Treating premature bronchiolitis at Hospital Clínic

Hospital Clínic de Barcelona is committed to prevention in the treatment of bronchiolitis. Prevention is based on control measures to prevent infection, and prophylaxis by strengthening the immune system in patients who are at high risk of developing severe RSV bronchiolitis.

Hygiene measures are essential in controlling the disease, both at home and at healthcare centres.

Some measures to prevent RSV infection include:

• Not exposing newborns to tobacco smoke, including during pregnancy.
• Washing hands with soap and water before holding the baby.
• Using disposable tissues, and throwing away used ones.
• Cleaning toys more often when they are used by other children, as well as plates and bottles.
• Preventing newborns coming into contact with people with fever or respiratory infections.
• Breastfeeding should be the method of choice where possible, as it protects against respiratory infections.
• Avoiding enclosed and potentially contagious environments, for example crowds.
• Remember: if you notice any signs or symptoms, speak to your paediatrician as soon as possible.

Palivizumab for immunoprophylaxis

Humanised monoclonal antibodies against RSV are available for immunoprophylaxis. Palivizumab is a drug administered to newborns with risk factors in hospital. The indications for palivizumab were published in July 2008 in the Anales Españoles de Pediatría (Spanish Annals of Paediatrics) under the title “Consenso multidisciplinar español sobre la profilaxis de la infección respiratoria pediátrica por VRS” (Multidisciplinary consensus on prophylaxis of paediatric respiratory RSV infection in Spain).

Palivizumab prophylaxis recommended in the following cases:

• Children under 2 years of age with bronchopulmonary dysplasia requiring treatment (oxygen supplements, bronchodilators, diuretics or corticosteroids) in the 6 months prior to the start of the RSV season, or who are discharged during the season.
• Children under 2 years of age with congenital heart disease involving significant haemodynamic disorders, who are receiving treatment for heart failure, moderate or severe pulmonary hypertension or cyanogenic (cyanotic) heart disease.
• Premature infants, born at the 28th week of pregnancy or before, who are 12 months of age or younger at the start of the RSV season.
• Premature infants born between the 29th and 32nd weeks of pregnancy, who are 6 months of age or younger at the start of the RSV season.
• Premature infants born between the 32nd and 35th weeks of pregnancy, who are younger than 6 months at the start of the RSV season, and who have two or more risk factors for hospitalisation due to RSV infection. These risk factors may include: not being breastfed, or being breastfed for less than 2 months, having at least one sibling of school age (up to 14 years), attending daycare, a family history of wheezing, crowded household conditions (living with 4 or more adults), malformations of the airways or neuromuscular disease.

Palivizumab is administered monthly via the intramuscular route for five months.  It has been shown to reduce RSV hospitalisations among at-risk patients. Nevertheless, it has not been shown to reduce disease incidence, the duration of hospitalisation, or the use of oxygen therapy and mechanical ventilation. Nor does it reduce mortality. This is why it is important to maintain hygiene measures, even when this treatment is used.

Hospital Clínic has developed protocols, clinical practice guidelines and recommendations regarding the treatment and prevention of RSV.