| Abstract | Akutni je bronhiolitis veoma čest razlog hospitalizacije dojenčadi i djece u prve dvije godine
života. Cilj ovog istraživanja bio je analizirati epidemiološka i klinička obilježja, tijek bolesti
te dijagnostičke i terapijske postupke kod djece hospitalizirane zbog akutnog bronhiolitisa u
Klinici za pedijatriju KBC-a Rijeka u razdoblju od 2014. do 2018. godine. Retrogradno, uvidom
u medicinsku dokumentaciju i povijesti bolesti, prikupljeni su podaci o ukupno 103 ispitanika
hospitalizirana s dijagnozom akutnog bronhiolitisa u navedenom razdoblju.
Kod navedenih ispitanika promatrani su dob, spol, mjesec oboljevanja, glavne tegobe, trajanje
tegoba prije hospitalizacije, duljina hospitalizacije, dijagnostičke metode, terapijske metode,
faktori rizika za razvoj bolesti, komplikacije i konačan ishod hospitalizacije.
U promatranom razdoblju hospitalizirano je više muške nego ženske djece s dijagnozom
akutnog bronhiolitisa, a prosječna dob u trenutku hospitalizacije bila je 5,2 mjeseci. Najveći
broj hospitalizacija bio je u veljači, što se objašnjava sezonskim javljanjem RSV-a koji je
dokazan kao uzročnik bronhiolitisa u većini slučajeva. Tegobe su u prosjeku trajale 4,1 dan
prije hospitalizacije, a glavne tegobe koje su se javljale kod ispitanika bile su kašalj, vrućica i
tahipneja. Hospitalizacija je tajala u prosjeku 6,2 dana.Većina je ispitanika prije oboljevanja
bila u kontaktu s osobom oboljelom od neke respiratorne infekcije. Promatrajući dijagnostičke
postupke, acidobazni je status u smislu respiratorne acidoze bio poremećen kod 17% ispitanika,
a patološke promjene u parenhimu pluća na RTG-u pluća su uočene kod nešto manje od
polovice ispitanika (45%).
Terapija bronhiolitisa bila je uglavnom suportivna u vidu inhalacija hipertonične otopine NaCla
(79,6%), parenteralne hidracije kod ispitanika koji se nisu mogli adekvatno hraniti peroralnim
putem (57%) te suplementacije kisika hipoksičnim ispitanicima (31%). Osim navedene suportivne terapije, nešto manje od polovice ispitanika u terapiji je imalo
kortikosteroide (41%), a njih 55% dobivalo je antibiotsku terapiju. Samo je 1 djevojčica
dobivala pasivnu imunoprofilaksu palivizumabom. Mehanički je ventilirano 4 ispitanika (4%),
putem CPAP-a je ventilirano 2 (2%) djece, neinvazivnog CPAP-a 1 dijete (1%). Na
izvantjelesnoj membranskoj oksigenaciji (ECMO) bilo je 1 dijete (1%).
Od ukupno 103 hospitalizirana ispitanika, njih 23 (22%) bili su prematurusi.
Bronhopulmonalnu displaziju imalo je 4 (4%) ispitanika, a ostale kongenitalne anomalije 17
(16.5%) ispitanika hospitaliziranih zbog bronhiolitisa.
Manji dio djece razvio je neku od komplikacija bolesti, od kojih je najčešća bila pneumonija
koja se razvila kod 8 (7,8%) djece. Do akutne je respiratorne insuficijencije došlo kod 6
ispitanika (5,8%). Bronhiolitis se zakomplicirao upalom srednjeg uha (otitis media) kod 4 djece
(3,9%), a pneumotoraksom kod 2 (1,9%) djece. Rotavirusni je enteritis tijekom hospitalizacije
dobio 1 ispitanik (1%). Sepsu je razvilo 1 dijete (1%), a srčannu insuficijenciju 1 (1%) dijete.
U 98% slučajeva (101 pacijent) hospitalizacija je završila otpustom kući, a kod 1 je ispitanice
bolest završila smrtnim ishodom (1%). |
| Abstract (english) | Acute bronchiolitis is a very common cause of hospitalization in infants and children under the
age of two. The aim of this study was to analyze the epidemiological and clinical characteristics,
course of the disease and diagnostic and treatment methods in children hospitalized with
bronchiolitis at the Pediatrics clinic of Clinical Hospital of Rijeka in the period from 2014 to
2018. Retrospective data was taken by accesing patient history of 103 patients who were
hospitalized with acute bronchiolitis in said period of time.
The parameters we analyzed were: age, sex, month of hospitalization, leading symptoms, the
duration of symptoms prior to hospitalization, length of hospitalization, diagnostic methods,
treatment methods, risk factors, complications and the final outcome of hospitalization.
There were more male than female children hospitalized with bronchiolitis in observed period,
and the average age of hospitalized patients was 5,2 months. Most of the hospitalizations
occured in February, due to seasonal outbreaks of RSV which was found to be the cause of
bronchiolitis in most cases.
The syptoms usually lasted 4,1 days on average prior to hospitalization and the leading
symptoms were: cough, fever and tachypnea. The average length of hospitalization was 6,2
days. Most of the patients came into contact with a person suffering a respiratory infection
before they got sick.
Respiratory acidosis was found in 17% of the hospitalized patients, and a little less than half
of the patients (45%) had pathological RTG findings in their pulmonary parenchyma.
Treatment was supportive for the most part, consisting of hypertonic NaCl solution (79,6%),
parenteral hydration in patients who couldn't take fluids orally (57%) and oxygen
supplementation in hypoxemic patients (31%). Except said supportive treatment, a little less than half of the patients (41%) had corticosteroides
in their treatment and 55% of the patients were given antibiotics. Only 1 patient was given
palivizumab as prophylaxis.
Four chidlren were intubated and mechanically ventilated (4%), 2 of them (2%) were ventilated
using CPAP and 1 with non invasive CPAP (1%). Extracorporal membrane oxygenation
(ECMO) had to be done in 1 patient (1%).
From 103 patients in total, 23 of them were born prematurely (22%). Bronchopulmonal
dysplasia was found in 4 patients (4%) and 17 patients had other congenital anomalies (16.5%).
A small percentage of children had complications during their hospitalization and pneumonia
was the most common one (8 children, 7,8%). Acute respiratory arrest was in 6 patients.
Bronchiolitis was complicated by otitis media in 4 children (3,9%) and pneumothorax in 2
children (1,9%). 1 patient (1%) has gotten rotavirus eneritis during hospitalization. 1 child
developed sepsis (1%), and 1 resulted in cardiac arrest (1%).
In 98% cases (101 patients) were realesed from the hospital and there was 1 lethal outcome
(1%). |
