OC-34 Management changes in acute bronchiolitis within a decade in the national institute for mother and child health “alessandrescu – rusescu”

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Abstract

Background and aims

Acute bronchiolitis (AB) is a relatively frequent respiratory disease in paediatric practice. Severity is variable, from mild – that can be treated as outpatient, to severe – that requires admission in the intensive care unit. Management continues to be controversial, no consensus exists on the use of bronchodilators, corticosteroids and hypertonic saline. The aim of this paper was to analyse changes in the management of AB within the space of a decade.

Methods

We conducted a retrospective study of patients admitted to our institution in the months of Jan – March and October – Dec of 2006 and 2016 with the diagnosis of AB. Data collection and analysis – ANOVA and Fisher’s exact tests were performed with IBM SPSS Statistics version 22. A p value<0.05 was considered statistically significant.

Results

A total of 459 admissions of 446 children were studied, 59.9% were males. 245 of children were admitted in 2006, 201 in 2016. Age at admission was less than 1 month in 4%, 1–12 months old in 76.9%. 205/446 (45.9%) had moderate to severe AB. Within the 10 year period median length of hospital stay has declined by one day, from 6 to 5 days (p=0.048).

Results

Respiratory Syncitial Virus was identified in 48 samples, adenovirus in 7 cases. In 2016, as bacterial coinfections could be tested by PCR, the most frequent associated bacterium was streptococcus pneumoniae, encountered mostly in severe AB.

Results

Therapeutical options used included oxygen (O2 – in 38.3% of the cases), hypertonic saline (HS −16.4%) – used predominantly in mild AB, nebulized adrenaline (79.1%) and salbutamol (22.9%). Corticosteroids – intravenous (40.1%) and inhaled (17.3%), nebulized ipratropium (4%) and antibiotics (62.3%) were used mostly in moderate – severe AB. None of the patients required mechanical ventilation.

Results

Within the ten years, significant changes were noted in the use of O2 – increased (p=0.049), HS – increased from 1.2% to 34.8%, mostly in mild AB (p<0.001). Ipratropium use increased from 1.2% to 7.5% (p=0.001), corticosteroids – decreased from 70.2% to 41.8% (p<0.001), antibiotics – decreased from 78% to 44.3% (p<0.001), mostly used in moderate – severe AB.

Conclusions

As controversies persist in the management of AB, in our sample significant changes have occurred within a decade – HS has become an option for mild cases and the use of corticosteroids and antiobiotics has declined in general, whilst they continue to be used in severe AB.

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