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
References
Barazzone C (2003) Treatment of acute bronchiolitis in infants. Traitement de la bronchiolite aiguë du nourrisson. Courrier 14:22–25
Breakell R, Thorndyke B, Clennett J, Harkensee C (2018) Reducing unnecessary chest X-rays, antibiotics and bronchodilators through implementation of the NICE bronchiolitis guideline. Eur J Pediatr 177:47–51. https://doi.org/10.1007/s00431-017-3034-5
Che D, Nicolau J, Bergounioux J, Perez T, Bitar D (2012) Bronchiolitis among infants under 1 year of age in France: epidemiology and factors associated with mortality. Bronchiolite aiguë du nourrisson en France : bilan des cas hospitalisés en 2009 et facteurs de létalité. Arch Pédiatrie 19:700–706. https://doi.org/10.1016/j.arcped.2012.04.015
David M, Luc-Vanuxem C, Loundou A, Bosdure E, Auquier P, Dubus J-C (2010) Assessment of the French consensus conference for acute viral bronchiolitis on outpatient management: progress between 2003 and 2008. Arch Pediatr 17:125–131. https://doi.org/10.1016/j.arcped.2009.10.022
De Betue CT, Van Waardenburg DA, Deutz NE, Van Eijk HM, Van Goudoever JB, Luiking YC, Zimmermann LJ, Joosten KF (2011) Increased protein-energy intake promotes anabolism in critically ill infants with viral bronchiolitis: a double-blind randomised controlled trial. Arch Child 96:817–822. https://doi.org/10.1136/adc.2010.185637
De Cosmi V, Mehta NM, Boccazzi A, Milani GP, Esposito S, Bedogni G, Agostoni C (2017) Nutritional status, metabolic state and nutrient intake in children with bronchiolitis. Int J Food Sci Nutr 68:378–383. https://doi.org/10.1080/09637486.2016.1245714
Easley D, Tillman E (2013) Hospital-acquired hyponatremia in pediatric patients: a review of the literature. J Pediatr Pharmacol Ther 18:105–111. https://doi.org/10.5863/1551-6776-18.2.105
Ergul AB, Calıskan E, Samsa H, Gokcek I, Kaya A, Zararsiz GE, Torun YA (2018) Using a high-flow nasal cannula provides superior results to OxyMask delivery in moderate to severe bronchiolitis: a randomized controlled study. Eur J Pediatr 177:1299–1307. https://doi.org/10.1007/s00431-018-3191-1
Hanna S, Tibby SM, Durward A, Murdoch IA (2003) Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis. Acta Paediatr 92:430–434. https://doi.org/10.1111/j.1651-2227.2003.tb00573.x
Hasegawa K, Stevenson MD, Mansbach JM, Schroeder AR, Sullivan AF, Espinola JA, Piedra PA, Camargo CA (2015) Association between hyponatremia and higher bronchiolitis severity among children in the intensive care unit with bronchiolitis. Hosp Pediatr 5:385–389. https://doi.org/10.1542/hpeds.2015-0022
Hubert A, Ford-Chessel C, Berthiller J, Peretti N, Javouhey E, Valla FV (2016) Nutritional status in pediatric intermediate care: assessment at admission, progression during the stay and after discharge. Arch Pédiatrie 23:333–339. https://doi.org/10.1016/j.arcped.2015.12.014
Kaur A, Singh K, Pannu MS, Singh P, Sehgal N, Kaur R (2016) The effect of exclusive breastfeeding on hospital stay and morbidity due to various diseases in infants under 6 months of age: a prospective observational study. Int J Pediatr 2016:1–6. https://doi.org/10.1155/2016/7647054
Khoshoo V, Edell D (1999) Previously healthy infants may have increased risk of aspiration during respiratory syncytial viral bronchiolitis. Pediatrics 104:1389–1390
Khoshoo V, Ross G, Kelly B, Edell D, Brown S (2001) Benefits of thickened feeds in previously healthy infants with respiratory syncytial viral bronchiolitis. Pediatr Pulmonol 31:301–302
Kugelman A, Raibin K, Dabbah H, Chistyakov I, Srugo I, Even L, Bzezinsky N, Riskin A (2013) Intravenous fluids versus gastric-tube feeding in hospitalized infants with viral bronchiolitis: a randomized, prospective pilot study. J Pediatr 162:640–642.e1. https://doi.org/10.1016/j.jpeds.2012.10.057
Lavagno C, Milani GP, Uestuener P, Simonetti GD, Casaulta C, Bianchetti MG, Fare PB, Lava SAG (2017) Hyponatremia in children with acute respiratory infections: a reappraisal. Pediatr Pulmonol 52:962–967. https://doi.org/10.1002/ppul.23671
Leroue MK, Good RJ, Skillman HE, Czaja AS (2017) Enteral nutrition practices in critically ill children requiring noninvasive positive pressure ventilation. Pediatr Crit Care Med 18:1093–1098. https://doi.org/10.1097/PCC.0000000000001302
Luu R, DeWitt PE, Reiter PD, Dobyns EL, Kaufman J (2013) Hyponatremia in children with bronchiolitis admitted to the pediatric intensive care unit is associated with worse outcomes. J Pediatr 163:1652–1656.e1. https://doi.org/10.1016/j.jpeds.2013.06.041
McNab S, Duke T, South M, Babl FE, Lee KJ, Arnup SJ, Young S, Turner H, Davidson A (2015) 140 mmol/L of sodium versus 77 mmol/L of sodium in maintenance intravenous fluid therapy for children in hospital (PIMS): a randomised controlled double-blind trial. Lancet 385:1190–1197
Medina A, del Villar-Guerra P, Modesto i Alapont V (2018) CPAP support should be considered as the first choice in severe bronchiolitis. Eur J Pediatr. https://doi.org/10.1007/s00431-018-3280-1
Meissner HC (2016) Viral bronchiolitis in children. N Engl J Med 374:62–72. https://doi.org/10.1056/NEJMra1413456
Milani GP, Rocchi A, Teatini T, Bianchetti MG, Amelio G, Mirra N, Grava A, Agostoni C, Fossali EF (2017) Hyponatremia in infants with new onset moderate-severe bronchiolitis: a cross-sectional study. Respir Med 133:48–50. https://doi.org/10.1016/j.rmed.2017.10.028
Oakley E, Borland M, Neutze J, Acworth J, Krieser D, Dalziel S, Davidson A, Donath S, Jachno K, South M, Theophilos T, Babl FE, Paediatric Research in Emergency Departments International Collaborative (PREDICT) (2013) Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial. Lancet Respir Med 1:113–120. https://doi.org/10.1016/S2213-2600(12)70053-X
Oakley E, Bata S, Rengasamy S, Krieser D, Cheek J, Jachno K, Babl FE (2016) Nasogastric hydration in infants with bronchiolitis less than 2 months of age. J Pediatr 178:241–245.e1. https://doi.org/10.1016/j.jpeds.2016.07.012
Oakley E, Carter R, Murphy B, Borland M, Neutze J, Acworth J, Krieser D, Dalziel S, Davidson A, Donath S, Jachno K, South M, Babl FE, for the Paediatric Research in Emergency Departments International Collaborative (PREDICT) (2017) Economic evaluation of nasogastric versus intravenous hydration in infants with bronchiolitis: ECONOMIC EVALUATION OF HYDRATION METHODS IN BRONCHIOLITIS. Emerg Med Australas 29:324–329. https://doi.org/10.1111/1742-6723.12713
Oakley E, Chong V, Borland M, Neutze J, Phillips N, Krieser D, Dalziel S, Davidson A, Donath S, Jachno K, South M, Fry A, Babl FE (2017) Intensive care unit admissions and ventilation support in infants with bronchiolitis: ICU ADMISSION AND VENTILATION IN BRONCHIOLITIS. Emerg Med Australas 29:421–428. https://doi.org/10.1111/1742-6723.12778
Pierce HC, Mansbach JM, Fisher ES, Macias CG, Pate BM, Piedra PA, Sullivan AF, Espinola JA, Camargo CA (2015) Variability of intensive Care Management for Children with Bronchiolitis. Hosp Pediatr 5:175–184. https://doi.org/10.1542/hpeds.2014-0125
Pinnington LL, Smith CM, Ellis RE, Morton RE (2000) Feeding efficiency and respiratory integration in infants with acute viral bronchiolitis. J Pediatr 137:523–526. https://doi.org/10.1067/mpd.2000.108396
Slain KN, Martinez-Schlurmann N, Shein SL, Stormorken A (2017) Nutrition and high-flow nasal cannula respiratory support in children with bronchiolitis. Hosp Pediatr 7:256–262. https://doi.org/10.1542/hpeds.2016-0194
Sochet AA, McGee JA, October TW (2017) Oral nutrition in children with bronchiolitis on high-flow nasal cannula is well tolerated. Hosp Pediatr 7:249–255. https://doi.org/10.1542/hpeds.2016-0131
Srinivasan M, Pruitt C, Casey E, Dhaliwal K, DeSanto C, Markus R, Rosen A (2017) Quality improvement initiative to increase the use of nasogastric hydration in infants with bronchiolitis. Hosp Pediatr 7:436–443. https://doi.org/10.1542/hpeds.2016-0160
Stagnara J, Balagny E, Cossalter B, Dommerges JP, Dournel C, Drahi E, Gauchez H, Guillot F, Javault D, Lagardère B, Le Masne A, Lesprit E, Maidenberg M, Maufroy D, Picherot G, Renaud H, Robert J, Undreiner F (2001) Management of bronchiolitis in the infant. Recommendations. Long text. Arch Pediatr 8 Suppl 1:11S–23S
Verstraete M, Cros P, Gouin M, Oillic H, Bihouée T, Denoual H, Barzic A, Duigou A-L, Vrignaud B, Levieux K (2014) Prise en charge de la bronchiolite aiguë du nourrisson de moins de 1 an: actualisation et consensus médical au sein des hôpitaux universitaires du Grand Ouest (HUGO). Arch Pédiatrie 21:53–62
Wang J, Xu E, Xiao Y (2014) Isotonic versus hypotonic maintenance IV fluids in hospitalized children: a meta-analysis. Pediatrics 133:105–113. https://doi.org/10.1542/peds.2013-2041
Weisgerber MC, Lye PS, Nugent M, Li S-H, De Fouw K, Gedeit R, Simpson P, Gorelick MH (2013) Relationship between caloric intake and length of hospital stay for infants with bronchiolitis. Hosp Pediatr 3:24–30
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).
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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.
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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.
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The authors declare that they have no conflict of interest.
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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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DOI: https://doi.org/10.1007/s00431-018-3300-1