TY - JOUR
T1 - Nutritional management of young infants presenting with acute bronchiolitis in Belgium, France and Switzerland
T2 - survey of current practices and documentary search of national guidelines worldwide
AU - Valla, Frédéric V
AU - Baudin, Florent
AU - Demaret, Pierre
AU - Rooze, Shancy
AU - Moullet, Clémence
AU - Cotting, Jacques
AU - Ford-Chessel, Carole
AU - Pouyau, Robin
AU - Peretti, Noël
AU - Tume, Lyvonne N
AU - Milesi, Christophe
AU - Le Roux, Bénédicte Gaillard
N1 - Funding Information:
We would like to thank all the physicians who responded to the survey, from a wide panel of paediatric units (Switzerland : Morges, Aigle, Yverdon, Nyon. Belgium : Li?ge, Libramont, Huy, Marche, Malmedy, Namur, Bruxelles, Ixelles, Mons, Hornu. France : Marseille, N?mes, B?zier, Carcassonne, Perpignan, Ales, Mende, Narbonne, Montpellier, Nantes, La Rochelle, Tours, Angers, Rennes, Chateaubriand, Caen, Brest, Bordeaux, P?rigueux, vannes, Le Mans, Morlaix, Paris, La Roche-sur-Yon, Saint Denis, Argenteuil, Paris, Pontoise, Lyon, Bourg en Bresse, Lons le Saulnier, Oyonnax, Belley, Annemasse, Chalon-sur-Sa?ne, Macon, Villefranche-sur-Sa?ne, Montbrison, Firminy, St Etienne, Vienne, Bourgoin-Jailleux, Chamb?ry, Sallanches, Annecy, Thonon les Bains, Romans-sur-Is?re, Valence, Mont?limar, Annonay, Voiron, Grenoble, Clermont-Ferrand, Vichy, Aurillac, Vaulx-en-Velin).
Publisher Copyright:
© 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Feeding difficulties are common in young infants presenting with acute bronchiolitis, but limited data is available to guide clinicians adapting nutritional management. We aimed to assess paediatricians' nutritional practices among Western Europe French speaking countries. A survey was disseminated to describe advice given to parents for at home nutritional support, in hospital nutritional management, and preferred methods for enteral nutrition and for intravenous fluid management. A documentary search of international guidelines was concomitantly conducted. Ninety-three (66%) contacted physicians responded. Feeding difficulties were a common indication for infants' admission. Written protocols were rarely available. Enteral nutrition was favoured most of the time when oral nutrition was insufficient and might be withheld in case of severe dyspnoea to decrease respiratory workload. Half of physicians were aware of hyponatremia risk and pathophysiology, and isotonic intravenous solutions were used in less than 15% of centres. International guideline search (23 countries) showed a lack of detailed nutritional management recommendations in most of them.Conclusion: practices were inconsistent among physicians. Guidelines detailed nutritional management poorly. Awareness of hyponatremia risk in relation to intravenous hypotonic fluids and of the safety of enteral hydration and nutrition is insufficient. New guidelines including detailed nutritional management recommendations are urgently needed. What is Known? • Infants presenting with acute bronchiolitis face feeding difficulties. • Underfeeding may promote undernutrition, and intravenous hydration with hypotonic fluids may induce hyponatremia. What is New? • Physicians' nutritional practices are inconsistent and awareness of hyponatremia risk and pathophysiology is insufficient among physicians. • Awareness of hyponatremia risk and pathophysiology is insufficient among physicians. • The reasons for enteral nutrition withholding in bronchiolitis infants are not evidence based, and national guidelines of acute bronchiolitis across the world are elusive regarding nutritional management. • National guidelines of acute bronchiolitis across the world are elusive regarding nutritional management.
AB - Feeding difficulties are common in young infants presenting with acute bronchiolitis, but limited data is available to guide clinicians adapting nutritional management. We aimed to assess paediatricians' nutritional practices among Western Europe French speaking countries. A survey was disseminated to describe advice given to parents for at home nutritional support, in hospital nutritional management, and preferred methods for enteral nutrition and for intravenous fluid management. A documentary search of international guidelines was concomitantly conducted. Ninety-three (66%) contacted physicians responded. Feeding difficulties were a common indication for infants' admission. Written protocols were rarely available. Enteral nutrition was favoured most of the time when oral nutrition was insufficient and might be withheld in case of severe dyspnoea to decrease respiratory workload. Half of physicians were aware of hyponatremia risk and pathophysiology, and isotonic intravenous solutions were used in less than 15% of centres. International guideline search (23 countries) showed a lack of detailed nutritional management recommendations in most of them.Conclusion: practices were inconsistent among physicians. Guidelines detailed nutritional management poorly. Awareness of hyponatremia risk in relation to intravenous hypotonic fluids and of the safety of enteral hydration and nutrition is insufficient. New guidelines including detailed nutritional management recommendations are urgently needed. What is Known? • Infants presenting with acute bronchiolitis face feeding difficulties. • Underfeeding may promote undernutrition, and intravenous hydration with hypotonic fluids may induce hyponatremia. What is New? • Physicians' nutritional practices are inconsistent and awareness of hyponatremia risk and pathophysiology is insufficient among physicians. • Awareness of hyponatremia risk and pathophysiology is insufficient among physicians. • The reasons for enteral nutrition withholding in bronchiolitis infants are not evidence based, and national guidelines of acute bronchiolitis across the world are elusive regarding nutritional management. • National guidelines of acute bronchiolitis across the world are elusive regarding nutritional management.
KW - Acute Disease
KW - Belgium
KW - Bronchiolitis/therapy
KW - Cross-Sectional Studies
KW - Fluid Therapy/adverse effects
KW - France
KW - Health Care Surveys
KW - Humans
KW - Infant
KW - Infant, Newborn
KW - Nutritional Support/adverse effects
KW - Practice Guidelines as Topic
KW - Practice Patterns, Physicians'/statistics & numerical data
KW - Switzerland
UR - http://www.scopus.com/inward/record.url?scp=85057812211&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85057812211&partnerID=8YFLogxK
U2 - 10.1007/s00431-018-3300-1
DO - 10.1007/s00431-018-3300-1
M3 - Article (journal)
C2 - 30506396
SN - 0340-6199
VL - 178
SP - 331
EP - 340
JO - European Journal of Pediatrics
JF - European Journal of Pediatrics
IS - 3
ER -