PRINCIPLES OF THERAPY OF ACUTE BRONCHIOLITHIS IN CHILDREN

Аннотация

Acute bronchiolitis is one of the most common lower respiratory tract infections in children and causes airway obstruction in 10%-30% of cases. In this regard, the aim of the study was to optimize the principles of therapy and enhance the prevention of recurrence of the disease. 54 children with acute bronchiolitis under the age of two were examined. The study revealed irrational use of antibiotics and incorrectly selected starting doses for children with acute bronchiolitis. Despite the existence of a large number of risk factors, in order to reduce the incidence of acute respiratory infections and bronchiolitis, breastfeeding should be recommended for at least the first 6 months of life. In case of bronchiolitis, antibiotic therapy is possible only in the presence of bacterial complications. Introduction: One of the most common lower respiratory tract infections in children is acute bronchiolitis, which causes airway obstruction in young children with a frequency of 10% to 30% [1,2]. Infectious bronchiolitis is common in young children. By the age of three, almost every child is infected with the respiratory syncytial virus, which most often affects the lower respiratory tract. Every year, 7-13% of patients with acute bronchiolitis worldwide require inpatient treatment and 1-3% require hospitalization in the intensive care unit [3]. The role of the etiological factor in the development of the disease depends on the child’s age, time of year, somatic status and a number of other factors [4]. Management of patients with acute bronchiolitis occupies a special place in pediatric practice due to the severity of the course and the tendency to relapse [5]. Repeated episodes of broncho-obstruction create conditions for the subsequent formation of chronic forms of allergic diseases of the respiratory tract, in particular, bronchial asthma [6]. An analysis of the literature indicates that antibiotics are not indicated for acute bronchiolitis, except in situations where there is a concomitant https://scientific-jl.com 2 6 5 59-son_2-to’plam_Aprel-2025 ISSN:3030- 3 6 1 3 T A D Q I Q O T L A R jahon ilmiy – metodik jurnali bacterial infection or a strong suspicion of it [7,8]. The severe course of acute bronchiolitis, the tendency to relapses of broncho-obstruction, transformation into respiratory allergies, determine the need for further study of immune-dependent pathogenetic mechanisms, the deciphering of which will increase the effectiveness of treatment measures for obstructive complications in young children. The aim of the study: based on the analysis of the treatment of children suffering from acute bronchiolitis, to optimize the principles of therapy and enhance the prevention of recurrence of the disease. Material and methods of the study. 54 children with acute bronchiolitis under the age of two were examined. The patients were hospitalized in the I and II departments of emergency pediatrics of the Samarkand branch of the Republican Scientific Center for Emergency Medical Care in the period from January to December 2024. All patients were diagnosed based on standard clinical and laboratory data and instrumental research methods. A general blood and urine test, a biochemical blood test with determination of C-reactive protein, a blood gas test, oxygen saturation (SpO2), chest X-ray, and a bacteriological examination of feces using a modified method by M.A. Akhtamova et al. (1979) were studied. The following were used as markers of bacterial infection: leukocytosis above 15x109/l; neutrophilia above 10x109/l; neutrophilic index: the ratio of young forms of neutrophils (myelocytes, metamyelocytes, promyelocytes, band neutrophils) to mature forms (segmented neutrophils) more than 0.2; CRP above 5 mg/l. RSV etiology of bronchiolitis was confirmed by polymerase chain reaction. The severity of broncho-obstruction was determined using the W. Tal scale (1996) [10]. To assess the severity of broncho-obstructive syndrome and determine indications for hospitalization [10], the M. H. Gurelick, S. B. Singh Scale (2001) was used, based on clinical and radiological data. Research Results. Indications for hospitalization of children with bronchiolitis were: cases of apnea in the anamnesis; signs of respiratory failure of 2-3 degrees; age, premature babies; dehydration, and aggravated premorbid background. Our studies have shown a slight predominance of girls (61.1% - 33) over boys (38.9% - 21) (p> 0.05). A study of the anamnesis of life showed that sick children were born with a body weight of 2100 - 4400 g. 5-9.3% of premature babies had a body weight of less than 2500 g, and 3-5.7% of children were delivered by Caesarean section with a body weight of over 4 kg. The patients had a history of a number of risk factors for severe acute bronchiolitis: 6-11.1% of children were born from multiple pregnancies, 8-14.8% were born with intrauterine pneumonia. 28-51.9% of children were breastfed, 5-9.3% of infants were bottle-fed from