoV can be detected alone and in co-infection respiratory samples of children with an acute respiratory tract infection. A cause–effect relationship between HBoV and respiratory infection is not clear, so further studies are needed to clarify this point.

Bronchiolitis is the most common acute lower respiratory tract infection in infants and the first cause of hospitalization in this age group. Despite it has been studied for over 70 years, its management remains controversial and nowadays the treatment is only supportive. Pediatricians should be well acquainted with the clinical course of the disease. In particular, they should know that the severity of respiratory symptoms peaks between days 3-7 of the disease and dehydration is a key sign to consider for the management. In this review, we will discuss the most controversial points in the management of bronchiolitis according to six evidence-based guidelines, six clinical practice guidelines and five consensus-based reviews.

Introduction: In the last years considerable interest has developed around the link between air pollution and morbidity and mortality in children, especially as regards respiratory disease. Aim: To evaluate the possible association between hospital admissions for bronchiolitis and air pollution from 2004 to 2014. Methods: We included children < 1 year who attended Paediatric Emergency Department for bronchiolitis from 2004 to 2014. Every child performed a nasal washing for PCR-based test for respiratory virus detection. Air pollutants (sulfur dioxide-SO2, nitrogen oxide and dioxide-NO, NO2, carbon oxide-CO, ozone-OZ, Benzene-BZ, levels of suspended particles with an aerodynamic diameter less than 10 mm-PM10 and less than 5 mm-PM2,5) were routinely measured by the ARPA Lazio monitoring network. We retained data from the urban monitoring sites near the residence of each recruited child. Results: We studied 724 children(mean age 78.5±58.0 days; male: 395). Respiratory syncytial virus(RSV) was found in 233 children, Rhinovirus(RV) in 54, human bocavirus(hBoV) in 13, human metapneumovirus(hMPV) in 9, other viruses 11, co-infections in 35. Only RSV infection showed a peak activity during winter season (December-March). RSV positive cases showed a significant correlation with benzene(p