In the trenches: a pediatrician's perspective on prevention and treatment strategies for RSV disease.
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Pharmacologic options in the treatment of RSV infection have no or minimal effectiveness. Therefore, for infants at high risk of RSV infection, proper hand hygiene, limiting exposure to infection, and immunoprophylaxis with palivizumab is paramount. The first injection of palivizumab must be given prior to the start of the local RSV season and subsequent injections should be administered every 30 days to provide protective levels until the end of the RSV season. Pediatricians should anticipate the start of the RSV season and attend to reimbursement issues and obtain all necessary approvals well in advance of the time when the first injections will be given. Compliance is the key to providing protection for high-risk infants. Compliance has a positive association with decreasing RSV hospitalization rates; however, it is difficult for pediatricians to achieve optimal compliance on their own. A collaborative effort involving the hospital and NICU, pediatrician, parent, home care provider, and insurer is necessary to achieve optimal compliance. (+info)
Genetic association study for RSV bronchiolitis in infancy at the 5q31 cytokine cluster.
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Lower levels of plasmacytoid dendritic cells in peripheral blood are associated with a diagnosis of asthma 6 yr after severe respiratory syncytial virus bronchiolitis.
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Infant exposure to fine particulate matter and traffic and risk of hospitalization for RSV bronchiolitis in a region with lower ambient air pollution.
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Effect of salbutamol on oxygen saturation in bronchiolitis.
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Inhaled sympathomimetic agents are often used in bronchiolitis with little objective evidence of benefit. The arterial oxygen saturation (SaO2) reflects the adequacy of ventilation-perfusion balance. The aim of the current study was to determine the effect of inhaled salbutamol on SaO2. In a randomised, double blind study, 21 infants, admitted with bronchiolitis positive for respiratory syncytial virus, had continuous SaO2 measurements made before and after nebulised salbutamol or placebo. SaO2 was recorded over 30 minutes for a baseline, then during the 10 minutes of first nebulisation with either salbutamol or saline, then over 30 minutes after nebulisation, the 10 minutes of second nebulisation with the alternate regime, and another 30 minutes after this second nebulisation. Desaturation occurred after salbutamol and saline nebulisation. The fall in SaO2 with salbutamol was seen whether infants received it as the first or second nebulisation. The fall in SaO2 after saline was seen when given first, but not when given after salbutamol. The decrease in SaO2 was greater and more prolonged with salbutamol than with saline. Routine nebulised aerosol sympathomimetic treatment during acute bronchiolitis cannot be recommended. (+info)