Although many infants with bronchiolitis have abnormalities on chest radiography, data are insufficient to demonstrate that chest radiography correlates well with disease severity. Articles included in the 2003 evidence report on bronchiolitis in preparation of the AAP 2006 guideline2 also were reviewed. When clinicians diagnose bronchiolitis on the basis of history and physical examination, radiographic or laboratory studies should not be obtained routinely (Evidence Quality: B; Recommendation Strength: Moderate Recommendation). Key action statements (KASs) based on that evidence are provided. Does epinephrine alone reduce admission in outpatient settings? Severe viral respiratory infections in infants with cystic fibrosis. Risk of secondary bacterial infection in infants hospitalized with respiratory syncytial viral infection. A recent Cochrane meta-analysis by Hartling et al64 systematically evaluated the evidence on this topic and found no evidence for utility in the inpatient setting. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. A placebo-controlled trial of antimicrobial treatment for acute otitis media. ), AND (exp Breast Feeding/ OR exp Milk, Human/ OR exp Bottle Feeding/), AND (MH “Breast Feeding+” OR MH “Milk, Human+” OR MH “Bottle Feeding+”), AND (hand hygiene OR handwashing OR hand decontamination), Shawn L. Ralston, MD, FAAP: Chair, Pediatric Hospitalist (no financial conflicts; published research related to bronchiolitis), Allan S. Lieberthal, MD, FAAP: Chair, General Pediatrician with Expertise in Pulmonology (no conflicts), Brian K. Alverson, MD, FAAP: Pediatric Hospitalist, AAP Section on Hospital Medicine Representative (no conflicts), Jill E. Baley, MD, FAAP: Neonatal-Perinatal Medicine, AAP Committee on Fetus and Newborn Representative (no conflicts), Anne M. Gadomski, MD, MPH, FAAP: General Pediatrician and Research Scientist (no financial conflicts; published research related to bronchiolitis including Cochrane review of bronchodilators), David W. Johnson, MD, FAAP: Pediatric Emergency Medicine Physician (no financial conflicts; published research related to bronchiolitis), Michael J. Clinicians should not administer systemic corticosteroids to infants with a diagnosis of bronchiolitis in any setting (Evidence Quality: A; Recommendation Strength: Strong Recommendation). Quality improvement interventions have shown reduced use of unnecessary treatments and reduced resource allocation. It is a common, and sometimes severe illness. Children with respiratory distress treated with high-flow nasal cannula. Clinical signs and symptoms of bronchiolitis consist of rhinorrhea, cough, tachypnea, wheezing, rales, and increased respiratory effort manifested as grunting, nasal flaring, and intercostal and/or subcostal retractions. Population-based data are not available on the incidence or severity of RSV hospitalization in children who undergo solid organ or hematopoietic stem cell transplantation, receive chemotherapy, or are immunocompromised because of other conditions. The efficacy of nebulized metaproterenol in wheezing infants and young children. 8. The resulting comments were reviewed by the subcommittee and, when appropriate, incorporated into the guideline. Bronchiolitis is a common lung infection in young children and infants. Pediatric Emergency Research Canada (PERC). Double-blind clinical trial [in Spanish]. Geneva, Switzerland: World Health Organization; 2009. A combination of systemic corticosteroids and nebulised adrenaline. The authors noted some conflicting evidence, but further study was recommended only if the population could be clearly defined and meaningful outcome measures could be identified. Stephen Sayles, III, MD, FACEP: Emergency Medicine Physician, American College of Emergency Physicians Liaison (no conflicts), Sinsi Hernández-Cancio, JD: Parent/Consumer Representative (no conflicts). High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study. Does this infant have pneumonia? Ralston SL, Lieberthal AS, Meissner HC, et al. One of these large trials, the Canadian Bronchiolitis Epinephrine Steroid Trial, however, did show a reduction in hospitalizations 7 days after treatment with combined nebulized epinephrine and oral dexamethasone as compared with placebo.69 Although an unadjusted analysis showed a relative risk for hospitalization of 0.65 (95% CI 0.45 to 0.95; P = .02) for combination therapy as compared with placebo, adjustment for multiple comparison rendered the result insignificant (P = .07). Clinicians should administer a maximum 5 monthly doses (15 mg/kg/dose) of palivizumab during the RSV season to infants who qualify for palivizumab in the first year of life (Evidence Quality: B, Recommendation Strength: Moderate Recommendation). Conversely, food intake in the previous 24 hours may be a predictor of oxygen saturation among infants with bronchiolitis. Corticosteroids for hospitalised children with acute asthma. Excessive secretion of antidiuretic hormone in infections with respiratory syncytial virus. One study found that food intake at less than 50% of normal for the previous 24 hours is associated with a pulse oximetry value of <95%.180 Infants with mild respiratory distress may require only observation, particularly if feeding remains unaffected. One key problem is the range of clinical guidelines and the few treatment options … An evaluation of chest physiotherapy in the management of acute bronchiolitis: changing clinical practice. 10b. Respiratory syncytial virus and recurrent wheeze in healthy preterm infants. How to care for your child at home, and what to look out for if you think they may need hospital treatment. Empiric antibiotics are justified for infants with RSV presenting with respiratory failure. Prediction of pneumonia in a pediatric emergency department. This review contained 17 trials with 2596 participants and included 2 large ED-based randomized trials, neither of which showed reductions in hospital admissions with treatment with corticosteroids as compared with placebo.69,86. Palivizumab for prophylaxis against respiratory syncytial virus infection in children with cystic fibrosis. Bronchiolitis in children; NICE Guideline (May 2015) Murray J, Bottle A, Sharland M, et al; Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study. There are no vaccines or specific treatments for bronchiolitis. Clinical and therapeutic variables influencing hospitalisation for bronchiolitis in a community-based paediatric group practice. Parental satisfaction scores did not differ between the intravenous and nasogastric groups. The potential adverse effects (tachycardia and tremors) and cost of these agents outweigh any potential benefits. Available at: Enter multiple addresses on separate lines or separate them with commas. By adhering to these standards, guidelines can improve their quality and promote their applicability and adoption in practice. Clinicians should administer palivizumab during the first year of life to infants with hemodynamically significant heart disease or chronic lung disease of prematurity defined as preterm infants <32 weeks 0 days’ gestation who require >21% oxygen for at least the first 28 days of life (Evidence Quality: B; Recommendation Strength: Moderate Recommendation). Rosen et al230 performed a meta-analysis of the effects of interventions in pediatric settings on parental cessation and found a pooled risk ratio of 1.3 for cessation among the 18 studies reviewed. A subsequent report176 followed 150 children hospitalized for bronchiolitis for the development of AOM. Insufficient data are available to recommend routine use of prophylaxis in children with Down syndrome, cystic fibrosis, pulmonary abnormality, neuromuscular disease, or immune compromise. A systematic review, The Fecal Microbiota Profile and Bronchiolitis in Infants. By Anne E. … 03-E014. Bronchiolitis: recent evidence on diagnosis and management. Monoclonal antibody for reducing the risk of respiratory syncytial virus infection in children. Long-acting beta2-adrenoceptor agonists synergistically enhance glucocorticoid-dependent transcription in human airway epithelial and smooth muscle cells. Copyright © 2020 American Academy of Family Physicians. Evidence Report/Technology Assessment No. The doctor can usually identify the problem by observing your child and listening to his or her lungs with a stethoscope. Paediatric Research in Emergency Departments International Collaborative (PREDICT). Palivizumab was licensed by the US Food and Drug Administration in June 1998 largely on the basis of results of 1 clinical trial.193 The results of a second clinical trial among children with congenital heart disease were reported in December 2003.194 No other prospective, randomized, placebo-controlled trials have been conducted in any subgroup. Randomized controlled trial of the efficacy of nebulized 3% saline without bronchodilators for infants admitted with bronchiolitis: preliminary data [abstr E-PAS2014:2952.685]. A draft version of this clinical practice guideline underwent extensive peer review by committees, councils, and sections within AAP; the American Thoracic Society, American College of Chest Physicians, American Academy of Family Physicians, and American College of Emergency Physicians; other outside organizations; and other individuals identified by the subcommittee as experts in the field. Studies have not found a difference in revisit rates, although the numbers of revisits are small and may not be adequately powered for this outcome. Monthly palivizumab prophylaxis should be restricted to infants born before 29 weeks, 0 days’ gestation, except for infants who qualify on the basis of congenital heart disease or chronic lung disease of prematurity. This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. The current literature review encompasses the period from 2004 through May 2014. All people should use alcohol-based rubs for hand decontamination when caring for children with bronchiolitis. If a breakthrough RSV infection is determined to be present based on antigen detection or other assay, monthly palivizumab prophylaxis should be discontinued because of the very low likelihood of a second RSV infection in the same year. History of underlying conditions, such as prematurity, cardiac disease, chronic pulmonary disease, immunodeficiency, or episodes of previous wheezing, should be identified. A systematic review on the effectiveness of alcohol-based solutions for hand hygiene. Physiologic Effects of Nasal Aspiration and Nasopharyngeal Suctioning on Infants With Viral Bronchiolitis, Paediatric critical illness associated with respiratory infection: a single-centre, retrospective cohort study, Nebulised hypertonic saline in moderate-to-severe bronchiolitis: a randomised clinical trial, Bedside clinical assessment predicts recurrence after hospitalization due to viral lower respiratory tract infection in young children, Hospitalizations associated with respiratory syncytial virus (RSV) and influenza in children, including children having a diagnosis of asthma. Parental smoking and lower respiratory illness in infancy and early childhood. Prospective comparative study of viral, bacterial and atypical organisms identified in pneumonia and bronchiolitis in hospitalized Canadian infants. Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations. There were no significant differences in the hospitalization rate among the 3 groups; however, there were significant differences in the duration of hospitalization and the rate of requiring oxygen therapy, both favoring breastfeeding. Factors predicting prolonged hospital stay for infants with bronchiolitis. Most guidelines recommend primarily supportive treatment, that is, oxygen, nasal suctioning, mechanical ventilation, and hydration. Start studying Bronchiolitis Treatment: Guidelines for 1 to 23 months Course # 81119. 14. 7. J. Schiappa, DO 4 . Bronchiolitis Treatment. This weak recommendation applies only if the average length of stay is >72 h. This weak recommendation is based on an average LOS and does not address the individual patient. Tests and X-rays are not usually needed to diagnose bronchiolitis. Nebulized hypertonic saline is an increasingly studied therapy for acute viral bronchiolitis. Nonetheless, antibiotic therapy continues to be overused in young infants with bronchiolitis because of concern for an undetected bacterial infection. Is there a role for humidified heated high-flow nasal cannula therapy in paediatric emergency departments? Clinicians may choose not to use continuous pulse oximetry for infants and children with a diagnosis of bronchiolitis (Evidence Quality: D; Recommendation Strength: Weak Recommendation [based on low-level evidence and reasoning from first principles]). 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