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Introduction: The role of anemia is raised as a risk of low respiratory infection of the child, but there are no data on anemia as a severity factor in acute viral bronchiolitis (AVB) in infants., Methods: All infants less than 16 weeks old admitted to Montpellier University Hospital from 2015/10/01 to 2016/04/01 for AVB were included in a retrospective observational study. The primary objective was to determine whether the hemoglobin (Hb) concentration on admission was an independent factor of clinical severity, judged by the modified Wood's clinical asthma score (m-WCAS). The secondary objective was to assess the impact of Hb level on the characteristics of hospitalization, including the type and duration of respiratory support., Results: The m-WCAS was used at least once during hospitalization in 180 out of 220 patients (82%), making it possible to distinguish patients with mild AVB (maximum m-WCAS<2, n=81) from patients with severe AVB (maximum m-WCAS>2, n=99). A logistic regression model indicated that the Hb concentration, for every 1g/dL decrement, was an independent factor of AVB severity (OR 1.16 [1.03-1.29], P=0.026). A level under 10g/dL on admission was associated with a higher use of continuous positive airway pressure (P<0.001), as well as a longer duration of respiratory support (P=0.01)., Conclusion: This study suggested that anemia may influence the clinical expression of AVB in young infants., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Acute bronchiolitis due to respiratory syncytial virus (RSV) can present with extrapulmonary manifestations, notably severe hyponatremia. Hyponatremia is caused by excess secretion of antidiuretic hormone and can be exacerbated by intravenous infusion of hypotonic solutions. We report three cases of infants admitted for acute bronchiolitis and hyponatremia leading to acute seizures. We describe how hyponatremia was corrected and analyze the management aspects that might have worsened the magnitude of hyponatremia. We underline the basic principles of water and electrolyte management of bronchiolitis., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

The concept of sudden infant death syndrome (SIDS) is defined as the sudden, unexpected death of an infant less than a year old which remains unexplained after in-depth investigations comprising a complete autopsy, biological analyses, and a clinical examination of the circumstances surrounding the death. This definition underlines the importance of finding the cause of this disease in order to improve preventative measures to reduce the number of deaths due to sudden infant death syndrome. Among the causes of SIDS, pediatric infectious diseases may be neglected and must be systematically sought after. We report upon a SIDS death case of a four and a half month-old that occurred during his sleep. Following the absence of an evident cause of death a scientific autopsy was performed. The histological examination of pulmonary tissue revealed broncolitic lesions associated with numerous micro-abscesses. The post mortem microbiological analyses revealed evidence of an infection by the respiratory syncytial virus complicated by a bacterial infection due to Haemophilus influenzae. The case underlines the necessity of a multidisciplinary approach to researching SIDS, involving both clinicians and biologists, in order to determine the causes of these deaths.

Relationships between lower respiratory diseases with wheezing during infancy and asthma at school-age remain debatted. Indeed, although epidemiologic studies show that wheezy infants most often become asymptomatic before entry to school, they also demonstrate that severe bronchiolitis during infancy is a significant risk factor for persistence of wheezing episodes at school-age. One of the most important factors demonstrated to enhance the risk for persistence of asthma is an early allergic sensitization.

Background: Respiratory syncytial virus (RSV) infection in infancy can induce bronchial reactivity and virus-specific IgE production; these responses may favor the later development of asthma. This retrospective study examines the influences of early and severe forms of bronchiolitis on such an outcome., Population and Methods: The files of 43 infants who had spent 1 to 24 days (mean 7.8 days) in intensive care between 1986-1990 for severe bronchiolitis with apnea and/or hypercapnia and/or hypoxemia were studied. The parents of all these children agreed to answer a standard questionnaire covering perinatal events, gestational age, number and frequency of recurrent episodes of wheezing, personal and familial history of allergy and environmental conditions. 15 of the children were preterm and 12 of them were given respiratory support during the neonatal period; 5 of these patients developed broncho-pulmonary dysplasia. RSV was isolated in 20 of 39 patients., Results: 26 of the 41 surviving patients developed at least 3 episodes of wheezing over periods ranging from 5 to 54 months (mean 27.6 months): 15 of them were admitted at least once for asthma and 17 were given long-term bronchodilators and/or corticosteroids. Of the 8 patients with histories of allergy, 6 developed asthma, as did 7 of the 9 that had been in close contact with other children, and 9 of the 15 patients who had been exposed to tobacco., Conclusions: Not only is the development of asthma associated with risk factors (RSV infection, bronchopulmonary dysplasia, history of allergy, close contact with other children and exposure to tobacco) but the severity of the bronchiolitis per se is also correlated with this risk.

Bronchiolitis and wheezy bronchitis are frequently associated with viral infection of the respiratory tract in infants. They play an important role in the natural history of chronic obstructive airway disease, not only in children, but also in adults. The risk of early recurrent wheezing and subsequent asthma or chronic bronchitis (with anatomical sequelae such as obliterans bronchiolitis) is significant. The precise pathogenic mechanisms of virus-induced wheezing and its sequelae are not clear. Whether airway hyperreactivity is inherited and airway hyperreactivity is present prior to, or is the result of bronchiolitis is not clear. Nevertheless the evidence for viral trigger of wheezing and long-term pulmonary sequelae must be considered and prevention must be undertaken at the first episode.

More than one-third of infants with respiratory syncytial virus (RSV) bronchiolitis subsequently experience recurrent episodes of wheezing. In asthmatic children, viral infections frequently trigger asthmatic attacks. Indeed, viruses induce immunological and respiratory functional disorders. As compared with non-wheezing RSV infected infants, wheezing infants with bronchiolitis or asthma due to RSV have: a) increased T-lymphocyte responsiveness to RSV antigen; b) more persistent IgE bound to nasopharyngeal epithelial cells; c) higher titers of RSV-specific IgE and higher histamine concentrations in nasopharyngeal secretions. In children with an atopic constitution, virus infections may trigger allergic sensitization. Furthermore, some viruses enhance the immunologic and non-immunologic human basophil histamine release. Non-specific bronchial hyperreactivity, which is a fundamental feature of asthma, can also be observed to a variable degree in viral respiratory infections. Pulmonary function testing allows in vivo determination of bronchial sensitivity and bronchial reactivity (respectively threshold dose and dose-response curves). Four factors may be involved in bronchoconstriction: a pre-existing diminution of bronchial diameter (which is lacking in many studies); hyperplasia or hypertrophy of bronchial muscles (which is to be excluded in recent viral infections); a non-specific decrease in the threshold for stimulation of irritant receptors due to airway epithelial injury; a partial beta blockade. Further studies are needed to ascertain whether this bronchial hyperreactivity is congenital or acquired.

The distinction between congenital or acquired lung disease is often a difficult problem. This is illustrated by case reports on two boys aged 10 and 12. The clinical, pulmonary function and radiological details were very similar in the two cases, suggesting pulmonary hypoplasia. However, the histology seen in the second case, a type of bronchiolitis obliterans and follicular bronchiectasis were among several arguments in favour of acquired pulmonary disease of infective origin. The recorded literature as well as this observation show that certain respiratory viral infections may lead to bronchial and above all bronchiolar damage which can be severe and progressive.