Rivista di formazione e aggiornamento professionale del pediatra e del medico di base, fondata nel 1982. In collaborazione con l'Associazione Culturale Pediatri.
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Linee guida

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Le nuove Linee Guida sulla bronchiolite

New bronchiolitis guidelines

Giorgio Cozzi1, Sara Pusceddu2, Lorenzo Mambelli2, Egidio Barbi3, Federico Marchetti2

1IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
2UOC di Pediatria e Neonatologia, Ospedale di Ravenna, AUSL della Romagna
3SC di Pediatria d’Urgenza e Pronto Soccorso Pediatrico, IRCCS Materno-Infantile “Burlo Garofolo”, Trieste

Giugno 2015 - pagg. 369 -375

Abstract
Bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year old. The American Academy of Pediatrics (AAP) and the Italian Pediatric Society (SIP) have recently published new guidelines for the diagnosis, management and prevention of bronchiolitis. Indications in the two documents are similar, but bronchiolitis management is still debated. In particular pharmacological treatments are not supported by enough evidence, whereas support therapy with oxygen, hydration and nutrition seems the only useful option. The aim of the present work is to summarise these new guidelines, adding a brief comment to each recommendation, in order to produce a useful and practical everyday guide for the paediatrician.

Bibliografia

1. Ralston SL, Lieberthal AS, Meissner HC, et al. American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014;134(5):e1474-502. 2. Baraldi E, Lanari M, Manzoni P, et al. Inter- society consensus document on treatment and prevention of bronchiolitis in newborns and infants. Ital J Pediatr 2014;40:65. 3. Levine DA, Platt SL, Dayan PS, et al.; RSVSBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics 2004;113(6):1728-34. 4. Librizzi J, McCulloh R, Koehn K, Alverson B. Appropriateness of testing for serious bacterial infection in children hospitalized with bronchiolitis. Hosp Pediatr 2014;4(1):33-8. 5. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2014;6:CD001266. 6. Plint AC, Johnson DW, Patel H, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med 2009;360 (20):2079-89. 7. Wainwright C, Altamirano L, Cheney M, et al. A multicenter, randomized, double-blind, controlled trial of nebulized epinephrine in infants with acute bronchiolitis. N Engl J Med 2003;349(1):27-35. 8. de Benedictis FM, Franceschini F, Budassi R, et al. I corticosteroidi nelle malattie respiratorie: certezze e dubbi 60 anni dopo (seconda parte). Medico e Bambino 2012;31: 652-9. 9. Mandelberg A, Tal G, Witzling M, et al. Nebulized 3% hypertonic saline solution treatment in hospitalized infants with viral bronchiolitis. Chest 2003;123(2):481-7. 10. Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2013;7:CD006458. 11. Wu S, Baker C, Lang ME, et al. Nebulized hypertonic saline for bronchiolitis: a randomized clinical trial. JAMA Pediatr 2014; 168(7):657-63. 12. Florin TA, Shaw KN, Kittick M, Yakscoe S, Zorc JJ. Nebulized hypertonic saline for bronchiolitis in the emergency department: a randomized clinical trial. JAMA Pediatr 2014; 168(7):664-70. 13. Everard ML, Hind D, Ugonna K, et al. SABRE: a multicentre randomised control trial of nebulised hypertonic saline in infants hospitalised with acute bronchiolitis. Thorax 2014;69(12):1105-12. 14. Kallappa C, Hufton M, Millen G, Ninan TK. Use of high flow nasal cannula oxygen (HFNCO) in infants with bronchiolitis on a paediatric ward: a 3-year experience. Arch Dis Child 2014;99(8):790-1 15. Wing R, James C, Maranda LS, Armsby CC. Use of high-flow nasal cannula support in the emergency department reduces the need for intubation in pediatric acute respiratory insufficiency. Pediatr Emerg Care 2012; 28(11):1117-23. 16. Beggs S, Wong ZH, Kaul S, Ogden KJ, Walters JA. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database Syst Rev 2014;1:CD009609. 17. Schroeder AR, Marmor AK, Pantell RH, Newman TB. Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations. Arch Pediatr Adolesc Med 2004;158(6):527-30. 18. Farley R, Spurling GK, Eriksson L, Del Mar CB. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev 2014;10:CD005189. 19. Thorburn K, Harigopal S, Reddy V, Taylor N, van Saene HK. High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis. Thorax 2006;61(7):611-5. 20. Chen CJ, Wu KG, Tang RB, Yuan HC, Soong WJ, Hwang BT. Characteristics of Chlamydia trachomatis infection in hospitalized infants with lower respiratory tract infection. J Microbiol Immunol Infect 2007;40(3):255-9. 21. Pinto LA, Pitrez PM, Luisi F, et al. Azithromycin therapy in hospitalized infants with acute bronchiolitis is not associated with better clinical outcomes: a randomized, doubleblinded, and placebo-controlled clinical trial. J Pediatr 2012;161(6):1104-8. 22. McCallum GB, Morris PS, Chatfield MD, et al. A single dose of azithromycin does not improve clinical outcomes of children hospitalised with bronchiolitis: a randomised, placebo- controlled trial. PLoS One 2013;8(9): e74316. 23. Oakley E, Borland M, Neutze J, et al; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial. Lancet Respir Med 2013;1(2): 113-20. 24. Ho SW, Huang KY, Teng YH, Ku MS, Chiou JY. Practice variations between emergency physicians and pediatricians in treating acute bronchiolitis in the Emergency Department: A nationwide study. J Emerg Med 2015;48(5):536-41.

Corrispondenza: federico.marchetti@ausl.ra.it