Acute Bronchiolitis in Children. Current Approaches to Diagnosis and Therapy

The article is dedicated to the problem of acute bronchitis in children. The relevance of this problem is obvious: according to conservative estimates, more than 150 million cases of bronchiolitis are registered annually. 7–13% of these cases require hospital treatment and 1–3% — hospitalization in an ICU. The most common etiologic factor is the virus — respiratory syncytial (the vast majority of cases — 90%); rhinovirus and influenza viruses A and B, parainfluenza, adenovirus, coronavirus, metapneumovirus, and human bocavirus are also important agents. A number of factors can cause the evolution of bronchiolitis in 0–2-years-old children. Premature infants, children with bronchopulmonary dysplasia, bottle-fed children, and patients with congenital malformations and immunodeficiencies undergo bronchiolitis especially hard. Specialists of the Professional Association of Pediatricians — The Union of pediatricians of Russia — have formulated and summarized fundamental criteria for the diagnosis, treatment and further management algorithms for patients with this pathology in accordance with the principles of evidence-based medicine.

1. Классификация клинических форм бронхолегочных заболеваний у детей. М.: Российское респираторное общество. 2009. 18 с.

2. Ralston S. L., Lieberthal A. S., Meissner H. C., Alverson B. K., Baley J. E., Gadomski A. M., Johnson D. W., Light M. J., Maraqa N. F.,Mendonca E. A., Phelan K. J., Zorc J. J., Stanko-Lopp D., Brown M. A., Nathanson I., Rosenblum E., Sayles S., 3rd, Hernandez-Cancio S. American Academy of Pediatrics. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014; 134 (5): e1474–e1502.

3. Paediatric Respiratory Medicine. ERS. Handbook. 1st Edition Editors E. Eber, F. Midulla. 2013. 719 p.

4. Miller E. K., Bugna J., Libster R., Shepherd B. E., Scalzo P. M., Acosta P. L., Hijano D., Reynoso N., Batalle J. P., Coviello S., Klein M. I., Bauer G., Benitez A., Kleeberger S. R., Polack F. P. Human rhinoviruses in severe respiratory disease in very low birth weight infants. Pediatrics. 2012; 129: e60.

5. Jansen R., Bont L., Siezen C. L., Hodemaekers H. M., Ermers M. J., Doornbos G., van‘t Slot R., Wijmenga C., Goeman J. J., Kimpen J. L., van Houwelingen H. C., Kimman T. G., Hoebee B. Genetic susceptibility to respiratory syncytial virus bronchiolitis is predominantly associated with innate immune genes. J. Infect. Dis. 2007; 196: 825–834.

6. Figueras-Aloy J., Carbonell–Estrany X., Quero J. IRIS Study Group. Case control study of the risk factors linked to respiratory syncytial virus infection requiring hospitalization in premature infants born at a gestational age of 33–35 weeks in Spain. Pediatr Infect Dis J. 2004; 23 (9): 815–820.

7. Law B. J., Langley J. M., Allen U., Paes B., Lee D. S., Mitchell I., Sampalis J., Walti H., Robinson J., O’Brien K., Majaesic C., Caouette G., Frenette L., Le Saux N., Simmons B., Moisiuk S., Sankaran K., Ojah C., Singh A. J., Lebel M. H., Bacheyie G. S., Onyett H., Michaliszyn A., Manzi P., Parison D. The Pediatric Investigators Collaborative Network on Infections in Canada study of predictors of hospitalization for respiratory syncytial virus infection for infants born at 33 through 35 completed weeks of gestation. Pediatr Infect Dis J. 2004; 23 (9): 806–814.

8. Stensballe L. G., Kristensen K., Simoes E. A., Jensen H., Nielsen J., Benn C. S., Aaby P. Danish RSV Data Network. Atopic disposition, wheezing and subsequent respiratory syncytial virus hospitalization in Danish children younger than 18 months: a nested case control study. Pediatrics. 2006; 118 (5): 1360–1388.

9. Orphan Lung Diseases. Ed. J. F. Cordier. Monograph. European Respiratory Society. 2011; 54: 84–103.

10. Таточенко В. К. Болезни органов дыхания у детей. Практическое руководство. Под ред. В. К. Таточенко. М.: ПедиатрЪ. 2012. 480 с.

11. Спичак Т. В. Постинфекционный облитерирующий бронхиолит у детей. М.: Научный мир. 2005. 96 с.

12. Ralston S., Hill V., Waters A. Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: A systematic review. Arch Pediatr Adolesc Med. 2011; 165: 951–956.

13. Hall C. B., Powell K. R., Schnabel K. C., Gala C. L., Pincus P. H. Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection. J Pediatr. 1988; 113: 266.

14. Thorburn K., Harigopal S., Reddy V., Taylor N., van Saene H. K. High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis. Thorax. 2006; 61: 611.

15. Duttweiler L., Nadal D., Frey B. Pulmonary and systemic bacterial co-infections in severe RSV bronchiolitis. Arch Dis Child. 2004; 89: 1155.

16. URL: http://www.uptodate.com (дата доступа: 13.06.2015).

17. Патрушева Ю. С., Бакрадзе М. Д. Этиология и факторы риска острого бронхиолита у детей. Вопросы диагностики в педиатрии. 2012; 3 (4): 45–52.

18. Wu S., Baker C., Lang M. E., Schrager S. M., Liley F. F., Papa C., Mira V., Balkian A., Mason W. H. Nebulized hypertonic saline for bronchiolitis: a randomized clinical trial. JAMA Pediatr. 2014; 168 (7): 657–663. Doi: 10.1001/jamapediatrics.2014.301.

19. Патрушева Ю. С., Бакрадзе М. Д., Куличенко Т. В. Диагностика и лечение острого бронхиолита у детей. Вопросы диагностики в педиатрии. 2011; 3 (11): 5–11.

20. Chen Y. J., Lee W. L., Wang C. M., Chou H. H. Nebulized hypertonic saline treatment reduces both rate and duration of hospitalization for acute bronchiolitis in infants: an updated meta-analysis. Pediatr. Neonatol. 2014 Jan. 21. Doi: 10.1016/j.pedneo.2013.09.013.

21. Zhang L., Mendoza-Sassi R. A., Wainwright C., Klassen T. P. Nebu lised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev. 2013; 7: CD006458. Doi: 10.1002/14651858.CD006458.pub3.

22. Committee on infectious diseases and bronchiolitis guidelines committee. Updated Guidance for palivizumab prophylaxis amonginfants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics. 2014; 134 (2): e620–e638.

23. Баранов А. А., Иванов Д. О., Алямовская Г. А., Амирова В. Р., Антонюк И. В. Асмолова Г. А., Беляева И. А., Бокерия Е. Л., Брюхано ва О. А., Виноградова И. В., Власова Е. В., Галустян А. Н., Га фарова Г. В., Горев В. В., Давыдова И. В., Дегтярёв Д. Н., Дегтярёва Е. А., Долгих ВВ., Донин И. М., Захарова Н. И., Зер но ва Л. Ю., Зимина Е. П., Зуев В. В., Кешишян Е. С., Кова лёв И. А., Колтунов И. Е., Корсунский А. А., Кривощеков Е. В., Крше мин ская И. В. Паливизумаб: четыре сезона в России. Вестник РАМН. 2014; 7–8: 54–68.