Bronchiolitis : Management and risk factors for severe disease

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Arvo building, Yellow Hall F025, address: Arvo Ylpön katu 34.

Doctoral defence of Lic.Med. Minna Mecklin

Bronchiolitis : Management and risk factors for severe disease

The field of science of the dissertation is Paediatrics.

The opponent is docent Paula Rautiainen (University of Helsinki). Professor emeritus Matti Korppi acts as the custos.

The language of the dissertation defence is Finnish.

Small infants are at risk for needing intensive care due the bronchiolitis

Preschool children infected with the virus experience breathing difficulties; a third of the children younger than 24 months will have at least one expiratory breathing difficulty. From those, one out of 10 is admitted to the hospital. The first breathing difficulty is called bronchiolitis. A unified consensus of the diagnosis’s criteria in still lacking. The cornerstones of the treatment are oxygen supplementation and rehydration. Previously, several medications, such as salbutamol, adrenaline, corticosteroids, and saline inhalations have been used, even though they have not influenced the course of the disease.

The thesis consists of four original publications, which evaluated the incidence of admissions to the paediatric intensive care unit (PICU), management of severe bronchiolitis, and the risk factors for PICU requirements and the need for respiratory support among infants younger than 12 months with bronchiolitis. In addition, the questionnaire survey investigated the definition and treatment of bronchiolitis in Finland and Sweden. The impact of Current Care Guidelines was evaluated in four university hospitals on the usage of racemic adrenaline.

In the Tampere University Hospital, 105 infants with bronchiolitis were treated in the PICU between 2000–2015, from whom 53 needed respiratory support. The incidence of infants with bronchiolitis who needed admission into the PICU was similar to those in Europe. The requirement of PICU admission remained constant. Independent risk factors were an age of younger than 2 months, a birth weight less than a 2000 g and congenital heart disease.

The management of bronchiolitis changed during the 16-year period in the Tampere University Hospital. Unnecessary treatments, such as salbutamol and corticosteroids, decreased. While the use of saline inhalations and adrenaline inhalations increased. The high-flow nasal cannula was introduced in 2011.

In Finland and Sweden, average upper age limit was 12 months. The responding paediatricians emphasised the importance of supplementary oxygen and rehydration. In Sweden, nasogastric tube hydration was used more commonly than in Finland. Both countries reported using salbutamol and adrenaline inhalations.

The Current Care Guidelines on lower respiratory tract infections were published 2014 and it recommended not to use racemic adrenaline inhalation in infants with bronchiolitis. Substantial differences existed in the yearly consumption of racemic adrenaline between four participating university hospitals, both before and after the publication of the Finnish Current Care Guidelines for bronchiolitis in 2014.


The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2441, Tampere University Press, Tampere 2018. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1954, Tampere University Press 2018.

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