Respiratory development of 5- to 6- year-old children experiencing a first bronchiolitis episode before age one.

BACKGROUND: The relationship between early infections due to respiratory syncytial virus (RSV), particularly bronchiolitis in infancy, and the subsequent development of asthma, bronchial hyper-responsiveness, and/or other allergic manifestations, seems increasingly certain, even if the mechanisms involved are not yet quite clear. OBJECTIVES: The objectives of this work were to determine the prevalence of, and risk factors for, asthma and allergy in 5 to 6 year-old children who five years previously, had experienced their first episode of bronchiolitis before the age of twelve months, and to define the possible effect of the age at which the bronchiolitis occurred on the subsequent development of asthma. METHOD: A retrospective cohort survey was conducted, based on the registers of two hospital paediatric emergency units (Unit A: the Ambroise Pare teaching hospital at Boulogne, France and unit B: the General Hospital of Cherbourg, France). The cohort comprised 5-6 years old children who had consulted or been admitted to emergency unit A or B between October 1993 and March 1994 for a first attack of bronchiolitis before the age of 12 months. RESULTS: One hundred and twenty eight children were included in the two centres (centre A: 78; centre B: 50). A familial history of allergy was found in 92 children (71.8%). Fifty-two (40.6%) were exposed to tobacco smoke. One hundred and five children (81.2%) had been hospitalised during the first episode of bronchiolitis, but none had been placed in intensive care. Their mean age at admission was 5.1 months, and 29 children were less than three months old. Ninety seven children (75.8%) had experienced at least one episode of wheezing at some time of their life. In the twelve months before the telephone interview, 40 children (31.3%) had had at least one such episode, 47 (36.7%) an attack of asthma, 32 (25.0%) wheezing after an effort, 43 (39.4%) a dry cough at night, 52 children (40.6%) had exhibited allergic rhinitis signs, and 32 (25.0%) eczema. Among the 47 children who had experienced at least one attack of asthma during the previous twelve months, 27 (57.4%) had a history of familial asthma (p<0.04). This was the only significant relationship observed in this study with regard to risk factors for asthma. No relationship was observed between asthma or recent wheezing on the one hand, and on the others age less than three months during the first bronchiolitis episode (p=0.6), initial hospital admission (p=0.6) tobacco smoke exposure (p=0.27), sex (p=0.10) or day care management until age three (p=0.73). DISCUSSION: This study showed a high prevalence of asthma and other allergic manifestations in children who five years previously, had experienced their first bronchiolitis episode before the age of twelve months. The only risk factor for asthma or chest wheezing identified in this study was a familial history of allergy. These data support the idea that for most children, early acute bronchiolitis, even if severe, is a transient event, with no or very few consequences in the middle or long term. Nevertheless it may be the expression of an interaction between viral infection and atopic familial predisposition leading to lasting bronchial hyper-responsiveness.

[Evaluation of the effectiveness of an injury prevention kit delivery for toddlers in four French cities]. / Evaluation de l'efficacité de la remise d'une trousse de prévention des accidents domestiques de jeunes enfants: essai d'intervention dans quatre communes des Hauts-de-Seine (France).

BACKGROUND: The home delivery of counseling and devices intended to prevent child injuries could help parents to adopt safe behavior more efficiently. The aim of the present study was to adapt and test in France a safety kit designed and used in Quebec (Canada). The intervention program (kit delivery and counseling) was assessed by measuring 6 to 8 weeks after a first home visit the percentage of safety changes adopted by the families included in the survey, compared with the pre-intervention situation; and by evaluating the satisfaction of families with their participation in the survey, and the satisfaction of nurses with the use of this new tool. POPULATION AND METHOD: One hundred families from 4 towns in the Hauts-de-Seine department in the Paris suburbs (Boulogne, Chaville, Sèvres, Ville d'Avray) were selected by the social services for home visits by nurses or doctors, when their child reached the age of 6 to 9 months. Selection criteria were usually primipara, medical problem, psychological and/or socio-economic difficulties. During the first visit, 49 families (group 1) (1 family lost for follow-up) received the usual informative and preventive counseling, and a kit including preventive devices and pamphlets about indoor injuries and ways of avoiding them. The other 50 families (group 2) received counseling but not the kit. Between 6 and 8 weeks later, a second home visit was paid to all selected families. RESULTS: Between the first and the second visits, the percentage of safety improvement was significantly higher in group 1 (with the kit) than in group 2 (without the kit). This improvement mainly related to the risk of fall (P < 0.02), fire and burns (P < 0.001), poisoning (P < 0.01) and suffocation (P < 0.001). When the analysis was focused on safety improvement related to devices provided in the kit, the difference between the 2 groups was significant: 67.8% of safety improvement in group 1 vs 38.1% in group 2 (P < 0.001). The relative risk (RR) was 1,78 (95% confidence interval (CI): 1,18-2,68). Even for items not related to the devices provided, the difference remained significant: 48.6% in group 1 vs 28.8% in group 2 (P < 0.001); RR =1,31 (95% CI: 1,23-1,40). The perceived usefulness of the kit was discussed in a focus group with all nurses and doctors. On the whole, the judgment was very positive, mainly because the kit facilitated the introduction of the notion of accident prevention in the discussion at home. CONCLUSION: As in the canadian survey, our results indicate that routine home visits by the social services offer a good opportunity to introduce the subject of child injury prevention. Free delivery of prevention kit and simple counseling allow often deprived families to modify their behavior and to arrange their apartments so as to reduce risks.