A newborn child often has an incompletely formed immune system; the respiratory organs may be underdeveloped, which can lead to frequent infection of the bronchioles by viruses and the occurrence of bronchiolitis. In the article we will look in detail at the etiology, symptoms and methods of treating the disease.

Description of the disease

An inflammatory process that affects the lower respiratory tract, namely the small bronchi, and is accompanied by bronchial obstruction (blockage resulting in obstruction) is called bronchiolitis.

Bronchiolitis is fundamentally different from bronchitis. Firstly, with bronchitis, medium and large bronchi are affected, and secondly, this pathology develops much more slowly. Bronchiolitis spreads rapidly, affecting the terminal branches of the bronchial tree - bronchioles, the diameter of which does not exceed 1 mm. They participate in filling the blood with oxygen, distributing air flow into the alveolar ducts of the lungs, so their blockage (obstruction) leads to oxygen starvation and the development of shortness of breath.

Statistics show that bronchiolitis usually affects newborns. Most often, the disease strikes a child between the ages of 1.5 and 7 months, and in 95% of cases, bronchiolitis in infants appears after influenza or acute respiratory viral infection (ARVI). Pediatricians believe that the cause of this complication is the fragile immunity of the newborn, which is unable to contain the spread of viruses in the body, as a result of which they actively penetrate deep into the walls of the bronchi.

According to statistics, boys are more susceptible to such complications than girls.

The disease is very dangerous not only due to the rate at which symptoms increase, but also due to the high mortality rate of children due to untimely or unqualified medical care.

Reasons

In addition to influenza and viruses, there are some other factors that provoke the appearance of bronchiolitis in newborns:

• the child's predisposition to allergies;
• excess weight of the baby due to poor nutrition with a predominance of flour (high in fast carbohydrates) and dairy products in the diet, plus vitamin deficiency;
• metabolic disorders;
• feeding with artificial formula;
• weak immunity from the first days of life;
• birth of a child before the established obstetric dates;
• presence of cardiovascular and pulmonary diseases;
• congenital brain pathologies;
• proliferation of the thymus gland;
• poor living conditions: dirty premises, dampness, mustiness, mold damage;
• smoking parents;
• being close to relatives and friends who attend school and preschool institutions and could potentially be carriers of the infection.

Types and forms

There are several types of disease. It depends on the pathogen, namely:

• Infectious. Caused by viruses. This is exactly what very young children often get sick with. As a rule, it develops as a complication after an untreated acute respiratory viral infection.
• Medication. It appears while taking certain medications.
• Respiratory. Occurs when harmful gases, dust, or cigarette (tobacco) smoke enter the respiratory tract.
• Independent. In this case, it is difficult to identify the specific reasons why bronchiolitis develops in an infant. The pathology can be paired with other pulmonary and lymphatic diseases, or independent.
• Constructive. A severe viral disease caused by progressive obstruction of the bronchioles.

There are also acute and chronic bronchiolitis:

• in the chronic course of the disease, significant structural changes are observed in the lungs and bronchioles. In this situation, the thinnest branches of the bronchial tree gradually narrow, which can lead to their complete closure. This is a life-threatening condition;
• the acute form manifests itself against the background of a bacterial, viral or fungal infection. Characterized by rapid development. Symptoms are observed immediately after infection and increase progressively. The disease can last for several months and become chronic.

Symptoms

Acute bronchiolitis in an infant is manifested by the following symptoms:

• loss of appetite or lack thereof;
• pale skin with a bluish tint;
• increased sweating;
• the child is mopey, sleeps poorly;
• high temperature rises;
• stuffy nose, runny nose;
• the baby rarely pees, experiences dry mouth, cries without tears;
• there is a cough, sometimes with sputum;
• wheezing and shortness of breath can be clearly heard;
• rapid breathing and heart rate are observed;
• the baby rushes around the crib, spins in his arms, cannot find a place for himself due to the fact that he lacks oxygen.

With bronchiolitis, spontaneous respiratory arrest (apnea) may occur. It occurs more often in premature babies.

At the onset of the disease, acute bronchiolitis can easily be confused with ARVI due to the characteristic manifestations: a stuffy nose in the baby and runny nose, sore throat, increased temperature, and as a result, the child feels unwell. After a couple of days, coughing, wheezing (noisy, clearly difficult breathing) and shortness of breath appear. The wheezing is so strong that even a person without medical education can hear it without a phonendoscope. The baby's general condition is rapidly deteriorating, and sweating increases.

During the course of the disease, mucus accumulates in the lumen of the bronchioles, closing the passages in the bronchi

Mucus plugs lead to shortness of breath and poor ventilation of the lungs. So, if during obstructive bronchitis there is spasm of the bronchi, then during acute bronchiolitis in a child, poor airway patency is caused by swelling of the walls of the bronchioles and accumulation of mucus in the passages.

Lung aeration and gas exchange are maintained by increased respiratory rate, but not for long. When respiratory failure intensifies, there is a lack of oxygen and an excess of carbon dioxide, and areas of the lungs begin to swell.

With rapid diagnosis and proper treatment of acute bronchiolitis, the pathology disappears within 3 to 4 days, while bronchial obstruction is observed for another couple of weeks.

During chronic bronchiolitis in newborns, the main symptom is shortness of breath with intense growth and a dry cough.

It should be summarized and noted that the main difference between bronchiolitis is acute respiratory failure, which is extremely dangerous due to the risk of suffocation, and in the worst case, death can occur. Therefore, a child suspected of having such a pathology should be quickly diagnosed and, based on its results, promptly provided with professional medical assistance.

Diagnosis and treatment

To make a correct diagnosis, a comprehensive examination is necessary, consisting of the following stages:

• listening with a stethoscope;
• general urine and blood tests;
• nasopharyngeal swab;
• chest x-ray;
• in severe cases, a tomogram of the lungs.

Children under 1 year of age must be hospitalized to avoid complications.

The appointment depends on the severity of the baby’s condition, but the basis of treatment must include:

• blood oxygen saturation;
• taking antibiotics, antiviral and anti-inflammatory drugs, as well as drugs that relieve pulmonary edema;
• inhalation with a nebulizer, as this is the fastest way to “deliver” the medicine to the site of inflammation;
• monitoring the amount of fluid in the body and taking diuretics. Monitoring fluid intake is mandatory in this situation, because bronchiolitis in infants provokes serious fluid retention, which leads to severe swelling of the bronchi.

It is important to understand that during a child’s illness it is strictly prohibited:

• treat the baby at home without qualified supervision by a pediatrician or simply wait for the condition to improve;
• independently prescribe medications to your child;
• give herbal decoctions, because this may further provoke shortness of breath;
• give the child compresses, mustard plasters and apply warming ointments.

You should definitely remember that you should not vaccinate for 5–6 months after the illness, since the child’s immunity is still weakened.

Important! Bronchiolitis in an infant is a very serious disease that can lead to the death of the baby in just a week.

Complications

The consequence of bronchiolitis is cardiac and respiratory failure. This is especially true for premature babies and children with weakened immune systems.

Against the background of illness and general weakening of the body, a secondary bacterial infection may occur, which will lead to pneumonia. Bronchial asthma is also a common complication.

It should be noted that even after complete relief from bronchiolitis, the sensitivity of the bronchi to infections and the tendency to relapse remain

Therefore, after recovery, observation by a pediatrician, allergist and pulmonologist is simply necessary for at least six months.

Prevention

It is known that it is easier to prevent a disease from entering than to cure it. Therefore, good care of the baby, breastfeeding, timely and competent complementary feeding, walks in the fresh air, gymnastics and developmental exercises will help parents strengthen the child’s immunity, and therefore protect him from many diseases, including bronchiolitis.

Pediatricians give general advice on how to prevent bronchiolitis in infants:

• seek medical help in a timely manner so as not to develop severe respiratory diseases;
• provide the child with fortified and balanced nutrition;
• If possible, avoid communication with other ARVI patients as much as possible;
• avoid contact with allergens;
• keep the house clean;
• Eliminate tobacco smoke near the child.

Bronchiolitis is a complex disease for young children that requires timely and competent treatment. Under no circumstances should the disease be ignored. Contacting doctors at the initial stage and proper therapy will reduce the risk of possible complications and transformation of the disease into a chronic stage, and will also help to get rid of the pathology forever and without consequences.

Inflammatory obstruction of small-caliber bronchi (bronchioles), usually developing in young children against the background of a viral infection. The initial symptoms resemble ARVI, which are soon joined by the phenomena of bronchial obstruction (expiratory shortness of breath, spasmodic cough, tachypnea, crepitating or wheezing, cyanosis of the nasolabial triangle, etc.). Diagnosis of acute bronchiolitis is based on data from an X-ray examination of the chest organs and blood gas composition. The basis of treatment for acute bronchiolitis is adequate oxygenation, oral or parenteral hydration, and the use of interferon.

General information

Acute bronchiolitis (capillary bronchitis) is a diffuse inflammatory lesion of the terminal sections of the respiratory tract, occurring with symptoms of broncho-obstruction and respiratory failure. In most cases, the disease develops in children in the first two to three years of life against the background of an acute respiratory viral infection; the maximum peak incidence occurs at the age of 5-7 months.

Every year, 3-4% of young children suffer from acute bronchiolitis, of which 0.5-2% suffer from severe bronchiolitis; death is recorded in 1% of cases. A severe course of acute bronchiolitis is observed in children with aggravated background: premature babies, suffering from congenital lung anomalies and heart defects. The wide prevalence of the pathology and the high frequency of hospitalizations make the problem of acute bronchiolitis extremely relevant for practical pediatrics and pulmonology.

Reasons

Up to 70-80% of all cases of acute bronchiolitis in children of the first year of life are etiologically associated with respiratory syncytial virus (RSV). Since MS infection occurs with annual seasonal epidemic outbreaks (in winter and early spring), more than half of young children experience MS infection, and the instability of post-infectious immunity causes frequent reinfection.

Other viral agents (adenoviruses, rhinoviruses, influenza and parainfluenza viruses, enteroviruses, coronaviruses, etc.) account for about 15% of cases of acute bronchiolitis. In recent years, there has been an increase in the role of human metapneumovirus in the development of broncho-obstructive syndrome in children. Early breastfeeding and the child receiving colostrum with a high IgA content contribute to a reduction in morbidity among infants.

In children of the second year of life, the importance of viruses that cause acute bronchiolitis changes: the RS virus gives way to enteroviruses and rhinoviruses. In children of preschool and school age, mycoplasmas and rhinoviruses predominate among the causative agents of bronchiolitis, and RS viruses usually cause viral pneumonia and bronchitis. In addition to traditional etiological agents, acute bronchiolitis can also be caused by cytomegalovirus, chlamydia, measles, chickenpox, mumps, and herpes simplex viruses. Among older children and adults, acute bronchiolitis affects people with immunodeficiency, those who have undergone organ and stem cell transplantation, and elderly patients.

During the first day after the penetration of respiratory viruses, necrosis of the epithelium of bronchioles and alveocytes develops, mucus formation increases, active release of inflammatory mediators occurs, lymphocytic infiltration and swelling of the submucosal layer occurs. Obstruction of the airways in acute bronchiolitis is not caused by bronchospasm (as, for example, in obstructive bronchitis), but by swelling of the walls of the bronchioles, accumulation of mucus and cellular detritus in their lumen. Together with the small diameter of the bronchi in children, these changes lead to an increase in resistance to air movement, especially during exhalation, like a valve mechanism.

Pathognomonic signs of acute bronchiolitis are tachypnea (RR up to 60-80 beats per minute), tachycardia (heart rate 160-180 beats per minute), participation in breathing of auxiliary muscles, flaring of the wings of the nose, retraction of the intercostal spaces and hypochondrium, perioral cyanosis or cyanosis all skin. Premature babies or babies with birth trauma may experience episodes of sleep apnea. Due to the increased airiness of the lungs and the flattening of the dome of the diaphragm, the liver and spleen protrude 2-4 cm from under the costal arches. Intoxication, refusal to eat and vomiting lead to dehydration and disruption of water-electrolyte homeostasis.

Extrapulmonary complications may include otitis media, myocarditis, and extrasystole. The severity of the patient's condition with bronchiolitis is determined by the degree of acute respiratory failure. In weakened patients, respiratory distress syndrome may develop and death may occur.

Diagnostics

When diagnosing acute bronchiolitis, a pediatrician or pulmonologist takes into account the relationship of bronchial obstruction with a viral infection, characteristic clinical and physical data. A typical auscultatory picture of a “wet lung” includes multiple rales (fine-bubbly, crepitating), prolonged exhalation, and distant wheezing. Due to increased inflation of the lungs, a percussion sound with a boxy tint is determined.

To assess oxygenation parameters, pulse oximetry, a study of the gas composition of the blood, is performed. The X-ray picture in the lungs is characterized by signs of hyperpneumatization and peribronchial infiltration, increased pulmonary pattern, the presence of atelectasis, and flattening of the dome of the diaphragm. Of the laboratory tests, the most valuable is the rapid analysis for determining RSV in a nasopharyngeal smear using ELISA, RIF or PCR. Bronchoscopy data (diffuse catarrhal bronchitis, a significant amount of mucus) in acute bronchiolitis are not indicative. Spirography cannot be performed on young children.

Acute bronchiolitis must be differentiated from obstructive bronchitis, bronchial asthma, CHF, pneumonia (aspiration, viral, bacterial, mycoplasma), whooping cough, foreign bodies in the respiratory tract, cystic fibrosis of the lungs, gastroesophageal reflux.

Treatment of acute bronchiolitis

To date, no etiotropic treatment for acute bronchiolitis has been developed. Inhaled use of ribavirin is considered inappropriate due to lack of effectiveness and frequent hypersensitivity reactions. The use of bronchodilators, physiotherapy, and inhaled steroids is also not recommended. The basis of basic therapy for acute bronchiolitis is adequate oxygenation and hydration of the patient. Young children are subject to hospitalization and isolation.

Humidified oxygen is supplied using a mask or an oxygen tent. In case of repeated apnea, persistence of hypercapnia, or general severe condition, transfer to mechanical ventilation is indicated. Replenishment of fluid losses is ensured through frequent fractional drinking or infusion therapy (under the control of diuresis, electrolyte composition and blood CBS). To remove mucus from the respiratory tract, aspiration with an electric suction, vibration massage of the chest, postural drainage, saline inhalation with a hypertonic solution or inhalation of adrenaline through a nebulizer are carried out.

Interferon preparations are used to eliminate viral infections. Glucocorticoids can be used in a short course to relieve bronchial obstruction. The clinical effectiveness of including the drug fenspiride, which has a pronounced anti-inflammatory effect, in the treatment regimen for acute bronchiolitis has been proven. Antibacterial agents should be prescribed only if bacterial complications are suspected.

Prognosis and prevention

In mild cases, acute bronchiolitis can resolve on its own, without special pathogenetic therapy. After 3-5 days, improvement occurs, although bronchial obstruction and cough may persist for up to 2-3 weeks or longer. In the next five years after acute bronchiolitis, children continue to have bronchial hyperreactivity and a high risk of developing bronchial asthma. Lethal outcomes are recorded mainly in persons with aggravated concomitant background.

A specific immunoglobulin, palivizumab, with anti-RSV activity has been developed as a means of passive immunoprophylaxis. The drug is intended for use during periods of increased MS infection in categories of children and adults at risk of developing severe forms of acute bronchiolitis.

When a child is sick, parents always worry. Particular concern arises if the doctor makes a diagnosis that is not the most popular, for example, bronchiolitis. What is this disease and how does it manifest itself?

Causes of the disease

Experts consider respiratory syncytial virus to be the leading causative agent of acute bronchiolitis.

Bronchiolitis is an inflammation of the smallest branches of the bronchi - bronchioles. This disease most often affects children under 3 years of age. More than 60% of young patients are boys.

Depending on the nature of the disease, it can be:

• acute – lasts no more than 5 weeks,
• chronic – lasts for 3 months or longer.

The culprit of acute bronchiolitis in most cases is respiratory syncytial virus (RSV). Similarly, this infection likes to “walk around” in the cold season - from October to April. However, unlike the common cold, RSV hits the lower respiratory tract rather than the upper respiratory tract.

Infection usually occurs by airborne droplets. This means that the virus is transferred from sick people to healthy people through sneezing and communication. Less commonly, the infection is transmitted through dirty hands, shared towels, and toys.

In a small number of children, other microorganisms become causative agents of the disease:

• influenza viruses,
• adenoviruses,
• parainfluenza,
• mycoplasma.

Chronic bronchiolitis can develop as a consequence of acute bronchiolitis, but usually it is an independent disease caused by prolonged inhalation of irritating gases. Very often this disease is found in children living in smoking families.

The rapid development of inflammation is promoted by:

• low baby weight,
• weakened immunity,
• age under 3 months,
• diseases of the cardiovascular system,
• congenital defects of the respiratory tract,
• visiting a nursery/kindergarten,
• smoking by parents in the presence of the baby.

Among newborns, children who are bottle-fed are more likely to get sick. Their body is more susceptible to infections due to the fact that it does not receive antibodies from mother's milk.

Clinical picture

The initial symptoms of the disease are similar to a cold. Children develop a dry cough and fever. After a few days the condition worsens. The temperature continues to rise (up to 39 degrees), appetite decreases. But the main thing is that respiratory failure develops.

Inhaling air, the child wheezes, the wings of his nose swell and the nasolabial triangle turns blue. Shortness of breath and rapid heartbeat are added. Vomiting may occur after severe coughing attacks. It is most difficult for infants, because due to the anatomical features of the chest, they are not able to cough properly.

In severe cases:

• "bloating of the chest,
• sudden holding of breath (apnea),
• swelling.

Development can be a dangerous complication of the disease.

Diagnostics

To make a diagnosis, a doctor only needs to examine the child and listen to the parents’ complaints. To distinguish bronchiolitis from other pathologies (for example, pneumonia), the doctor may order a chest x-ray.

The causative agent of the disease is identified by a general blood test. In viral infections, results show increased numbers of lymphocytes and monocytes. The neutrophil content is below normal. With bacterial infections, the number of leukocytes and neutrophils increases.

To detect respiratory syncytial virus, rapid diagnostic methods are used. Swabs from the nasal cavity are taken as material for analysis. They are applied to special test systems that react to the presence of RSV by changing color.

In case of severe shortness of breath, pulse oximetry is performed - a test that helps determine the degree of oxygen saturation in the blood. Values ​​below 95% indicate respiratory failure.

Therapy methods

The child is prescribed ultrasonic inhalations with saline solution, and in severe cases - with corticosteroids.

In case of bronchiolitis, the child must be hospitalized. Treatment tactics are aimed at maintaining normal breathing and preventing complications.

If RSV is detected, a specific antiviral drug, Ribavirin, is prescribed. It blocks the reproduction of the pathogen and prevents the further development of the disease.

If a bacterial infection has been established, the child is prescribed antibiotics. Preference is given to drugs from the group of penicillins and cephalosporins (Ampicillin, Cefotaxime). Medicines are administered intramuscularly for 7–10 days.

If necessary, the doctor recommends sputum thinners (mucolytics - Ambroxol, Bromhexine). To facilitate the passage of mucus, it is also prescribed. In severe cases, inhalations with corticosteroids (Dexamethasone) are added, which have an anti-inflammatory effect.

In addition to medications, a mixture of oxygen and helium is given through a mask. This allows you to reduce the manifestations of respiratory failure and improve the patient’s well-being.

Since babies lose a lot of fluid due to rapid breathing, they are advised to drink plenty of fluids. Liquids are given 2 times more than the daily requirement. If the child refuses to drink, he is given saline solution through an IV.

For 5 years after bronchiolitis in children, the bronchi remain highly susceptible to the action of negative factors. Such babies are more susceptible to bronchitis and bronchial asthma, and therefore require long-term monitoring by a specialist.

Bronchiolitis is inflammation of the bronchioles (parts of the lower respiratory tract). To understand the disease, let’s remember how breathing occurs. With inhalation, air passes through the nasal cavity, pharynx, larynx, trachea and enters the bronchi, which look like a branching tree. The branches gradually become thinner and end in small passages - bronchioles. They approach the alveoli - the bubbles in which gas exchange occurs.

When the lower respiratory tract becomes inflamed, the bronchioles become blocked (obstruction) and become swollen (emphysema). A person has to inhale twice as much air as usual to maintain sufficient oxygen levels in the blood. The respiratory muscles become overstrained and gradually become tired. Breathing weakens and respiratory failure occurs. In young children, acute bronchiolitis leads to temporary cessation of breathing (apnea) and ultimately death.

The development of the respiratory system begins on the twenty-fourth day of intrauterine development and ends by the age of eight. Bronchiolitis in children occurs under the influence of certain causes, but the main factor is the underdevelopment of the respiratory system.

Bronchiolitis is an inflammation of the bronchioles of the respiratory system. Affects young children: from birth to three years. Dangerous and fatal for premature babies, with developmental defects or in the absence of medical care. Treatment includes hospitalization, combating the cause of the disease and respiratory failure.

Acute bronchiolitis is a disease in which the baby needs urgent help. There is a possibility of death. Pay attention to warning signs!

Smoking by close relatives of a child is a cause of illness in children

Causes of bronchiolitis in children.

• Infectious diseases of the respiratory system (respiratory syncytial, rhino-, adeno-, parainfluenza virus, influenza, mumps, mycoplasma, pneumococci). At the same time, the MS virus is the source of the disease in 4 - 7 children out of 10. Infection most often occurs in winter from a patient in a kindergarten, hospital or within the family.
• Smoking by close relatives of the child.
• Weakened immunity due to various reasons.
• Lack of weight.
• Lack of breastfeeding. The baby does not receive antibodies to fight infections from mother's milk.
• disease of the cardiovascular or respiratory system.

Symptoms

In children, bronchiolitis manifests itself:

• symptoms of a respiratory infection, which served as a source of inflammation of the bronchioles (coughing, sneezing, runny nose, fever, etc.);
• fever, chills;
• shortness of breath on inhalation and exhalation (increased and increased breathing);
• increased heart rate;
• problems with breast or pacifier sucking, loss of appetite;
• blueness of the skin (first the nasolabial triangle changes color);
• swelling of the wings of the nose;
• wheezing when breathing;
• lethargy, irritability.

Bronchiolitis is dangerous due to its transition to asthma, chronic bronchopulmonary pathology, and death. Timely treatment will help avoid unpleasant consequences.

If your baby develops chronic bronchitis, then it is important to notice it in time. for such frequent inflammation of the bronchi is fraught with serious consequences.

Species

There are two types of bronchiolitis.

1. Spicy. Lasts a month. The symptoms are pronounced, and there are breathing problems. The condition worsens sharply;
2. Chronic. The child is sick from one to three months or more. The symptoms are mild and unnoticeable.

In a newborn

Children from birth to 28 days receive passive immunity from their mother, so they rarely get sick. However, when infected, bronchiolitis is the most severe infection. Newborns are immediately hospitalized and given intensive care. The disease is especially dangerous for babies born prematurely or with congenital developmental defects (heart defects).

In a baby

Children from 28 days to one year are most susceptible to inflammation of the bronchioles. The peak incidence occurs between three and nine months of age. Bronchiolitis affects 11 - 12 babies out of 100. Children under six months are hospitalized in the same way as newborns.

In children older than one year

Bronchiolitis affects 6% of children aged 1 - 2 years, 3.5% - over 2 years. In three-year-old children, the disease, as a rule, does not occur. This is due to the development of the respiratory system and strengthening one’s own immunity. The decision on treatment tactics is made by the doctor, taking into account the patient’s condition.

Diagnostics

To make a diagnosis and prescribe treatment, the doctor asks parents about the symptoms they have noticed. Next, he orders an examination.

• General blood test. The presence of bronchiolitis in children is indicated by changes in the level of lymphocytes, monocytes and neutrophils.
• X-ray. A chest X-ray is taken.
• Wash and swab from the nose and throat (if the RS virus is suspected).
• Pulse oximetry (performed for signs of respiratory failure). A special device is used, the sensor of which is placed on the finger. Normally, blood oxygen saturation is 95 - 98%.

Treatment

Treatment is carried out according to the following scheme.

• Hospitalization of the baby. He is isolated in the hospital so as not to infect others. Doctors monitor the child’s condition and, if necessary, carry out resuscitation measures.
• Fighting the cause of the disease. For a viral infection, antiviral medications are prescribed (Ribovirin), and for a bacterial infection, antibiotics are prescribed (Ampicillin, Cefotaxime).
• Eliminate symptoms. Mucolytics help with coughs by thinning and facilitating the removal of sputum (Ambroxol, Bromhexine). To improve breathing, it is recommended to attend ultrasonic inhalation sessions with saline solution or corticosteroids (“Dexamethasone”), which are prescribed in severe cases. Such hormonal drugs quickly relieve inflammation, but at the same time they affect the entire body (side effects occur).
• Oxygen saturation (breathing through a special mask).
• Restoration of fluid loss (give twice as much water as usual). If you refuse to drink, saline solution is administered intravenously.

After recovery, the child’s body is especially susceptible to bronchial diseases (bronchitis, bronchial asthma). Carefully monitor the condition of your baby’s respiratory system for the next five years.

Bronchiolitis suffered by an infant under one year of age or under the age of 2 years affects the quality of his health in adulthood.

Disease of bronchioles - the smallest bronchi of the tracheobronchial tree, causes oxygen deficiency in tissues, disrupts the development of all organ systems.

Unformed immunity and incomplete development of the infant's respiratory organs are the cause of frequent viral damage to bronchioles and small-diameter bronchi with the occurrence of bronchiolitis.

A severe course of acute bronchiolitis is observed in children under 2 years of age; the maximum incidence of disease occurs in infants 1–9 months of age (80% of cases). With age, the number of diseases decreases, and the older children become, the easier their immunity is to resist infection.

Reasons

Bronchiolitis is caused primarily by the RSV virus - respiratory syncytial virus (50% of cases), parainfluenza virus (about 30%), adenovirus (up to 10%), influenza viruses (8%), rhinovirus (10%).

Bronchiolitis is severe in newborns suffering from pathologies of the heart and lungs; premature babies are often infected with this disease. The RSV virus is highly contagious and primarily affects infants between 2 and 24 months of age.

A high concentration of this virus in the blood plasma causes the formation of antibodies to it, the formation of bronchial sensitivity, which increases the likelihood of bronchial asthma.

Adults who have suffered a complicated form of bronchiolitis are at risk of developing COPD, a chronic lung disease.

Infection does not always provoke bronchiolitis; more often it causes infection in children. The occurrence of bronchiolitis is provoked by external factors and the characteristics of the baby’s immunity.

Who is at risk for bronchiolitis

Male infants suffering from pathologies of the respiratory system and children born prematurely are at greatest risk.

The likelihood of infection with viruses increases if there is smoking in the environment. Even passive smoking causes a spasm of the smallest bronchioles in an infant and provokes circulatory disorders, which contributes to the spread of the virus along the bronchial tree.

There is a high probability of bronchiolitis in infants if older children attend educational institutions, especially in winter, during seasonal epidemics of ARVI.

Mechanism of inflammation

Blockage of bronchioles with viscous secretion is caused by swelling of the mucous membrane. In children, bronchospasm does not make an insignificant contribution to the development of bronchiolitis.

And the younger the children, the smaller the diameter of their bronchioles, the greater the contribution to the progression of bronchiolitis from mucosal edema. This phenomenon is the reason that antispasmodics do not have the expected effect in the treatment of children with bronchiolitis.

Another feature of bronchiolitis in infants is rapid dehydration, changes in the properties of the secretion, desquamation of the ciliated epithelium with its subsequent replacement by germ cells not equipped with cilia.

The absence of ciliated cells, the directed movement of which, like a brush, cleanses the airways, leads to the accumulation of secretions.

It becomes viscous, forms plugs that clog the lumen, which creates the opportunity for the accumulation of viscous thick sputum in the bronchioles and their colonization by bacteria.

We suggest you get acquainted with the disease of bronchiolitis in adults in our next article.

How to recognize bronchiolitis

Manifestations of the disease begin with minor cold symptoms and a runny nose. Usually the temperature at this time is normal.

From infection to the onset of symptoms of bronchiolitis, children lose their appetite, become lethargic, reluctant and drink very little.

4 days after the first signs of a viral infection appear:

• shortness of breath with a frequency of 90 breaths in 1 minute, difficulty in exhaling;
• bluish skin in the area of ​​the nasolabial triangle;
• dry cough, quickly changing to wet;
• a sharp rise in temperature to 39 0 C, lasting 2 days, after which it does not rise above 38 0 C;
• the occurrence of respiratory failure caused by hyperventilation of the lungs due to changes in the concentrations of carbon dioxide and oxygen;
• enlargement of the chest with the appearance of a box-shaped sound when tapping (percussion);
• Listening (auscultation) allows you to hear whistling exhalation and fine wheezing when exhaling and when inhaling.

How to prevent bronchiolitis in infants at home

Bronchiolitis in newborns and premature babies

Even a completely healthy child can get bronchiolitis, but the infection is most severe and poses the greatest danger to newborns and premature babies. The peculiarity of this group is that their immunity has not yet developed.

Premature babies almost always require oxygen therapy if they have bronchiolitis. More often than full-term babies, they require intensive care and artificial ventilation.

In premature infants, bronchiolitis begins not with signs of a cold, but with respiratory arrest (apnea). And the younger the baby, the earlier he was born, the more dangerous the apnea.

The risk of bronchiolitis increases in premature infants with heart defects and pulmonary pathologies. Due to frequent breathing and high body temperature, babies quickly become dehydrated.

To stabilize a satisfactory condition during bronchiolitis, children are given more fluids, fed in fractional portions, and monitored for the cleanliness of their nasal passages. To moisturize the nasal mucosa, inhalations are done through a nebulizer. You can read more about inhalation and the benefits of these procedures in the article.

Adenovirus infection in bronchiolitis

With adenovirus infection, persistent long-term fever is observed. This type of infection is more severe than other forms of bronchiolitis.

If diagnosed late, adenovirus infection can lead to the formation of acute bronchiolitis obliterans, in which the walls of the bronchioles are destroyed and filled with connective tissue.

The result of these changes is sclerosis of the affected area of ​​the lung or the appearance of a non-ventilated area - a “transparent lung”.

Bronchiolitis obliterans can be suspected if symptoms return after temporary improvement. The x-ray shows a “cotton lung” - scattered infiltrates (compactions).

The temperature can last for 3 weeks; after the condition improves, crepitus (sounds resembling crackling) persists for a long time, usually one-sided, over the lesion.

Treatment of this type of bronchiolitis requires the use of antibiotics, hormonal agents, and artificial ventilation of the respiratory organs.

Treatment of bronchiolitis

Children under 1 year of age must be treated in a hospital and hospitalized to avoid complications. Depending on the state of health and the severity of the condition, children are prescribed oxygen therapy; in rare cases, antibiotics are used according to indications.

Treatment with salbutamol by inhalation through a nebulizer or through a spacer - a face mask with a spray of a drug solution - is indicated.

The inhalation method of drug delivery is preferable to use due to the speed and selectivity of the drug’s action on the site of inflammation.

Antitussives and antihistamines are not prescribed to children. Mucolytics - only if necessary, in the acute phase of bronchiolitis.

Severe neonatal bronchiolitis is treated with the antiviral drug riboverine. In the treatment of bronchiolitis caused by the RSV virus, the drug palivizumab (USA) is used.

Complications

• Obliterating acute bronchiolitis;
• apnea;
• acute form of cor pulmonale - pulse with a frequency of 200 beats per 1 minute;
• visually noticeable enlargement of the liver.

Very rare complications of bronchiolitis include respiratory arrest and sudden death.

Forecast

With uncomplicated bronchiolitis, symptoms disappear 2-3 weeks after the first signs of the disease appear. However, increased sensitivity of the bronchi persists for a long time after recovery, and a lingering cough persists.

Difficult prognosis for bilateral bronchiolitis obliterans caused by adenoviral infection.