Medical Minute: Pediatric Bronchiolitis Updates

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May 27, 2015 by dailybolusoflr

By Marrissa Baker, MD
Bronchiolitis is the most common lower respiratory tract viral infection in infants
The clinical practice guideline for diagnosing and managing bronchiolitis was updated in 2014 from the previous 2006 version.
Key recommendations with updates:
  • Clinicians should diagnose bronchiolitis on the basis of history and physical exam and should not order lab or radiographic studies routinely
  • Update: Clinicians should not administer nebulized albuterol or epinephrine to infants and children with the diagnosis of bronchiolitis
  • Update: Nebulized hypertonic saline should not be administered to infants and children diagnosed with bronchiolitis in the ED but may be administered to those hospitalized for bronchiolitis
  • Clinicians should not administer systemic corticosteroids to infants with a diagnosis of bronchiolitis
  • Clinicians may choose not to administer supplemental oxygen if the oxyhemoglobin saturation exceeds 90% in infants and children with a diagnosis of bronchiolitis
  • Update: Clinicians may choose not to use continuous pulse oximetry for infants and children with a diagnosis of bronchiolitis. There is no mention of pulse oximetry for infants or children with hemodynamically significant heart or lung disease and premature infants as in the 2006 guidelines. 
  • Clinicians should not use chest physiotherapy for infants and children with a diagnosis of bronchiolitis
  • Clinicians should not administer antibacterial medications to infants and children with a diagnosis of bronchiolitis unless there is a concomitant bacterial infection, or a strong suspicion of one
  • Clinicians should administer nasogastric or intravenous fluids for infants with a diagnosis of bronchiolitis who cannot maintain hydration orally

References:
American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006 Oct;118(4):1774-93.

Ralston et al. A Clinical Practice Guideline: The diagnosis, Management and Prevention of Bronchiolitis. Pediatrics 2014; 134: e1474-e1502.

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