Paula Heikkilä

Aim: To compare high‐flow oxygen therapy (HFOT) with continuous positive airway pressure (CPAP) in children with bronchiolitis aged < 24 months, using treatment failure, length of stay (LOS) in the paediatric intensive care unit (PICU), and adverse events as outcomes. Methods: Systematic literature search was conducted using PubMed and Scopus until March 13, 2024. Data from prospective and retrospective studies comparing HFOT to CPAP were incorporated in the random‐effects meta‐analysis model. The results for treatment failure were presented as risk ratios (RRs) with 95% confidence intervals (95% CIs), and those for LOS in the PICU as mean differences (MD) with 95% CIs. Results: Eight studies fulfilled the inclusion criteria, and one study was found by manual search. Treatment failure was less often associated with CPAP than with HFOT (RR: 0.65; 95% CI: 0.51–0.81). Instead, LOS in the PICU did not differ (standardised MD: −0.10; 95% CI: −0.27 to 0.06). Adverse events were minor being associated more often with CPAP. Conclusion: Both HFOT and CPAP were safe for treating bronchiolitis, but CPAP showed a lower risk of treatment failure. Our results can be generalized to those treated in the PICU.

Background and Aims: Viral respiratory tract infections are common in all age groups, and they are responsible for a vast number of health care visits every year. Furthermore, the incidence of respiratory infections is the highest in children. We aimed to determine how infants presenting with fever and symptoms of respiratory infections were treated at Tampere University Hospital (Tays) and their responses to treatment. The secondary purpose was to describe the specific diagnosis behind the respiratory symptoms. Methods: This study was conducted in the Department of Paediatrics in Tays, Finland. Inclusion criteria were age < 1 year, fever, and symptoms of a respiratory infection. We documented from the electronic patient records the medication and other treatments the infants received during their hospital stays. For infants given the same medication multiple times, only the first dosing and response to that medication were documented. Results: The study included 119 episodes (117 infants), 50 (42%) of whom were hospitalized. Symptom‐relieving medications, such as paracetamol, were used frequently, with generally good responses. Overall, 59% of the infants were administered antibiotics, the most common indication being otitis media. The most common primary or secondary diagnosis was bronchiolitis or bronchitis (43%). Conclusion: Nearly half of the infants needed hospitalization. Symptom‐relieving medications, such as analgesics, were a key treatment choice, and the responses were generally good. Although the majority of the infants had a viral infection, antibiotics were used frequently, at least partially due to secondary bacterial infections.

Aim: The aim of this umbrella review was to summarise the existing evidence on the effectiveness of nursing interventions targeted at adult patients in hospitals.Design: Existing systematic reviews were synthesised.Data Sources: The literature search was conducted in PubMed, CINAHL Complete, and the Cochrane Library by two of the authors until June 6th 2024 without a time limit.Methods: A total of 2652 records were identified. After screening the titles and abstracts, 2421 records were excluded. Then two records were excluded as they were not retrieved, and 125 records were excluded during full‐text review as they did not meet the inclusion criteria. Finally, 11 reviews (141 original studies) were included in the quality assessment and were analysed narratively.Results: The most commonly used interventions were educational, followed by preventive, observative, or combinations of various interventions. All interventions were targeted at the care of somatic patients. The interventions lacked detailed descriptions of their content and duration. Nursing interventions were found to reduce anxiety, depression, disorder symptoms, pain intensity, length of hospital stay, serious adverse effects, mortality, infections and pressure ulcer prevalence.Conclusions: There is limited high‐quality evidence on the effectiveness of nursing interventions used by nurses at hospital settings. While nursing interventions can improve hospital patient outcomes, more high‐quality systematic reviews and meta‐analyses are needed. Only preventive interventions (such as pressure ulcer prevention and use of early warning scores) consistently showed positive effects and are relatively easy to implement in hospital nursing practice. Other interventions are not yet widely integrated into standard care in hospitals. It is necessary to study the cost‐effectiveness of nursing interventions.No Patient or Public Contributions: This umbrella review did not include any patient or public involvement.Reporting Method: This umbrella review of systematic reviews adheres to the PRISMA statement.

The aim was to evaluate asthma and health-related quality of life (HRQoL) outcomes in adolescents, after hospital-treated bronchiolitis experienced in less than 6 months of age. A prospective cohort study started in 2001–2004 and followed up 166 children hospitalised for bronchiolitis in early infancy. At 16–20 years of age, 76 cases and 41 population-based controls without a history of bronchiolitis participated in the current study. Clinical asthma, presumptive symptoms and HRQoL data were collected with a structured questionnaire and the St. Georges Respiratory Questionnaire (SGRQ). Flow-volume spirometry was measured before and after bronchodilator administration. Asthma was present in 21.1% of cases in the post-bronchiolitis cohort compared to 9.8% in the control group (p = 0.21). Also, 35.5% of cases and 19.5% of controls reported dyspnea during the last 12 months (p = 0.04). In addition, total SGRQ scores were higher in the bronchiolitis group (4.26) than in the control group (1.67, p < 0.001) referring to a reduced health-related quality of life. Conclusion: Viral bronchiolitis in early infancy was associated with increased respiratory symptoms and lower health-related quality of life at age 16–20 years. What is known:• The prevalence of asthma at the school age and adolescence is increased after hospitalisation required bronchiolitis in infancy compared to those without hospitalisation due to bronchiolitis. What is new:• Viral bronchiolitis requiring hospitalisation in early infancy was associated with increased respiratory symptoms, such as dyspnoea, and lower health-related quality of life at age 16–20 years in a prospectively followed post-bronchiolitis cohort.

To evaluate the management of bronchiolitis in the paediatric intensive care unit (PICU) before and after publication of the national bronchiolitis guidelines in June 2015. All infants treated between 2016–2020 for bronchiolitis in the PICU of Tampere University Hospital at < 12 months of age were included. The data were retrospectively collected from electronic patient records. The current results reflecting the post-guideline era were compared with previously published results for the pre-guideline 2000–2015 period. These two studies used identical protocols. Forty-six infants treated in the PICU were included. During the post-guideline era, inhaled adrenaline was given to 26 (57%), salbutamol to 7 (15%), and hypertonic saline inhalations to 35 (75%) patients. Forty-three patients (94%) received high-flow oxygen therapy (HFOT). Seventeen patients (37%) were treated with nasal continuous positive airway pressure (CPAP) and 4 (9%) with mechanical ventilation.Conclusion: When post-guideline years were compared with pre-guideline years, the use of bronchodilators decreased in agreement, but the use of inhaled saline increased in disagreement with the guidelines. The use of respiratory support increased, evidently because of an introduction of the non-invasive HFOT treatment modality. What is Known:• Oxygen supplementation and respiratory support, when needed, are the cornerstones of bronchiolitis treatment.• Medicines are frequently given to infants with bronchiolitis, especially if intensive care is needed, although evidence of their effectiveness is lacking. What is New:• Nearly all (94%) infants who needed intensive care were treated with HFOT and 37% with nasal CPAP, and finally, only 9% were intubated, which reflects the effectiveness of non-invasive techniques.• When pre- and post-guideline eras were compared, use of racemic adrenaline decreased from 84 to 57%, but use of hypertonic saline increased up to 75%, which disagrees with the current guidelines.

Aim: We evaluated antibiotic prescriptions issued for Finnish children with acute sinusitis by a nationwide private outpatient clinic network from 2014–2020. Data were compared before and after updated guidelines in 2018.Methods: The study comprised data on 45 296 children aged 2–17 years with acute sinusitis, namely diagnoses, ages, dates, the doctor's specialty and any antibiotics. We measured compliance with the updated 2018 Finnish guidelines, which recommended amoxicillin or amoxicillin‐clavulanic acid for children under 12 years old, with doxycycline as an alternative for 12 years plus.Results: There were 6621–7585 visits per year for acute sinusitis in 2014–2019 and 2954 in 2020. Antibiotics were prescribed for 37.9%–41.6% of patients during the study years. Amoxicillin, including penicillin, accounted for 35.9% of prescriptions, followed by amoxicillin‐clavulanic acid (26.9%). Macrolides accounted for 20.6% and, encouragingly, decreased by 38% from 2014–2019. Doxycycline accounted for 5.3%. Paediatricians, general practitioners (GPs) and ear, nose and throat specialists followed the guidelines in 75.1%, 73.8% and 66.7% of cases, respectively. GPs prescribed antibiotics more often than other physicians.Conclusion: Antibiotics were prescribed for about 40% of acute sinusitis visits by Finnish children from 2014–2019. Specialities differed with regard to prescribing rates and whether they followed the guidelines.

Purpose To evaluate the management of bronchiolitis in the paediatric intensive care unit (PICU) before and after publication of the national bronchiolitis guidelines in 2014. Methods All infants treated between 2016–2020 for bronchiolitis in the PICU of Tampere University Hospital at < 12 months of age were included. The data were retrospectively collected from electronic patient records. The current results reflecting the post-guideline era were compared with previously published results for the pre-guideline 2000–2015 period. These two studies used identical protocols. Results Forty-six infants treated in the PICU were included. During the post-guideline era, inhaled adrenaline was given to 26 (57%), salbutamol to 7 (15%), and hypertonic saline inhalations to 35 (75%) patients. Forty-three patients (94%) received high-flow oxygen therapy (HFOT). Seventeen patients (37%) were treated with nasal continuous positive airway pressure (CPAP) and 4 (9%) with mechanical ventilation. Conclusion When post-guideline years were compared with pre-guideline years, the use of bronchodilators decreased in agreement, but the use of inhaled saline increased in disagreement with the guidelines. The use of respiratory support increased, evidently because of an introduction of the non-invasive HFOT treatment modality.

Aim: This study aimed to evaluate antibiotic prescriptions for children with otitis media (OM) in a large nationwide network of private clinics between 2014 and 2020. Special focus was paid to amoxicillin and amoxicillin-clavulanic acid prescriptions, which the national guidelines recommend for first-line drugs. We also focused on macrolides, which are commonly prescribed for respiratory tract infections in children but are not appropriate for OM cases. Methods: The data were obtained from the electronic health records of about 250,000 annual visits in <18 years old children. The collected variables were all diagnoses, age, visit year, doctor’s specialty, and prescribed antibiotics. Children with OM and upper respiratory tract infections were included, but those with lower respiratory tract infections were excluded. Results: The number of children with OM was 357,390 (55.2% boys). Antibiotics were prescribed in 44.8% of cases, with the lowest proportion (44.1%) being in <2 years old children. The overall prescription rate decreased from 48.3% in 2014 to 41.4% in 2020. The rates were 19.3% and 18.1% for amoxicillin and 12.6% and 13.2% for amoxicillin-clavulanic acid, respectively. Macrolide prescriptions were reduced from 7.5% to 3.5%. Pediatricians prescribed antibiotics for 38.8%, general practitioners for 54.0% and ear, nose and throat physicians for 39.8% of children with OM. Conclusion: The selection of antibiotics for OM, when prescribed, was according to the recommendations (amoxicillin or amoxicillin-clavulanic acid) in 80.1% of pediatricians, 67.0% of general practitioners and 55.1% of ear, nose and throat physicians.

Background: Bronchiolitis, a lower respiratory tract infection, causes a remarkable number of hospitalizations globally. The epidemiology follows the same pattern as respiratory syncytial virus (RSV), the most common pathogen in bronchiolitis. Epidemics have typically followed a biannual pattern in Nordic countries—first, a small epidemic during spring, followed by a higher peak the next autumn. The aim of this study was to evaluate whether the incidence of bronchiolitis hospitalization has changed during the last 2 decades in Tampere, Finland. Methods: In this retrospective register-based study, data on infants <12 months of age hospitalized with bronchiolitis in 2000–2019 were collected from electronic files of Tampere University Hospital and analyzed by monthly incidences. Additionally, data on RSV incidences were collected from the Finnish National Infectious Diseases Register for children <5 years of age and living in the study area. Poisson’s regression analysis was used to evaluate changes in the incidence rates of bronchiolitis. Results: Of the 1481 infants hospitalized with bronchiolitis, 82.0% had a diagnosis of RSV bronchiolitis. At first, bronchiolitis’ epidemiological pattern followed its typical biannual pattern, then shifted to annual in the middle of the study period, and thereafter occurred biannually again. The highest incidence rate ratios compared to the low-incidence months were between December (22.5), January (25.8) and February (25.5) in 2000–2006, and between February (24.7), March (25.1) and April (21.0) in 2007–2019. Conclusions: The epidemiological pattern of bronchiolitis changed during the study period; incidence peaks were higher and have shifted toward spring in recent years.

Upper respiratory tract infection (URTI) is a self-limiting viral infection and should not be treated with antibiotics. The aim was to evaluate antibiotic prescriptions for children with uncomplicated URTI in a large nationwide private clinic network between 2014 and 2020. Special focus was given to macrolide prescriptions and costs. The data were obtained from the electronic health records (EHR) of the largest private healthcare company in Finland (with about 250,000 paediatric visits annually across the country). The collected variables included diagnoses, age, visit year, speciality of the doctor, and prescribed antibiotics. The number of uncomplicated URTIs in < 18-year-old children was 156,187 (53.0% in boys). The prescription rate of antibiotics decreased from 18.0% in 2014 to 8.8% in 2020, and that of macrolides from 6.1 to 1.7%. The costs decreased accordingly. Paediatricians prescribed antibiotics less often than general practitioners or ear, nose, and throat specialists.Conclusion: Antibiotic prescriptions for uncomplicated URTIs, especially macrolides, decreased substantially during the 7-year surveillance period; however, 8.8% of children still received unnecessary antibiotics. To further reduce unwarranted antibiotic prescriptions, active interventions are needed that can be performed by applying the available EHR system. What is Known:• Upper respiratory tract infection (URTI) is the most common infection in children. Uncomplicated URTI is a self-limiting viral infection, and antibiotic treatment is not warranted. What is New:• Almost 9% of children with uncomplicated URTIs still received unnecessary antibiotics. Paediatricians prescribed antibiotics less often than general practitioners or ear, nose, and throat specialists. To further reduce unwarranted antibiotic prescriptions, active interventions are needed that can be performed by applying the available EHR system.