Beware of infantile bronchiolitis

Beware of infantile bronchiolitis. Whenever the cold current goes south, if the baby at home catches a cold, there will be fever, cough, runny nose, excessive phlegm, shortness of breath and even wheezing. The baby drinks half as much milk as usual. At this time, it is doubtful whether the baby is infected with highly contagious respiratory fusion virus (RSV)! In 2006, the World Health Organization (WHO) estimated that there were about 64 million cases of RSV infection worldwide every year. If you are infected in infancy, a higher proportion may suffer from diseases such as bronchial abnormalities or asthma during the growing period, so parents should not underestimate the threat of RSV.

The common cause of bronchiolitis is Xu Kaixiang, the attending physician of neonatology department of Children's Medical Center of Linkou Chang Gung Hospital. He said that the baby's infection with bronchiolitis is an infectious disease in the deep lower respiratory tract. The so-called lower respiratory tract refers to the trachea (bronchioles) below the glottis, including the main bronchus, left and right bronchus, and below. The characteristic of RSV is that bronchial mucosa produces a large amount of secretions, which in turn causes bronchiole obstruction.

Dr. Xu Kaixiang said that the main cause of bronchiolitis infection is RSV infection, and others include influenza virus or other respiratory infection viruses, which may also affect the baby's bronchiolitis, thus causing symptoms such as cough or fever. Parents are particularly confused, including mycoplasma pneumoniae, streptococcus pneumoniae and other infections. In addition to similar symptoms, they usually have longer fever and obvious respiratory distress symptoms, and are more likely to be complicated with severe pneumonia or even respiratory failure.

Once the baby at home suffers from bronchiolitis, he may have symptoms such as cough, respiratory distress, breathlessness and forced breathing. In more serious cases, there may be blue lips and wheezing accompanied by breathing, especially for babies with allergic constitution, and breathing is more prone to wheezing; Because babies with allergies are more sensitive to the respiratory tract, they are more prone to wheezing. For those with mild symptoms, symptom treatment is the main method; But if the symptoms are serious, such as: high fever at 38℃ ~ 39℃ for 2 ~ 3 days; Or because of high fever and shortness of breath, the baby doesn't want to drink milk; Or even if you barely drink milk, you often spit milk because of coughing, which reduces your baby's urine output and causes dehydration. You need to see a doctor as soon as possible.

The clinical treatment of RSV is viral infection, and the treatment is mainly to improve symptoms. At present, there is no specific medicine. If we want to judge the real killer of infant bronchiolitis in clinic, we can detect the secretions such as sputum or snot to see if the baby is infected with RSV. But if the baby's clinical symptoms are serious, is it necessary to worry about whether it is complicated with bacterial infection? If necessary, it can be tested to distinguish virus or bacterial infection.

So when must antibiotics be used? Dr. Xu Kaixiang said that if the clinical symptoms have not deteriorated or become serious, symptom treatment should be given priority to. Unless the condition is serious, empirical antibiotics can be given to prevent other severe pneumonia while detecting pathogens, and drugs can be increased or decreased according to the condition.

Foreign countries are prone to fall and winter, and it happens in all seasons in Taiwan Province Province. Because of the distinct seasons abroad, bronchiolitis infected by RSV often occurs in autumn and winter, but the seasonal differentiation in Taiwan Province Province is not obvious, so RSV can occur all year round. According to the analysis report based on the data of health insurance database, from 2007 to 2009, about 9 out of every 65,438+0,000 infants in China were infected with RSV in the first year after birth, and about 3 out of every 65,438+0,000 infants were infected with RSV in the second year.

Which babies are at high risk? High-risk group of RSV infection? The most common are infants under two years old, the elderly with poor immunity or patients with special major diseases; Among them, premature infants, especially the high-risk group of RSV infection, are more prone to respiratory distress when they are sick because of immature alveoli, bronchial sensitivity, weak immunity and dependence on ventilator in early birth, which makes the alveoli mature slowly and then become the high-risk group of RSV invasion.

How to prevent infant bronchiolitis from being infected with RSV virus? The main transmission route of RSV, like influenza virus, belongs to droplet infection, including sneezing, runny nose, and even touching nose, mouth and eyes with hands after touching these mucosal germs, thus causing infection. Therefore, once adults at home catch a cold, they must wash their hands and wear masks before and after touching children, especially the babies of the above-mentioned high-risk groups, and should reduce their access to crowded public places. In addition, it is also important to protect your baby from second-hand smoke, so as not to reduce the immune function of the respiratory tract.

As for the infants in high-risk groups, Taiwan Province Neonatal Medical Association suggested that RSV monoclonal antibody vaccine should be provided at 20 10. At present, the groups eligible for medical insurance payment include premature infants whose birth weeks are less than 28 weeks, premature infants whose birth weeks are less than 35 weeks, and infants with severe congenital heart disease. The first dose of RSV vaccine can be injected a few days before discharge, and then once a month (up to 6 times) for babies who do not meet the requirements of medical insurance payment at present. If parents think it is necessary, they can discuss with pediatricians before considering whether it is necessary to inject RSV vaccine at their own expense.

The key to baby's daily care ※RSV attacks babies under 2 years old.

When adults at home have a cold, cough or fever, they should take the initiative to wear masks to avoid transmitting the virus to babies. ※.

The infection route is droplet infection, oral and nasal secretions contact infection, and parents Qin Ying will wash their hands before approaching the baby. ※.

Don't take your baby to crowded and unventilated public places. ※.

Babies with allergic constitution, babies with weak cardiopulmonary function, premature babies and high-risk babies with congenital heart diseases and immune diseases must be carefully cared for. ※.

In the case of alternating seasons and changeable temperature and humidity, the virus is more active, so be extra careful. ※.

The baby will have symptoms such as wheezing, wheezing, runny nose, excessive phlegm, vomiting milk, anorexia, etc., so seek medical diagnosis as soon as possible. ※.

The infected baby should eat a small amount of food, give a proper amount of milk, and spit out the milk after drinking it (to avoid letting the baby lie down immediately), so as to avoid choking the respiratory tract with milk or phlegm and causing suffocation accidents. ※.

However, bronchiolitis caused by RSV infection usually lasts for a long time, and it usually takes about a week to gradually recover. In the weather with alternating seasons, flu season and changeable temperature and humidity, you should be more careful to avoid repeated infections of your baby. Usually, you should carefully look after your baby to see if there is any abnormal or blocked respiratory tract. If the baby has been infected, if there are dehydration symptoms such as shortness of breath, embarrassment, cyanosis of face or lip color, or the amount of milk and urine is reduced, it means that the baby's condition is more serious. At this time, parents should take their baby to see a doctor as soon as possible. Finally, Dr. Xu also reminded Mommy that breastfeeding can improve the self-protection ability of infants, so it is best to breastfeed the baby until it is six months old!

Xu Kaixiang

Education: Department of Medicine, Chang Gung University

Experience: Attending physician of children's internal medicine in Chiayi Chang Gung Memorial Hospital, deputy director of children's internal medicine in Xiamen Chang Gung Memorial Hospital, attending physician of neonatology in Linkou Chang Gung Memorial Hospital, and chief physician of neonatology in Linkou Chang Gung Memorial Hospital.

Current position: Director of Nursery Room of Linkou Chang Gung Memorial Hospital, and attending physician of Neonatal Department of Linkou Chang Gung Memorial Hospital.