Respiratory Support of Neonate Affected by Bronchiolitis in Neonatal Intensive Care Unit

Abstract

Acute respiratory infections are very common medical emergency in early infancy, often requiring hospitalization. The most frequent respiratory infection at this stage of life is bronchiolitis, with a benign course in the majority of cases. However, especially during neonatal period, infants are at higher risk for developing complications, and ventilatory support of various degrees is needed. The two most widespread methods to provide noninvasive respiratory support are heated humidified high-flow nasal cannula and nasal continuous positive airway pressure. They are both used in neonatal intensive care unit to treat respiratory distress syndrome of the premature infants, and the main concept of recruiting and distending alveoli is valid also for respiratory failure occurring during bronchiolitis. However, there is still ongoing debate about the superiority of one method, and their real efficacy still need to be confirmed. Once respiratory failure does not respond to noninvasive ventilation, more intensive care must be provided in the form of conventional mechanical ventilation or high-frequency ventilation. There is currently no evidence of the optimal ventilation strategy to use, and a deeper comprehension of the pulmonary mechanics during bronchiolitis would be desirable to tailor ventilation according to the degree of severity. Further research is then urgently needed to better clarify these aspects.

Key Points

• Guidelines on the management of bronchiolitis in neonatal population are lacking.

• Noninvasive respiratory support is mostly delivered with HHHFNC and nCPAP.

• A deeper comprehension of the pulmonary mechanics during bronchiolitis is crucial to tailor invasive ventilation.

Keywords

bronchiolitis - newborn infants - intensive care unit - respiratory therapy

Publication History

Article published online:
08 September 2020

• References

• 1 Shi T, McAllister DA, O'Brien KL. , et al; RSV Global Epidemiology Network. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet 2017; 390 (10098): 946-958
• 2 Fujiogi M, Goto T, Yasunaga H. , et al. Trends in bronchiolitis hospitalizations in the United States: 2000-2016. Pediatrics 2019; 144 (06) e20192614
• 3 Carbonell-Estrany X, Figueras-Aloy J, Law BJ. Infección Respiratoria Infantil por Virus Respiratorio Sincitial Study Group; Pediatric Investigators Collaborative Network on Infections in Canada Study Group. Identifying risk factors for severe respiratory syncytial virus among infants born after 33 through 35 completed weeks of gestation: different methodologies yield consistent findings. Pediatr Infect Dis J 2004; 23 (11, Suppl): S193-S201
• 4 Bresesti I, Zivanovic S, Ives KN, Lista G, Roehr CC. National surveys of UK and Italian neonatal units highlighted significant differences in the use of non-invasive respiratory support. Acta Paediatr 2019; 108 (05) 865-869
• 5 Hodgson KA, Manley BJ, Davis PG. Is nasal high flow inferior to continuous positive airway pressure for neonates?. Clin Perinatol 2019; 46 (03) 537-551
• 6 Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med 2009; 103 (10) 1400-1405
• 7 Vahlkvist S, Jürgensen L, la Cour A, Markoew S, Petersen TH, Kofoed PE. High flow nasal cannula and continuous positive airway pressure therapy in treatment of viral bronchiolitis: a randomized clinical trial. Eur J Pediatr 2020; 179 (03) 513-518
• 8 Lin J, Zhang Y, Xiong L, Liu S, Gong C, Dai J. High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis. Arch Dis Child 2019; 104 (06) 564-576
• 9 Evans J, Marlais M, Abrahamson E. Clinical predictors of nasal continuous positive airway pressure requirement in acute bronchiolitis. Pediatr Pulmonol 2012; 47 (04) 381-385
• 10 Jat KR, Mathew JL. Continuous positive airway pressure (CPAP) for acute bronchiolitis in children. Cochrane Database Syst Rev 2019; 1: CD010473
• 11 Essouri S, Durand P, Chevret L. , et al. Optimal level of nasal continuous positive airway pressure in severe viral bronchiolitis. Intensive Care Med 2011; 37 (12) 2002-2007
• 12 Liet JM, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database Syst Rev 2015; (09) CD006915
• 13 Chowdhury MM, McKenzie SA, Pearson CC. , et al. Heliox therapy in bronchiolitis: phase III multicenter double-blind randomized controlled trial. Pediatrics 2013; 131 (04) 661-669
• 14 Colnaghi M, Pierro M, Migliori C. , et al. Nasal continuous positive airway pressure with heliox in preterm infants with respiratory distress syndrome. Pediatrics 2012; 129 (02) e333-e338
• 15 Ralston SL, Lieberthal AS, Meissner HC. , et al; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014; 134 (05) e1474-e1502
• 16 Krieger I. Mechanics of respiration in bronchiolitis. Pediatrics 1964; 33: 45-54
• 17 Cruces P, González-Dambrauskas S, Quilodrán J. , et al. Respiratory mechanics in infants with severe bronchiolitis on controlled mechanical ventilation. BMC Pulm Med 2017; 17 (01) 129
• 18 Gupta M, Guertin S, Martin S, Omar S. Inhaled prostacyclin and high-frequency oscillatory ventilation in a premature infant with respiratory syncytial virus-associated respiratory failure. Pediatrics 2012; 130 (02) e442-e445
• 19 Berner ME, Hanquinet S, Rimensberger PC. High frequency oscillatory ventilation for respiratory failure due to RSV bronchiolitis. Intensive Care Med 2008; 34 (09) 1698-1702