Criteria heterogeneity in the diagnosis of acute bronchiolitis in Spain

Abstract

Introduction: Acute viral bronchiolitis (AB) is one of the most common respiratory diseases in infants. However, diagnostic criteria for AB are heterogeneous and not very well known. Objective: To identify the diagnostic criteria for AB used by experts and clinical paediatricians in Spain. Methods: Delphi study with Spanish AB experts, looking for the points of agreement about AB diagnosis. A subsequent cross-sectional study was conducted by means of an online questionnaire addressed to all Spanish paediatricians, reached through electronic mail messages sent by nine paediatric scientific societies. Descriptive and factorial analyses were carried out, looking for any association of diagnostic criteria with demographic or geographic variables, or with paediatric subspecialty. Results: Agreement was reached by 40 experts in many issues (first episode of respiratory distress and high respiratory frequency, diagnosis in any season of the year, and usefulness of virus identification in making diagnosis), but opposite views were maintained on key characteristics

The impact of viral bronchiolitis phenotyping: Is it time to consider phenotype-specific responses to individualize pharmacological management?

“…The causative virus and the inclusion or exclusion of infants with previous presentations and/or various comorbidities are additional sources of variability [18]. In a recent survey of Spanish pediatricians, it was determined that the adherence to diagnostic criteria for viral bronchiolitis is heterogeneous, with high agreement on issues such as being the first episode of respiratory distress and the usefulness of virus identification in making a diagnosis, but poor agreement on other important issues such as the maximum age for diagnosis [19]. Notably, although there is overall consensus that the term viral bronchiolitis must be used only to describe the first/ single episode of viral LRTI in infants, a recent study found that >60% of bronchiolitis cases requiring hospitalization are really recurrent wheezing cases [20].…”

Factores de riesgo asociados a la hospitalización por bronquiolitis aguda en pacientes menores de 2 años atendidos en el servicio de pediatría del Hospital de Huaycán durante el periodo 2019

“…El primer paso para realizar es una buena historia clínica y ahondar en la anamnesis, de ella debemos rescatar factores de riesgo que puedan estar relacionados a un desarrollo más grave de la enfermedad. Entre ellos, debemos preguntar lo siguiente: edad (más grave en menores de 6 semanas), si es nacido prematuro, alguna patología de antecedente personal, tiempo de evolución, si hay personas que fuman en el entorno o cerca al niño, si hubo lactancia materna o no, si el niño tubo bajo peso al nacer (menor a 2500 gr) y estatus socioeconómico (por hacinamiento y pobreza) (47).…”

“…Es adecuado apoyarse en una escala que objetive la severidad del cuadro, idealmente debería usarse una escala que tenga como parámetros clínicos: frecuencia respiratoria y cardiaca, y saturación de oxígeno. La escala más usada y propuesta es la de Wood-Downes (47).…”