Bronchiolitis primary prevention
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Overview
In general, prevention of bronchiolitis relies on measures to reduce the spread of the viruses that cause respiratory infections (that is, handwashing, and avoiding exposure to those symptomatic with respiratory infections). Premature infants, and others with certain major cardiac and respiratory disorders, can receive passive immunization with Palivizumab (a monoclonal antibody against RSV). This form of passive immunization therapy requires monthly injections every winter. Whether it could benefit infants with lung problems secondary to muscular dystrophies and other vulnerable groups is currently unknown.
Palivizumab prophylaxis
Recommendations are based on the 2009 AAP Modified Recomendations for Use of Palivizumab for Prevention of Respiratory Syncytial Virus Infections.[1]
- Prophylaxis is recommended in selected patients with high risk of severe bronchiolitis:
- Patients younger than 2 years of age who required medical therapy for chronic lung disease 6 months or less before the RSV season.
- Patients younger than 2 years of age with congenital heart disease.
- Infants who are receiving congestive heart failure treatment.
- Cyanotic heart disease.
- Moderate to severe pulmonary hypertention.
- Hystory of prematurity.
- Prophylaxis is recommended in premature infants with less than 32 weeks of gestation with or without chronic lung disease of prematurity.
- For patients born with 28 weeks of gestation or less, prophylaxis is recommended for their first RSV season disregarding the age of the patient. If the prophylaxis is started, it should continue through all the RSV season.
- For patients born with 29 to 32 weeks of gestation, prophylaxis is recommended for patients are born 6 months or less before the RSV season. If the prophylaxis is started, it should continue through all the RSV season.
- For patients bor with 32 to 35 weeks of gestation, prophylaxis ir recommended in patients who are born 3 months before the RSV season or during the RSV season and 1 of the following risk factors which may require hospitalization due to bronchiolitis:
- Infants with school-aged sbilings.
- Infants who attend to child care centers.
- Infants who have either congenital abnormalities of the airway or neuromuscular disease that compromises handling of respiratory secretions.
Dosage
- 15 mg/kg monthly doses to a maximum of 5 doses is the recommended regimen for patients born before 32 weeks of gestation, congenital heart disease with significant hemodynamic consequences or chronic lung disease.
- 15 mg/kg montly doses to a maximum of 3 doses is the recommended regimen for patients bor between 32 and 35 weeks of gestation who meet the criteria for prophylaxis.
Other measures
Recommendations for the prevention of bronchiolitis are based on the 2006 American Academy of Pediatrics Practice Guidelines for the Diagnosis and Management of Bronchiolitis.[2]
- Infants should not be exposed to tobacco as it has been shown that it increases the risk of RSV infection.
- Breasfeeding lowers the risk of lower tract infections in infants by the ingestion of immune factors such as immunoglobulins A and G.
- The use of alcohol-based rubs or antimicrobial soaps to mantain a correct hand hygiene in health care workers is important to prevent nosocomial dissemination of the disease when dealing with hospitalized patients.
References
- ↑ Committee on Infectious Diseases (2009). "From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections". Pediatrics. 124 (6): 1694–701. doi:10.1542/peds.2009-2345. PMID 19736258.
- ↑ American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis (2006). "Diagnosis and management of bronchiolitis". Pediatrics. 118 (4): 1774–93. doi:10.1542/peds.2006-2223. PMID 17015575.