Letters to the Editor
To the Editors:
We read the article by Heinonen et al1 regarding the association between transient tachypnea (TTN) of the newborn and the risk of hospitalization due to respiratory syncytial virus bronchiolitis. In their article, the authors stated that TTN diagnosis after birth was associated with an increased risk for respiratory syncytial virus (RSV) hospitalization during the first year of life. In the study group although RSV was not detected, assumptions were made according to previous studies. But etiology of bronchiolitis and other respiratory tract infections could change according to geography and season of the study group.
In a study from Taiwan between January 2009 and March 2011, out of 113 children with bronchiolitis, <2 years of age, RSV was the most common pathogen and was identified in only 43.4% of the cases.2
In our study, in which 688 pediatric patients hospitalized with the influenza-like disease during the 2017–2018 were evaluated, 74 patients were influenza-positive (22%), 115 patients were RSV positive (34.3%) and 146 patients were positive for other-agents (43.5%) (unpublished data, 2017–2018). In patients admitting to hospital with a presentation of bronchiolitis or other respiratory tract infections, knowing the causative agent is important in terms of treatment of influenza infection and prevention of complications. And also laboratory tests to detect viral causative agents reduce unnecessary use of antibiotics.
Assumption that >70% of bronchiolitis patients younger than 1 years old were caused by RSV could affect prophylaxis regimens and also future treatment plans of RSV, so it could be better to say that TTN of the newborn is associated with an increased risk of hospitalization due to bronchiolitis (not only due to RSV bronchiolitis).
Heinonen et al1 also discussed that gestational age at birth, mode of delivery, gender, birth weight, multiple births, older siblings and maternal smoking, TTN was associated with an increased risk for bronchiolitis hospitalization. These studies defining risk factors for bronchiolitis are very helpful to guide clinicians. Further studies, particularly randomized controlled trials, are warranted in pediatric patients with bronchiolitis to fully elucidate the etiology and to guide therapy.
Aslinur Ozkaya-Parlakay, MD
Belgin Gulhan, MD
Tugba Bedir-Demirdag, MD
Saliha Kanik-Yuksek, MD
Pediatric Infectious Diseases Unit, Ankara Hematology and Oncology, Research Hospital, Health Sciences University, Ankara, Turkey
1. Heinonen S, Süvari L, Gissler M, et al. Transient tachypnea of the newborn is associated with an increased risk of hospitalization due to respiratory syncytial virus bronchiolitis. Pediatr Infect Dis J. 2019;38:419–421.
2. Chen YW, Huang YC, Ho TH, et al. Viral etiology of bronchiolitis among pediatric inpatients in northern Taiwan with emphasis on newly identified respiratory viruses. J Microbiol Immunol Infect. 2014;47:116–121.