2023-11-06 17:36:16
The cold season arrives and, with it, the respiratory syncytial virus, the main cause of bronchiolitis in children and of concern for parents. Bronchiolitis, in fact, mainly affects children under 10-12 months and is the most frequent cause of hospital admission in this age group. So much so that it is sometimes necessary to resort to intensive care. In Italy the epidemic season runs from November to March, as explained by Eugenio Baraldi, head of the neonatal intensive care unit of the hospital-university of Padua, for the Italian Society of Paediatrics (Sip), Fabio Midulla, president of the Italian Society for childhood respiratory diseases (Simri) and Susanna Esposito, head of the Sip infectious diseases technical table.
Although it is a common infection, information is not so widespread, while it would be useful for parents to have the necessary information to recognize the disease and know what to do. “Some simple measures can drastically reduce the spread of the virus, particularly in newborns and infants,” say pediatricians. Each year, respiratory syncytial virus is responsible for approximately 3.4 million hospitalizations worldwide with high mortality in developing countries. Symptoms appear 2-6 days after contact and the average duration of bronchiolitis is 5-7 days. But other viruses such as rhinovirus can also cause bronchiolitis.
The virus spreads from person to person very easily, especially through contact with nose secretions and saliva but also through microparticles dispersed in the air with sneezing or coughing by an infected person. Infants almost always contract the infection from contact with family members who have a cold. The virus can survive for many hours on surfaces (tables, door handles, cell phones, PC keyboards) and can therefore also be contracted simply by touching toys or other contaminated materials. The virus spreads rapidly where there are groups of young children such as in nurseries. The use of masks, hand washing and social distancing during the Covid pandemic have reduced cases of bronchiolitis by 70-80% but when these rules were slowed down, major epidemics occurred in numerous countries around the world.
Breastfeeding, mask, hand washing among the rules to avoid infections
But how can we protect children from respiratory syncytial virus? The first weapon is breast milk which contains antibodies against numerous infectious agents and reduces the risk of serious infections from respiratory syncytial virus and hospitalization for bronchiolitis. It is also important to wash your hands with soap and water or with an alcoholic gel before touching the child, this applies to parents as well as other people who come into contact with the child. The use of a mask in case of a cold is also useful for those who come close to the child. With cold symptoms you should refrain from kissing the baby and avoid touching his face.
The child, therefore, should be kept away from other children or adults with colds. Another fundamental rule is to wash and disinfect surfaces and objects (toys) that come into contact with the child. Cigarettes should also be kept indoors because smoking increases the risk of infection. If the child is premature or suffering from heart or lung disease, it is necessary to ask the pediatrician if there are indications for the use of monoclonal antibodies for the prevention of respiratory syncytial virus infections. All these measures, of course, “also help prevent respiratory infections caused by other viruses and bacteria”, add the pediatricians.
In cases of symptoms, however, there are some alarm bells to alert the pediatrician. In particular in the presence of respiratory difficulty: “fast breathing, insistent cough, movement of the nasal fins, appearance of a dimple in the jugulus and indentations at the sternal level, noisy breathing or breathing with an audible hiss when bringing the ear close to the child’s mouth. A sign of alarm is the appearance of a purplish color of the lips or face”.
And again: it is necessary to call the pediatrician even in the presence of loss of appetite, that is, milk intake less than 50% compared to usual, which is the first sign that indicates that the child is getting worse. In fact, in infants, a reduction in nutrition can quickly lead to dehydration (dry lips, little pee, crying without tears). Signs not to be overlooked are also long breathing pauses (apnea) which can be a complication of the infection even without a clear picture of bronchiolitis. Infants under 3 months are more at risk and can deteriorate rapidly. Poor responsiveness or drowsiness are warning signs.
As regards treatment, “there are no effective therapies for bronchiolitis. In the event of hospitalization, ‘supportive therapy’ is implemented to maintain adequate hydration and, if necessary, oxygen is administered. In severe cases, uses mechanical ventilation in intensive care. Nasal washing with saline solution and aspiration of nasal secretions are useful (particularly before meals). It is important to encourage the child to take liquids in small sips or to take small, frequent meals. Drugs such as bronchodilators , corticosteroids and antibiotics are not routinely indicated. Antibiotics in particular should not be used because the causative agent is a virus and bacterial superinfections are rare.
The children most at risk of severe bronchiolitis are infants born prematurely, with congenital heart defects, chronic lung diseases, neuromuscular diseases and immunosuppressive conditions. In these children it is possible to do prophylaxis against respiratory syncytial virus using a monoclonal antibody (Palivizumab) administered monthly from the beginning of the epidemic season. 30-40% of children who have had bronchiolitis, particularly if they have required hospitalisation, may present recurrent episodes of bronchospasm up to school age and in some cases there may be a progression towards asthma. These long-term consequences alter the quality of life of these children and their families. Once healed they should be followed over time and it is useful to have a measurement of respiratory function (spirometry) once they reach school age.
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