{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:46:05Z","timestamp":1793213165941,"version":"4.5.0"},"reference-count":30,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,1,1]]},"abstract":"<jats:p>Objective. Respiratory syncytial virus (RSV) bronchiolitis is a common cause of hospitalizations in children and has been increasingly identified as a risk factor in the development of asthma. Little is known about what determines the severity of RSV bronchiolitis, which may be helpful in the initial assessment of these children.<\/jats:p>\n                  <jats:p>Design. We evaluated a variety of environmental and host factors that may contribute to the severity of RSV bronchiolitis in the RSV Bronchiolitis in Early Life prospective cohort study. Severity of bronchiolitis was based on the quantization of lowest O2 saturation and the length of stay. These factors included the child's and family's demographics, presence of household allergens (dust mite, cat, dog, and cockroach), peripheral blood eosinophil count, immunoglobulin E level, infant feeding, prior illnesses, exposure to intrauterine and postnatal cigarette smoke, and family history of atopy.<\/jats:p>\n                  <jats:p>Patients. We prospectively enrolled 206 hospitalized infants, all under 12 months old (4.0 \u00b1 3.3 months old), with their first episode of severe RSV bronchiolitis (mean O2 saturation: 91.6 \u00b1 7.3%; length of stay: 2.5 \u00b1 2.5 days; presence of radiographic opacities: 75%). Patients were excluded for a variety of reasons including previous wheezing, regular use of bronchodilator or antiinflammatory medications, any preexisting lung disease including asthma, chronic lung disease of prematurity\/bronchopulmonary dysplasia, or cystic fibrosis; gastroesophageal reflux disease on medical therapy; or congenital anomalies of the chest or lung.<\/jats:p>\n                  <jats:p>Results. Age was found to be a significant factor in the severity of infection. The younger an infant was, the more severe the infection tended to be as measured by the lowest oxygen (O2) saturation. We also found that infants exposed to postnatal cigarette smoke from the mother had a lower O2 saturation than those not exposed. However, there was no significant difference in RSV bronchiolitis severity between infants exposed only to intrauterine smoke and those infants never exposed to cigarette smoke. Infants with a family history of atopy, especially a maternal history of asthma or hay fever, had a higher O2 saturation. Although a history of maternal atopy seemed to be protective, there was no association between allergens and bronchiolitis severity, although 25% of households had elevated allergen levels. Black infants demonstrated less severe RSV bronchiolitis than their white counterparts. Multivariate analysis revealed age, race, maternal atopy, and smoking to be associated with severity of RSV bronchiolitis.<\/jats:p>\n                  <jats:p>Conclusion. The severity of RSV bronchiolitis early in life seems modified by postnatal maternal cigarette smoke exposure and atopy and age of the infant, not by levels of allergens in the home environment.<\/jats:p>","DOI":"10.1542\/peds.2004-0059","type":"journal-article","created":{"date-parts":[[2017,1,26]],"date-time":"2017-01-26T13:31:21Z","timestamp":1485437481000},"page":"e7-e14","source":"Crossref","is-referenced-by-count":164,"title":["Severity of Respiratory Syncytial Virus Bronchiolitis Is Affected by Cigarette Smoke Exposure and Atopy"],"prefix":"10.1542","volume":"115","author":[{"given":"Joseph P.","family":"Bradley","sequence":"first","affiliation":[{"name":"Departments of Internal Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard B.","family":"Bacharier","sequence":"additional","affiliation":[{"name":"Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JoAnn","family":"Bonfiglio","sequence":"additional","affiliation":[{"name":"Departments of Internal Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth B.","family":"Schechtman","sequence":"additional","affiliation":[{"name":"Biostatistics, Washington University School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Strunk","sequence":"additional","affiliation":[{"name":"Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Storch","sequence":"additional","affiliation":[{"name":"Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Castro","sequence":"additional","affiliation":[{"name":"Departments of Internal Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2005,1,1]]},"reference":[{"key":"2021121011054657300_R1","doi-asserted-by":"crossref","unstructured":"Moler F, Ohmit S. Severity of illness models for respiratory syncytial virus-associated hospitalization. Am J Respir Crit Care Med.\u20081999;159:1234\u20131240","DOI":"10.1164\/ajrccm.159.4.9807075"},{"key":"2021121011054657300_R2","doi-asserted-by":"crossref","unstructured":"Frankel L, Lewiston N, Stevenson D. Clinical observations on mechanical ventilation for respiratory failure in bronchiolitis. Pediatr Pulmonol.\u20081986;2:307\u2013311","DOI":"10.1002\/ppul.1950020511"},{"key":"2021121011054657300_R3","doi-asserted-by":"crossref","unstructured":"Everard M, Milner A. The respiratory syncytial virus and its role in acute bronchiolitis. Eur J Pediatr.\u20081992;151:638\u2013650","DOI":"10.1007\/BF01957564"},{"key":"2021121011054657300_R4","doi-asserted-by":"crossref","unstructured":"Tissing W, van Steensel-Moll H, Offringa M. Risk factors for mechanical ventilation in respiratory syncytial virus infection. Eur J Pediatr.\u20081993;152:125\u2013127","DOI":"10.1007\/BF02072488"},{"key":"2021121011054657300_R5","doi-asserted-by":"crossref","unstructured":"Sigurs N, Bjarnason R, Sigurbergsson F, Kjellman B. Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7. Am J Respir Crit Care Med.\u20082000;161:1501\u20131507","DOI":"10.1164\/ajrccm.161.5.9906076"},{"key":"2021121011054657300_R6","doi-asserted-by":"crossref","unstructured":"Stein R, Sherrill D, Morgan W, et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet.\u20081999;354:541\u2013545","DOI":"10.1016\/S0140-6736(98)10321-5"},{"key":"2021121011054657300_R7","doi-asserted-by":"crossref","unstructured":"Hamilton RG, Eggleston PA. Environmental allergen analyses. Methods.\u20081997;13:53\u201360","DOI":"10.1006\/meth.1997.0495"},{"key":"2021121011054657300_R8","doi-asserted-by":"crossref","unstructured":"Weiss S, Horner A, Shapiro G, Sternberg A, for the Childhood Asthma Management Program (CAMP) Research Group. The prevalence of environmental exposure to perceived asthma triggers in children with mild-to-moderate asthma: data from the Childhood Asthma Management Program (CAMP). J Allergy Clin Immunol.\u20082001;107:634\u2013640","DOI":"10.1067\/mai.2001.113869"},{"key":"2021121011054657300_R9","doi-asserted-by":"crossref","unstructured":"Hanrahan J, Tager I, Segal M, et al. The effect of maternal smoking during pregnancy on early infant lung function. Am Rev Respir Dis.\u20081992;145:1129\u20131135","DOI":"10.1164\/ajrccm\/145.5.1129"},{"key":"2021121011054657300_R10","doi-asserted-by":"crossref","unstructured":"Tager I, Ngo L, Hanrahan J. Maternal smoking during pregnancy. Effects on lung function during the first 18 months of life. Am J Respir Crit Care Med.\u20081995;152:977\u2013983","DOI":"10.1164\/ajrccm.152.3.7663813"},{"key":"2021121011054657300_R11","doi-asserted-by":"crossref","unstructured":"Corbo G, Agabiti N, Forastiere F, et al. Lung function in children and adolescents with occasional exposure to environmental tobacco smoke. Am J Respir Crit Care Med.\u20081996;154:695\u2013700","DOI":"10.1164\/ajrccm.154.3.8810607"},{"key":"2021121011054657300_R12","doi-asserted-by":"crossref","unstructured":"Li Y, Gilliland F, Berhane K, et al. Effects of in utero and environmental tobacco smoke exposure on lung function in boys and girls with and without asthma. Am J Respir Crit Care Med.\u20082000;162:2097\u20132104","DOI":"10.1164\/ajrccm.162.6.2004178"},{"key":"2021121011054657300_R13","doi-asserted-by":"crossref","unstructured":"Dezateux C, Stocks J, Dundas I, Fletcher M. Impaired airway function and wheezing in infancy: the influence of maternal smoking and a genetic predisposition to asthma. Am J Respir Crit Care Med.\u20081999;159:403\u2013410","DOI":"10.1164\/ajrccm.159.2.9712029"},{"key":"2021121011054657300_R14","doi-asserted-by":"crossref","unstructured":"Hofhuis W, De Jongste J, Merkus P. Adverse health effects of prenatal and postnatal tobacco smoke exposure on children. Arch Dis Child.\u20082003;88:1086\u20131090","DOI":"10.1136\/adc.88.12.1086"},{"key":"2021121011054657300_R15","doi-asserted-by":"crossref","unstructured":"Gilliland F, Li Y, Dubeau L, et al. Effects of glutathione S-transferase M1, maternal smoking during pregnancy, and environmental tobacco smoke on asthma and wheezing in children. Am J Respir Crit Care Med.\u20082002;166:457\u2013463","DOI":"10.1164\/rccm.2112064"},{"key":"2021121011054657300_R16","doi-asserted-by":"crossref","unstructured":"Gilliland F, Li Y, Peters J. Effects of maternal smoking during pregnancy and environmental tobacco smoke on asthma and wheezing in children. Am J Respir Crit Care Med.\u20082001;163:429\u2013436","DOI":"10.1164\/ajrccm.163.2.2006009"},{"key":"2021121011054657300_R17","doi-asserted-by":"crossref","unstructured":"Ehrlich R, Du Toit D, Jordann E, et al. Risk factors for childhood asthma and wheezing. Importance of maternal and household smoking. Am J Respir Crit Care Med.\u20081996;154:681\u201388","DOI":"10.1164\/ajrccm.154.3.8810605"},{"key":"2021121011054657300_R18","doi-asserted-by":"crossref","unstructured":"Infante-Rivard C, Gautrin D, Malo J, Suissa S. Maternal smoking and childhood asthma. Am J Epidemiol.\u20081999;150:528\u2013531","DOI":"10.1093\/oxfordjournals.aje.a010042"},{"key":"2021121011054657300_R19","doi-asserted-by":"crossref","unstructured":"Larsson M, Frisk M, Hallstrom J, Kiviloog J, Lundback B. Environmental tobacco smoke exposure during childhood is associated with increased prevalence of asthma in adults. Chest.\u20082001;120:711\u2013717","DOI":"10.1378\/chest.120.3.711"},{"key":"2021121011054657300_R20","doi-asserted-by":"crossref","unstructured":"Singh S, Barret E, Kalra R, et al. Prenatal cigarette smoke decreases lung cAMP and increases airway hyperresponsiveness. Am J Respir Crit Care Med.\u20082003;168:342\u2013347","DOI":"10.1164\/rccm.200211-1262OC"},{"key":"2021121011054657300_R21","doi-asserted-by":"crossref","unstructured":"Lanari M, Giovannini M, Giuffre L, et al. Prevalence of respiratory syncytial virus infection in Italian infants hospitalized for acute lower respiratory tract infections, and association between respiratory syncytial virus infection risk factors and disease severity. Pediatr Pulmonol.\u20082002;33:458\u2013465","DOI":"10.1002\/ppul.10047"},{"key":"2021121011054657300_R22","unstructured":"Gurkan F, Kiral A, Dagli E, Karakoc F. The effect of passive smoking on the development of respiratory syncytial virus bronchiolitis. Eur J Epidemiol.\u20082000;16:465\u2013468"},{"key":"2021121011054657300_R23","doi-asserted-by":"crossref","unstructured":"Aligne C, Stoddard J. Tobacco and children. An economic evaluation of the medical effects of parental smoking. Arch Pediatr Adolesc Med.\u20081997;151:648\u2013653","DOI":"10.1001\/archpedi.1997.02170440010002"},{"key":"2021121011054657300_R24","doi-asserted-by":"crossref","unstructured":"La Via W, Grant S, Stutman H, Marks M. Clinical profile of pediatric patients hospitalized with respiratory syncytial virus infection. Clin Pediatr (Phila).\u20081993;32:450\u2013454","DOI":"10.1177\/000992289303200801"},{"key":"2021121011054657300_R25","doi-asserted-by":"crossref","unstructured":"Castro M, Halstead J, Schechtman K, Bloomberg G. Risk factors for asthma morbidity and mortality in a large metropolitan city. J Asthma.\u20082001;38:625\u2013636","DOI":"10.1081\/JAS-100107540"},{"key":"2021121011054657300_R26","doi-asserted-by":"crossref","unstructured":"Coultas D, Gong HJ, Grad R, et al. Respiratory diseases in minorities of the United States. Am J Respir Crit Care Med.\u20081993;149:S93\u2013S131","DOI":"10.1164\/ajrccm\/149.3_Pt_2.S93"},{"key":"2021121011054657300_R27","doi-asserted-by":"crossref","unstructured":"Robinson P, Hegele R, Schellenberg R. Allergic sensitization increases airway reactivity in guinea pigs with respiratory syncytial virus bronchiolitis. J Allergy Clin Immunol.\u20081997;100:492\u2013498","DOI":"10.1016\/S0091-6749(97)70141-6"},{"key":"2021121011054657300_R28","doi-asserted-by":"crossref","unstructured":"Martinez F. Links between pediatric and adult asthma. J Allergy Clin Immunol.\u20082001;107:S449\u2013S455","DOI":"10.1067\/mai.2001.114993"},{"key":"2021121011054657300_R29","doi-asserted-by":"crossref","unstructured":"Strannegard O, Cello J, Bjarnason R, Sigurbergsson F, Sigurs N. Association between pronounced IgA response in RSV bronchiolitis and development of allergic sensitization. Pediatr Allergy Immunol.\u20081997;8:1\u20136","DOI":"10.1111\/j.1399-3038.1997.tb00134.x"},{"key":"2021121011054657300_R30","doi-asserted-by":"crossref","unstructured":"Green M, Brayer A, Schenkman K, Wald E. Duration of hospitalization in previously well infants with respiratory syncytial virus infection. Pediatr Infect Dis.\u20081989;8:601\u2013605","DOI":"10.1097\/00006454-198909000-00007"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/115\/1\/e7\/1003976\/zpe001050000e7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/115\/1\/e7\/1003976\/zpe001050000e7.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T19:06:41Z","timestamp":1639163201000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/115\/1\/e7\/66968\/Severity-of-Respiratory-Syncytial-Virus"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,1,1]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2005,1,1]]},"published-print":{"date-parts":[[2005,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2004-0059","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2005,1,1]]}}}