PP-270. HLA and bronchopulmonary dysplasia susceptibility

Indian Journal of Critical Care Medicine

Objectives: The objective of the study was to describe the clinico-virological profile, treatment details, intensive care needs, and outcome of infants with acute viral bronchiolitis (AVB). Methodology: In this prospective observational study, 173 infants with AVB admitted to the pediatric emergency room and pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India during November 2019 to February 2020 were enrolled. The data collection included clinical features, viruses detected [respiratory syncytial virus (RSV), rhinovirus, influenza A virus, parainfluenza (PIV) 2 and 3, and human metapneumovirus (hMPV)], complications, intensive care needs, treatment, and outcomes. Multivariate analysis was performed to determine independent predictors for PICU admission. Results: Most common symptoms were rapid breathing (98.8%), cough (98.3%), and fever (74%). On examination, tachypnea (98.8%), chest retractions (93.6%), respiratory failure (84.4%), wheezing (49.7%), and crepitations (23.1%) were observed. RSV and rhinovirus were the predominant isolates. Complications were noted in 25% of cases as encephalopathy (17.3%), transaminitis (14.3%), shock (13.9%), acute kidney injury (AKI) (7.5%), myocarditis (6.4%), multiple organ dysfunction syndrome (MODS) (5.8%), and acute respiratory distress syndrome (ARDS) (4.6%). More than one-third of cases required PICU admission. The treatment details included nasal cannula oxygen (11%), continuous positive airway pressure (51.4%), high-flow nasal cannula (14.5%), mechanical ventilation (23.1%), nebulization (74%), antibiotics (35.9%), and vasoactive drugs (13.9%). The mortality was 8.1%. Underlying comorbidity, chest retractions, respiratory failure at admission, presence of shock, and need for mechanical ventilation were independent predictors of PICU admission. Isolation of virus or coinfection was not associated with disease severity, intensive care needs, and outcomes. Conclusion: Among infants with AVB, RSV and rhinovirus were predominant. One-third infants with AVB needed PICU admission. The presence of comorbidity, chest retractions, respiratory failure, shock, and need for mechanical ventilation independently predicted PICU admission.

Paediatric Respiratory Reviews, 2009

Italian Journal of Pediatrics, 2014

Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection. Criteria for hospitalization include low oxygen saturation (<90-92%), moderate-to-severe respiratory distress, dehydration and presence of apnea. Children with pre-existing risk factors should be carefully assessed. To date, there is no specific treatment for viral bronchiolitis, and the mainstay of therapy is supportive care. This consists of nasal suctioning and nebulized 3% hypertonic saline, assisted feeding and hydration, humidified O 2 delivery. The possible role of any pharmacological approach is still debated, and till now there is no evidence to support the use of bronchodilators, corticosteroids, chest physiotherapy, antibiotics or antivirals. Nebulized adrenaline may be sometimes useful in the emergency room. Nebulized adrenaline can be useful in the hospital setting for treatment as needed. Lacking a specific etiological treatment, prophylaxis and prevention, especially in children at high risk of severe infection, have a fundamental role. Environmental preventive measures minimize viral transmission in hospital, in the outpatient setting and at home. Pharmacological prophylaxis with palivizumab for RSV bronchiolitis is indicated in specific categories of children at risk during the epidemic period. Viral bronchiolitis, especially in the case of severe form, may correlate with an increased incidence of recurrent wheezing in pre-schooled children and with asthma at school age. The aim of this document is to provide a multidisciplinary update on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications, identify gaps in knowledge and drive future research.

2019

Summary Background Viral respiratory infection (VRI) is a frequent cause of hospitalization in children under 24 months of age. Prematurity or heart disease histories may be risk factors for complications in patients hospitalized for VRI.Objective To describe the epidemiological data of pediatric patients 1 to 24 months of age who were hospitalized for VRI and identify risk factors for the presence of in-hospital complications over a period of 5 years.Methods This was a cross-sectional study. The database was compiled by doctors, electronically validated by engineers and analyzed by statisticians. Patients with VRI (based on International Classification of Diseases [ICD-10] codes B974, J12, J120-J129X, J168, J17, J171, J178, J20, J203-J209, J21, J210, J211, J218, J219, J22X, and J189) from 2013 to 2017 were registered. The patients were classified into 2 groups according to the absence or presence of a history of prematurity (P070, P072, P073), bronchopulmonary dysplasia (BPD) (P271...

2016

Background: Lower respiratory tract infection (LRTI) is a main cause of hospitalization in infants and children. These patients' nasopharyngeal swabs more frequently contain respiratory syncytial virus (RSV) than human adenovirus (HAdV) in cold seasons; recent data suggest that oropharyngeal swabs more frequently contain HAdV than RSV. Knowing more about virus detection with oropharyngeal swabs, seasonal fluctuations and age-related distribution of RSV and HAdV would help treat children hospitalized for LRTI more effectively. We investigated the seasonal virus-related frequency (as assessed by oropharyngeal swabs) and environmental and clinical features in infants and children hospitalized for LRTI from autumn to spring. Methods: We studied 98 subjects hospitalized for LRTI in our Pediatric Unit, from November 2006 to May 2007. RSV and HAdV in oropharyngeal swabs were assessed by real-time polymerase chain reaction (PCR) assay. Results: PCR assays more frequently detected HAdV (29.6% of patients) than RSV (25.5%). The seasonal incidence also differed (RSV, narrow peak in December and HAdV, wide peak from April to May). Most patients infected with RSV were aged 2 yrs or younger (23/25: 88%); no difference was found in age between subjects who tested HAdV-positive (13/29: 45%) or undetectable-virus (23/44: 52%). Bronchiolitis was more frequently associated with RSV than HAdV or undetectable-virus oropharyngeal swabs. No difference was found in risk factors (school attendance, atopic parents, exposure to cigarette smoking, home dampness or exposure to animals) or clinical features (vital parameters or duration of hospital stay) among the three viral groups. Conclusions: Our findings show a high frequency of HAdV-positive oropharyngeal swabs during acute LRTIs in infants and children and differences in the seasonal distribution of RSV and HAdV in Rome.

Frontiers in Pediatrics

Acute Viral Bronchiolitis is one of the leading causes of hospitalization in the first 12–24 months of life. International guidelines on the management of bronchiolitis broadly agree in recommending a minimal therapeutic approach, not recommending the use of bronchodilators. Guidelines, generally, consider bronchiolitis as a “unique disease” and this runs the risk of not administering therapy in some patients who could benefit from the use of bronchodilators, for instance, in those who will develop asthma later in their life and face first episode in the age of bronchiolitis. Today, there is growing evidence that bronchiolitis is not a single illness but can have different “endotypes” and “phenotypes,” based on age, personal or family history of atopy, etiology, and pathophysiological mechanism. There is evidence that some phenotypes of bronchiolitis are more strongly associated with asthma features and are linked to higher risk for asthma development. In these populations, possible...

Journal of Korean medical science, 2015

The aim of this study was to observe the effects of prophylactic palivizumab on hospitalization secondary to respiratory syncytial virus (RSV) infection (RSVhospitalization) in former very low birth weight infants (VLBWI) with bronchopulmonary dysplasia (BPD). This study also sought to identify the risk factors of RSVhospitalizationin this particular infant population. A prospective observational study was conducted between September 2007 and April 2008 in seven Korean hospitals. Children with a history of very low birth weight, a diagnosis of BPD and who were &lt;2 yr old at the onset of the RSV season were included in this study. Palivizumab injections were administered monthly for a maximum of five months during the RSV season. RSVhospitalization rates were reviewed, and RSVhospitalization rates between subgroups were categorized by gestational age, birth weight, and duration of ventilator care. A total of 90 subjects completed the follow-up interviews. The mean gestational age a...

Conference: GAAF - 15 eme Rencontre du Groupe d'Anthropologie et Archéologie Funéraire

The Hypogeum I of Monte do Carrascal 2, located in the inner region of Alentejo (Portugal), is a collective grave used during the Chalcolithic period as the final destination, at least 71 individuals (adults of both sexes and non-adults). During the excavation the implementation of a field archaeothanatological protocol permitted the characterization of 1) the ways of deposition of the 71 individuals, 2) the reconstitution of the rhythm and succession of the depositions, 3) the specific signs of open space decomposition, 4) the evidence of body wrapping with vegetable or animal fibers, and the 5) the existence of (now) invisible structures built to accommodate the deceased. This poster will present the last two particular aspects in detail, aiming to reconstruct past funerary practices and gestures that occurred inside that artificial grave between 2900 and 2300 cal. B.C. These findings will be framed in their spatial, temporal, and geographic context to contribute to a better understanding of the world of the living and the world of the dead of those Chalcolithic groups.

Sebagaimana telah saya uraikan pada tulisan saya sebelumnya, bahwa esensi dari Kurikulum 2013 adalah keseimbangan antara sikap, keterampilan, dan pengetahuan. Dalam hal ini sikap harus menjadi dasar utama yang menyelimuti keterampilan dan pengetahuan, dalam arti sikap harus dapat memandu keterampilan dan pengetahuan. Bagaimana dalam implementasi pembentukan sikap tersebut? Dalam proses perancangan RPP dan pelaksanaan pembelajaran di kelas, sikap diintegrasikan dalam aktivitas keterampilan dan pengetahuan. Sikap yang dimaksud meliputi sikap spiritual dan sikap sosial. Dalam Kurikulum 2013, standar kompetensi lulusan (SKL) dirumuskan ke dalam tiga domain di atas, yaitu (1) sikap dan prilaku dasar (KD). Kompetensi inti tersebut meliputi, yaitu kompetensi inti 1 (KI 1) tentang sikap spritual, kompetensi inti 2 (KI 2) tentang sikap sosial, kompetensi 3 (KI 3) tentang pengetahuan, dan kompetensi 4 (KI 4) tentang keterampilan. Oleh sebab itu, urutan kompetensi inti dalam Kurikulum 2013 adalah sikap spritual (KI-1), sikap sosial (KI-2), pengetahuan (KI-3) dan keterampilan (KI-4). Meskipun urutan KI tersebut seperti itu, namun dalam perancangan dan pelaksanaan pembelajaran hendaknya dimulai dari KI-3 menuju KI-4. Keterampilan hanya dapat dibangun dengan hasil yang baik melalui pengetahuan (pelukis, penyanyi, olahragawan pasti memiliki pengetahuan yang memadai tentang keterampilan yang ditekuninya). Keterampilan yang tidak melalui proses pengetahuan (KI-3) tidak akan menghasilkan karya yang baik (Materi Sosialisasi Implementasi Kurikulm 2013, slide 8). Dalam proses perolehan pengetahuan dan keterampilan, sikap diintegrasikan sehingga seluruh mata pelajaran diorientasikan memiliki kontribusi terhadap pembentukan sikap. Selanjutnya dari KI 4 berlanjut ke KI 2, kemudian KI 1). Dengan demikian, dalam proses perancangan (menyusun RPP) dan pelaksanaan pembelajaran di kelas, alur yang digunakan adalah diawali dengan KD dari KI-3 menuju KD dari KI 4 dan selanjutnya memberikan dampak terhadap terbentuknya KD pada KI-2 dan KD pada KI-1.