Pediatrics First treatment to curb admissions of children due to bronchiolitis
Health Bronchiolitis in children: "Up to 40% more admissions than before Covid in some ERs"
Doubts What is bronchiolitis: symptoms, causes and treatment
The peak of the respiratory syncytial virus (RSV) responsible for bronchiolitis in children
has not yet been reached .
Two years ago we began to call the outbreaks produced by the coronavirus waves.
And we learned to 'predict' declines when cases stabilized.
"we don't have a crystal ball" say pediatricians
"The Sivira (Surveillance System for Acute Respiratory Infections in Spain) sees a stabilization based on the usual parameters.
The problem is that in other neighboring countries, the peak has been higher
. But we don't know if it can still rise higher here" , explains Federico Martinón, head of Pediatrics at the Hospital Clínico Universitario de Santiago.
The data from the latest report from the Carlos III Health Institute, Sivira, already indicate two months of rise in VRS, the last three weeks with a high number of admissions.
Thus, with data as of November 30, the hospitalization rate for RSV infection stands at 8.4 cases per 100,000 inhabitants (8.1 in the previous one).
In the smallest, under four years of age, it exceeds one hundred, 105.1.
Martinón points out that "
the feeling here [Galicia] is that for the moment the pressure has not eased
From Aragon, the vice president of the Spanish Association of Primary Care Pediatrics (AepAP) agrees with him, "
we still do not see the peak. We continue to accumulate cases and not only in the smallest, but also in older ages up to 10-12
years They do not require admission, the infection follows its natural course, but that means that the virus continues to circulate."
That is why collapse is what defines the situation of pediatric ICUs and emergency and outpatient care services.
The Galician head of Pediatrics is forceful: "What the authorities in general have to find out once and for all is that in Pediatrics this is their pandemic and that
we want the same resources and care that were made available to adults for Covid
In addition, he stresses, like other experts in his situation, that they are still on the limit.
"You have to stop looking at where the peak is going or if it is going to decrease or not, and take the current situation very seriously, and prepare for what may come.
We have warned that this was going to happen. Children are not small adults
The problem is not only that there are more children in primary school or in the emergency room, but that the proportion of children admitted is much higher, that is, there are really sick children among that increase in number.
Martinón claims that "
if we have twice as many patients in the emergency room, we need twice as many resources, human and material, and so on, as long as it is necessary.
The areas where the necessary measures are being taken are coping, not without a huge dose of sacrifice of the professionals. The areas where they don't, will collapse".
Regarding the differences that occur between age groups, Cenarro explains that the impact of VRS is different depending on the vulnerability of the patients, especially at the extremes of age: the youngest and the oldest.
"The difference is that, depending on the age group, it produces one pathology or another.
The youngest will develop the famous bronchiolitis
, but in the elderly they also produce catarrhal processes and bronchitis. In the older ones, since it is not tested, it is not It does it because the ones sold in the pharmacy do not cover RSV, only influenza A, influenza and coronavirus".
Covid, flu and VRS, a cocktail of viruses
Along with VRS, Cenarro stresses that there are many cases of flu and that we are already in an epidemic period.
It's a curious thing because normally the syncytial virus started and then the flu
. What happened is that it went up little by little until the peak arrived and then the next one took its turn."
Now, all the viruses coexist at the same time, "we have even seen the mouth-hand-foot virus [due to the Coxsackie virus 16]. None displaces another, but rather each one has its space," explains the president of AepAP.
All in all, it is a different situation from the one experienced during the pandemic and also previously.
"It is striking that the flu did not peak rapidly like other times, but that we are at sustained epidemic levels, without making those high peaks in coexistence with the syncytial virus," Cenarro insists, summarizing that "it
is an epidemiological situation Totally unpredictable
Antibiotic crisis for children, when to use them
If RSV collapses the system and alerts parents, antibiotic supply problems add to the crisis.
Cenarro recalls that "it is a different problem, because these drugs should not be used in the viral processes that we have referred to, but rather against those produced by bacteria."
The president of primary care pediatricians stresses that "
its use beyond that indicated only causes resistance and loss of effectiveness
And he gives a clear example with this sequence of events: "Antibiotics should only be given in the case of these viruses if there is a bacterial complication, that is, someone has started with the respiratory syncytial virus and the flu and is complicated by otitis or pneumonia. Those are the only two exceptions."
If there is no bacterial infection, "
the only thing we have to resort to are antipyretics
, if the infection passes to the bronchi, we will administer the
bronchodilators with the cameras
," concludes Cenarro.
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