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Nutritional management of young infants presenting with acute bronchiolitis in Belgium, France and Switzerland: survey of current practices and documentary search of national guidelines worldwide

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Abstract

Feeding difficulties are common in young infants presenting with acute bronchiolitis, but limited data is available to guide clinicians adapting nutritional management. We aimed to assess paediatricians’ nutritional practices among Western Europe French speaking countries. A survey was disseminated to describe advice given to parents for at home nutritional support, in hospital nutritional management, and preferred methods for enteral nutrition and for intravenous fluid management. A documentary search of international guidelines was concomitantly conducted. Ninety-three (66%) contacted physicians responded. Feeding difficulties were a common indication for infants’ admission. Written protocols were rarely available. Enteral nutrition was favoured most of the time when oral nutrition was insufficient and might be withheld in case of severe dyspnoea to decrease respiratory workload. Half of physicians were aware of hyponatremia risk and pathophysiology, and isotonic intravenous solutions were used in less than 15% of centres. International guideline search (23 countries) showed a lack of detailed nutritional management recommendations in most of them.

Conclusion: practices were inconsistent among physicians. Guidelines detailed nutritional management poorly. Awareness of hyponatremia risk in relation to intravenous hypotonic fluids and of the safety of enteral hydration and nutrition is insufficient. New guidelines including detailed nutritional management recommendations are urgently needed.

What is Known?

• Infants presenting with acute bronchiolitis face feeding difficulties.

• Underfeeding may promote undernutrition, and intravenous hydration with hypotonic fluids may induce hyponatremia.

What is New?

• Physicians’ nutritional practices are inconsistent and awareness of hyponatremia risk and pathophysiology is insufficient among physicians.

• Awareness of hyponatremia risk and pathophysiology is insufficient among physicians.

• The reasons for enteral nutrition withholding in bronchiolitis infants are not evidence based, and national guidelines of acute bronchiolitis across the world are elusive regarding nutritional management.

• National guidelines of acute bronchiolitis across the world are elusive regarding nutritional management.

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Abbreviations

IV:

Intravenous

NutriSIP:

the French speaking paediatric intensive care nutrition group

PICU:

paediatric intensive care units

SIADH:

syndrome of inappropriate secretion of antidiuretic hormone

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Acknowledgments

We would like to thank all the physicians who responded to the survey, from a wide panel of paediatric units (Switzerland: Morges, Aigle, Yverdon, Nyon. Belgium: Liège, Libramont, Huy, Marche, Malmedy, Namur, Bruxelles, Ixelles, Mons, Hornu. France: Marseille, Nîmes, Bézier, Carcassonne, Perpignan, Ales, Mende, Narbonne, Montpellier, Nantes, La Rochelle, Tours, Angers, Rennes, Chateaubriand, Caen, Brest, Bordeaux, Périgueux, vannes, Le Mans, Morlaix, Paris, La Roche-sur-Yon, Saint Denis, Argenteuil, Paris, Pontoise, Lyon, Bourg en Bresse, Lons le Saulnier, Oyonnax, Belley, Annemasse, Chalon-sur-Saône, Macon, Villefranche-sur-Saône, Montbrison, Firminy, St Etienne, Vienne, Bourgoin-Jailleux, Chambéry, Sallanches, Annecy, Thonon les Bains, Romans-sur-Isère, Valence, Montélimar, Annonay, Voiron, Grenoble, Clermont-Ferrand, Vichy, Aurillac, Vaulx-en-Velin).

Author information

Authors and Affiliations

  1. Paediatric Intensive Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500, Lyon-Bron, France

    Frédéric V. Valla, Florent Baudin, Carole Ford-Chessel & Robin Pouyau

  2. Faculty of Health and Applied Sciences, The University of the West of England, Glenside Campus, Blackberry Hill, Stapleton, Bristol, BS16 1DD, UK

    Frédéric V. Valla & Lyvonne N. Tume

  3. CarMEN INSERM UMR 1060 Equipe INFOLIP, 69100, Villeurbanne, France

    Frédéric V. Valla & Noël Peretti

  4. Université Claude Bernard Lyon 1, Ifsttar, UMRESTTE, UMR T 9405, 69373, Lyon, France

    Florent Baudin

  5. Division of Paediatric Critical Care Medicine, Department of Paediatrics, CHC, Liège, Belgium

    Pierre Demaret

  6. Paediatric Intensive Care, Hôpital Universitaire des Enfants Reine Fabiola, 1020, Laeken-Brussels, Belgium

    Shancy Rooze

  7. Department of Nutrition and Dietetics, Haute Ecole de Santé, University of Applied Sciences of Western Switzerland, Carouge, Geneva, Switzerland

    Clémence Moullet

  8. Paediatric Intensive Care, University Hospitals of Lausanne, Lausanne, Switzerland

    Jacques Cotting

  9. Paediatric Nutrition and Dietetic Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500, Lyon-Bron, France

    Carole Ford-Chessel

  10. Paediatric Gastroenerology and Nutrition Department, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 bd Pinel, 69500, Lyon-Bron, France

    Noël Peretti

  11. Paediatric Intensive Care Unit, Bristol Children’s Hospital, Upper Maudlin Street, Bristol, UK

    Lyvonne N. Tume

  12. Paediatric Intensive Care, Hôpital Arnaud de Villeneuve, 371 av Doyen Giraud, 34296, Montpellier, France

    Christophe Milesi

  13. Paediatric Intensive Care, Hôpital Femme Mère Enfant, Nantes, France

    Bénédicte Gaillard Le Roux

Authors
  1. Frédéric V. Valla
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  2. Florent Baudin
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  3. Pierre Demaret
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  7. Carole Ford-Chessel
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  8. Robin Pouyau
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  9. Noël Peretti
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  11. Christophe Milesi
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  12. Bénédicte Gaillard Le Roux
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Contributions

FVV, BGLR, CFC and LNT conceived the idea for this paper, undertook the literature search and worked on the review and manuscript. LNT edited the English wording.

PD, SR, CM, JC, CM, RP tested the survey, disseminated the survey and helped analysing the results.

FB and NP critically reviewed the results and the manuscript.

Corresponding author

Correspondence to Frédéric V. Valla.

Ethics declarations

Ethical approval was obtained for the study (Hospices Civils de Lyon ethical committee 18/07/2017).

This paper complies with ethical standards.

Informed consent was implicit for surveyed physicians upon response to the survey.

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Mario Bianchetti

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Valla, F.V., Baudin, F., Demaret, P. et al. Nutritional management of young infants presenting with acute bronchiolitis in Belgium, France and Switzerland: survey of current practices and documentary search of national guidelines worldwide. Eur J Pediatr 178, 331–340 (2019). https://doi.org/10.1007/s00431-018-3300-1

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