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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 57-58

Risk factors for bronchiolitis - Can we really predict?


Departments of Pediatrics and Intensive Care, INHS Kalyani, Visakhapatnam, Andhra Pradesh, India

Date of Submission01-Mar-2020
Date of Acceptance09-Mar-2020
Date of Web Publication10-Apr-2020

Correspondence Address:
Dr. Bal Mukund
Department of Pediatrics and Intensive Care, INHS Kalyani, Visakhapatnam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JPCC.JPCC_39_20

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How to cite this article:
Mukund B, Jamal AZ. Risk factors for bronchiolitis - Can we really predict?. J Pediatr Crit Care 2020;7:57-8

How to cite this URL:
Mukund B, Jamal AZ. Risk factors for bronchiolitis - Can we really predict?. J Pediatr Crit Care [serial online] 2020 [cited 2020 Sep 25];7:57-8. Available from: http://www.jpcc.org.in/text.asp?2020/7/2/57/282231



Acute bronchiolitis (AB) is one of the most common respiratory infection in infant and toddler <2 years of age with significant morbidity and huge economic burden to the society. The incidence peaks in winter and may require hospital admission in around 1.8% of such children.[1] Typically, AB is characterized by generalized peripheral small airway obstruction and manifests with tachypnea, increased work of breathing and low hemidiaphragms on chest radiographs. Respiratory syncytial virus (RSV) is the most common virus in 50%–80% cases; however, adenovirus, influenza, parainfluenza, metapneumovirus, coronavirus, enterovirus, and rhinovirus are other viral etiological agents.[2] Pathologically, infection by RSV is characterized by sloughed necrotic respiratory epithelium, excessive mucus secretions, bronchial mucosal edema, and peribronchial inflammation. Most of the symptomatic children are managed with oxygen therapy and generalized supportive therapy.[3] None of the pharmacological agents including nebulization has been effective in the management of AB.[2] Lately, the use of continuous positive pressure and heated humidified high-flow nasal cannula have been used with good results. The main predictor of severity and poor outcome appears to be young age, prematurity, low birth weight, previous history of pulmonary or cardiac diseases, immunodeficiency, malnutrion, lack of breast feeding, presence of apnea, and pulmonary consolidation on admission chest radiograph.[4] There is paucity of clinical data from India on risk factors for the development of AB.

In this issue, J of Peds Crit care by Kulhalli. et al., a retrospective study from south India has been published to determine risk factors in the development of AB.[5] All demographic data, immunization status, socioeconomic status, malnutrition, overcrowding, exposure to pets, and allergies were studied. A total of 85 cases and 91 controls were studied. On multiple logistic regression, low socioeconomic status, unimmunized status, exposure to pets, and birth by cesarean section were found to have significant risk factor for development of AB. The present study found increased incidence in younger infant which has been attributed to reduced immunity to viral infection in this vulnerable age group. Low socio economic condition has been attributed in studies from China, Spain, and other countries too and has been hypothesized to result from enhanced risk of nutritional deficiency, increased risk of pollution, low immunization status, environmental hazards contributing to this risk factor.[5],[6] Cesarean section as modality of delivery has been found to a have conflicting results. In the present study, exposure to pets have been found a predictor, similar to another study from this subcontinent by Mallaet al. has found, however, such predisposition is mired with controversy due to inconsistent results.[7] In another similar study by Das et al., this study also found heightened risk of AB in unvaccinated children which might have been due to either other co-risk factors or due to lack of cross protection from other infection in such deprived children.[8] Since very few prospective study exists for predictor of risk factors of AB in small infant and children, it is considered prudent to do such multicentric clinic-epidemiological study to understand risk factors for development and severity of AB in children from our region. Till we have such studies, it is difficult to predict both development and severity of AB.



 
  References Top

1.
Brooks AM, McBride JT, McConnochie KM, Aviram M, Long C, Hall CB. Predicting deterioration in previously healthy infants hospitalized with respiratory syncytial virus infection. Pediatr 1999;104:463-7.  Back to cited text no. 1
    
2.
Meissner HC. Viral bronchiolitis in children. N Engl J Med 2016;374:62-72.  Back to cited text no. 2
    
3.
Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet 2017;389:211-24.  Back to cited text no. 3
    
4.
Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al. Clinical practice guideline: The diagnosis, management, and prevention of bronchiolitis. Pediatr 2014;134:e1474-502.  Back to cited text no. 4
    
5.
Kulhalli P, Dakshayini JN, Ratageri VH, Shivanand I, Kari PK. Risk factors for bronchiolitis. J Ped Crit Care 2020;7:79-83.  Back to cited text no. 5
    
6.
Leem JH, Kim HC, Lee JY, Sohn JR. Interaction between bronchiolitis diagnosed before 2 years of age and socio-economic status for bronchial hyperreactivity. Environ Health Toxicol 2011;26:e2011012.  Back to cited text no. 6
    
7.
Malla T, Poudyal P, Malla KK. Modifiable demographic factors that differentiate bronchiolitis from pneumonia in Nepalese children less than two years-a hospital based study. Kathmandu Univ Med J(KUMJ) 2014;12:175-80.  Back to cited text no. 7
    
8.
Das PK, Saha JB, Basu K, Lahiri S, Sarkar GN. Some clinico-epidemiological aspect of bronchiolitis among infants and young children – A hospital based study. Indian J Public Health 2003;47:66-71.  Back to cited text no. 8
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