الفهرس 
BronchiolitisOnly 14 pages are availabe for public view
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Abstract
Bronchiolitis of infancy is a clinically diagnosed respiratory condition
presenting with breathing difficulties, cough, poor feeding, irritability
and, in the very young, apnea. These clinical features, together with
wheeze and/or crepitations on auscultation combine to make the
diagnosis. Bronchiolitis most commonly presents in infants aged three to
six months (Paediatric Society of New Zealand 2006).
Bronchiolitis occurs in association with viral infections (respiratory
syncytial virus; RSV, in around 75% of cases) and is seasonal, with peak
prevalence in the winter months (November to March) when such viruses
are widespread in the community. Re-infection during a single season is
possible ( Garcia-Garcia et al., 2007 ).
The burden of disease is significant. Around 70% of all infants will
be infected with RSV in their first year of life and 22% develop
symptomatic disease. Since RSV is associated with only 75% of
bronchiolitis cases, it may be estimated that around a third of all infants
will develop bronchiolitis (from all viruses) in their first year of life
(Scottish Intercollegiate Guidelines Network 2006).
The rate of admissions to hospital with bronchiolitis has increased
over the past 10 years. The reasons for this are not fully understood and
are likely to be multifactorial and include improved survival of preterm
infants ( Garcia-Garcia et al., 2007 ).
In most infants the disease is self limiting, typically lasting between
three and seven days. Most infants are managed at home, often with
primary care support. Admission to hospital is generally to receive
supportive care such as nasal suction, supplemental oxygen or nasogastric
tube feeding (Southern Health Clinical Practice 2006).
Children with underlying medical problems (prematurity, cardiac
disease or underlying respiratory disease) are more susceptible to severe
disease and so have higher rates of hospitalisation.In preterm infants less
than six months of age, admission rate with acute bronchiolitis is 6.9%
with admission to intensive care more frequent in such patients.In a UK
study, the RSV-attributed death rate (measured in infants aged one to 12
months) was 8.4 per 100,000 population. (Fleming et al., 2005)
Twenty percent of infants with bronchiolitis (40-50% of those
hospitalised) proceed to a grumbling, sometimes protracted, respiratory
syndrome of persistent cough and recurrent viral induced wheeze.
Ongoing symptoms may relate to continuing inflammation and temporary
cilial dysfunction. An association between acute bronchiolitis and later
respiratory morbidity is recognised.( Jartti et al., 2005)
Hypertonic saline has recently been trialed in patients with acute
bronchiolitis (Kuzik et al., 2007).