Chronic idiopathic bronchiolitis of infancy
a Royal
Children's Hospital, Melbourne, Australia: Department of Thoracic
Medicine, b Department of
Pathology
Correspondence to: Dr Jeremy Hull, Department of Paediatrics, Level 4, John Radcliffe Hospital, Headington, Oxford OX3 9DU.
Accepted 5 August 1997
The clinical and morphological features are presented of eight
infants who developed a chronic respiratory illness in the first year
of life characterised by tachypnoea and inspiratory crackles on
auscultation. The median age at the onset of symptoms was 1 month
(range 1 day to 7 months). Five of the infants required supplemental
oxygen. Chest radiographs showed only non-specific perihilar alveolar
shadowing and generalised hyperinflation. Investigations into the cause
of the illness in these infants, including studies for infection,
cardiac disease, and gastro-oesophageal reflux, were negative, and an
open lung biopsy sample was subsequently taken from each infant.
Histological examination showed mild lymphocytic bronchiolar
infiltration only in six of the eight infants. The other two biopsy
samples were normal. Seven of the infants were given a trial of
steroids by mouth (mean duration of treatment four months) without any
apparent benefit. These infants have now been followed up for a median
duration of 21 months (range 1-9 years). All have shown continuous
improvement, with either the end of oxygen treatment (three patients)
or the use of low flow oxygen only at night (two patients). All have
normal development and all but one have normal growth. Chest
examination has become normal in four subjects. In the remainder the
inspiratory crackles have persisted, although they have decreased
markedly in all patients. It is proposed that these infants have a
previously unreported respiratory entity and that the clinical and lung
biopsy sample findings reported here predict a favourable medium term prognosis.
© 1997 by Archives of Disease in Childhood
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