editorial sobre a escala PERN 2018

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Overcoming the Bronchiolitis Blues: 
Embracing Global Collaboration 
and Disease Heterogeneity
Jonathan M. Mansbach, MD, MPH, a Kohei Hasegawa, MD, MPHb
Although bronchiolitis is 1 of the 
most common conditions in infancy, 
no medicine has been proven to be 
consistently beneficial. As a result, 
the primary objective of frontline 
providers in primary care and 
emergency medicine is to triage infants 
to the appropriate level of care (ie, 
home, hospital ward, or intensive care) 
for their hydration and respiratory 
needs.1
However, prospectively validated 
risk-stratification tools for infants 
with bronchiolitis do not exist for 
frontline providers. Freire et al, 2 
as part of the Pediatric Emergency 
Research Networks, addressed this 
knowledge gap by analyzing data that 
were collected from 38 emergency 
departments across the globe to 
develop a bronchiolitis risk score. 
In the resulting article, 2 the authors 
report that the usual suspects (ie, 
being ≤2 months of age; having 
apnea; oxygen saturation ofSR, et al; 
Pediatric Emergency Research 
Networks. Practice variation in acute 
bronchiolitis: a Pediatric Emergency 
Research Networks study. Pediatrics. 
2017;140(6):e20170842
 4. Pierce HC, Mansbach JM, Fisher 
ES, et al. Variability of intensive 
care management for children 
with bronchiolitis. Hosp Pediatr. 
2015;5(4):175–184
 5. Schuh S, Freedman S, Coates A, et al. 
Effect of oximetry on hospitalization 
in bronchiolitis: a randomized clinical 
trial. JAMA. 2014;312(7): 
712–718
 6. Franklin D, Babl FE, Schlapbach LJ, 
et al. A randomized trial of high-
flow oxygen therapy in infants 
with bronchiolitis. N Engl J Med. 
2018;378(12):1121–1131
 7. Kepreotes E, Whitehead B, Attia J, 
et al. High-flow warm humidified 
oxygen versus standard low-flow 
nasal cannula oxygen for moderate 
bronchiolitis (HFWHO RCT): an open, 
phase 4, randomised controlled trial. 
Lancet. 2017;389(10072):930–939
 8. Hasegawa K, Dumas O, Hartert 
TV, Camargo CA Jr. Advancing 
our understanding of infant 
bronchiolitis through phenotyping and 
endotyping: clinical and molecular 
approaches. Expert Rev Respir Med. 
2016;10(8):891–899
 9. Mansbach JM, Piedra PA, Teach SJ, 
et al; MARC-30 Investigators. 
Prospective multicenter study of 
viral etiology and hospital length 
of stay in children with severe 
bronchiolitis. Arch Pediatr Adolesc 
Med. 2012;166(8):700–706
 10. Hasegawa K, Mansbach JM, Ajami 
NJ, et al; the MARC-35 Investigators. 
Association of nasopharyngeal 
microbiota profiles with bronchiolitis 
severity in infants hospitalised 
COMPANION PAPER: A companion to this article can be found online at www. pediatrics. org/ cgi/ doi/ 10. 1542/ peds. 2017- 4253.
MANSBACH and HASEGAWA2
http://www.pediatrics.org/cgi/doi/10.1542/peds.2017-4253
for bronchiolitis. Eur Respir J. 
2016;48(5):1329–1339
 11. Mansbach JM, Hasegawa K, 
Ajami NJ, et al. Serum LL-37 
levels associated with severity of 
bronchiolitis and viral etiology. 
Clin Infect Dis. 2017;65(6): 
967–975
 12. Hasegawa K, Mansbach JM, Ajami 
NJ, et al. The relationship between 
nasopharyngeal CCL5 and microbiota 
on disease severity among 
infants with bronchiolitis. Allergy. 
2017;72(11):1796–1800
 13. Jartti T, Aakula M, Mansbach JM, 
et al. Hospital length-of-stay is 
associated with rhinovirus etiology 
of bronchiolitis. Pediatr Infect Dis J. 
2014;33(8):829–834
 14. Mansbach JM, Clark S, Teach SJ, 
et al. Children hospitalized with 
rhinovirus bronchiolitis have asthma-
like characteristics. J Pediatr. 
2016;172:202–204.e1
 15. Bergroth E, Aakula M, Korppi M, et al. 
Post-bronchiolitis use of asthma 
medication: a prospective 1-year 
follow-up study. Pediatr Infect Dis J. 
2016;35(4):363–368
 16. Mansbach JM, Hasegawa K, Henke 
DM, et al. Respiratory syncytial virus 
and rhinovirus severe bronchiolitis 
are associated with distinct 
nasopharyngeal microbiota. J Allergy 
Clin Immunol. 2016;137(6):1909–1913.
e4
 17. Hasegawa K, Pérez-Losada M, 
Hoptay CE, et al. RSV vs. rhinovirus 
bronchiolitis: difference in nasal 
airway microRNA profiles and 
NFκB signaling. Pediatr Res. 
2018;83(3):606–614
 18. Stewart CJ, Hasegawa K, Wong MC, 
et al. Respiratory syncytial virus and 
rhinovirus bronchiolitis are associated 
with distinct metabolic pathways. 
J Infect Dis. 2018;217(7):1160–1169
 19. Ralston SL, Lieberthal AS, Meissner 
HC, et al; American Academy of 
Pediatrics. Clinical practice guideline: 
the diagnosis, management, and 
prevention of bronchiolitis [published 
correction appears in Pediatrics. 
2015;136(4):782]. Pediatrics. 
2014;134(5). Available at: www. 
pediatrics. org/ cgi/ content/ full/ 134/ 5/ 
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