Epidemiologia da bronquiolite viral aguda em crianças internadas em um hospital em Curitiba

• Autor(a) principal: Cezar, Eliza de Almeida
• Data de Publicação: 2021
• Outros Autores: Lunardelli, Gabriela, Bertoli, Luís Eduardo Martins, Linhares, Nayara Gabriela de
• Tipo de documento: Trabalho de conclusão de curso
• Idioma: por
• Título da fonte: Repositório do Centro Universitário Braz Cubas
• Texto Completo: https://repositorio.cruzeirodosul.edu.br/handle/123456789/3685
• topic: Bronquiolite; Vírus; Infecções respiratórias; Pediatria; Epidemiologia; CNPQ::CIENCIAS DA SAUDE::MEDICINA

This study evaluated the epidemiology of acute viral bronchiolitis in children admitted to a hospital in Curitiba-PR, investigating the main factors for the worsening of the disease, as well as identifing etiological agents. This is a retrospective descriptive study carried out from the analysis of medical records of children up to two years old hospitalized in the neonatal intensive care unit (ICU) or in the pediatric sector of the Hospital do Trabalhador in Curitiba-PR, with the diagnosis of bronchiolitis in the period of January of 2012 until December of 2020. A total of 97 patients were studied, divided into two groups based on their age: younger than 30 days (n = 50) and older than or equal to 30 days (n = 47). All patients had their medical records reviewed, seeking information about the clinical picture, radiographic changes, treatment and viral polymerase chain reaction (PCR) test results. It was evident that, regardless of age, respiratory syncytial virus (RSV) and rhinovirus were the most frequent pathogens, with no difference in their prevalence between groups. RSV was the most prevalent pathogen, being detected in 70.3% in patients younger than 30 days and in 66.6% in patients aged 30 days or more (P = 0,8). Rhinovirus was detected in 24.3% in children under 30 days and in 18.2% in older children (P = 0.64). A median age of 29 days was observed, in addition to a similarity in the number of boys and girls (P = 0,15) and in the age between the two sexes (P = 0,87). Regarding clinical parameters, respiratory effort, tachypnea and oxygen saturation below 95% were most commonly observed, with percentage frequency of 70%, 44% and 42%, respectively. On chest Xrays, the most frequent finding was interstitial infiltrate (27%), indicating that the absence of this alteration cannot be used as an exclusion criteria for the disease. Atelectasis and condensation were also frequently reported. With regard to the management of the disease, 13 therapeutic alternatives listed in the medical records were found, with the use of respiratory physiotherapy, antibiotics and inhalation with beta-2-agonist being common. It was noted that there was no well-established standardization for the treatment of the disease, indicating that protocols for the treatment of bronchiolitis are still lacking. Regarding the evolution of the disease, an interquartile range (IQR) of 6 to 9 days of hospitalization was observed, with discharge being the most common outcome and with only one death. It was also noticed that the length of stay among patients with bronchiolitis and pneumonia was longer than those with bronchiolitis alone. It was concluded that the disease, within the age group of 2 years, has a greater predilection for younger babies and that RSV behaves as the main etiological agent, regardless of age. However, this epidemiological data does not exclude the importance of PCR collection, since rhinovirus and co-infection are also present. Clinically, respiratory effort, tachypnea and desaturation associated with the interstitial infiltrate raise the suspicion of bronchiolitis. Finally, the need for therapeutic standardization and the need to create a protocol for the treatment of the disease were emphasized.