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We believe that a critical issue has been missed in the articles of Hartling et al1 and Christakis and Lehmann2 about epinephrine and the treatment of bronchiolitis. Both articles considered studies involving children younger than 2 years, which meets the North American definition of bronchiolitis; however, bronchiolitis morbidity and finding an effective treatment concern mainly infants (younger than 1 year).
The newborn's lungs move through important changes from birth to 2 years of age. The proper fetal period of lung development, with the end being the saccular stage, is close to 6 months of age, and the alveolar-arterial ratio of 20:1 in the newborn changes to 12:1 at 2 years of age, which is closer to the ratio for older children of 10:1.
For this reason, studies involving patients older than 1 year may have an increased chance of showing efficacy of treatment. The 2000 Cochrane Review3 about the use of bronchodilators in bronchiolitis showed a modest short-term improvement in clinical scores, but only some of the trials were limited to children younger than 1 year with most including toddlers and patients with recurrent wheeze.
In recent studies,4 - 5 the need for a more accurate definition of bronchiolitis is perceived and only infants at first episode of wheeze were included, without evidence of efficacy.
Ancient Romans used to say that names are a consequence of things: bronchiolitis concerns infants. A definition is an operative tool, and we believe that a more accurate definition of bronchiolitis could improve the trials' quality.
Corresponding author: Egidio Barbi, MD, Clinica Pediatrica, Istituto per l'Infanzia Burlo Garofolo, University of Trieste, Via dell'Istria 65/1, 34100 Trieste, Italy (e-mail: ebarbi@libero.it).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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